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Bulletins and Information for All Medicaid Providers

Rate Increase for Respite Services (T1005)

The South Carolina Department of Health and Human Services (SCDHHS) has increased the reimbursement rate for respite care services provided to Healthy Connections Medicaid members participating in waiver programs operated by the South Carolina Department of Disabilities and Special Needs (DDSN).

Coronavirus Disease 2019 (COVID-19) Third Dose of Vaccine Administration Coverage

The South Carolina Department of Health and Human Services (SCDHHS) will reimburse for the administration of additional doses of the COVID-19 vaccine consistent with the updated emergency use authorization issued by the U.S. Food and Drug Administration (FDA) and the recommendations of the Centers for Disease Control and Prevention (CDC).

Vaccines for Children Policy and Coding Update

The South Carolina Department of Health and Human Services (SCDHHS) is issuing a clarification regarding billing for vaccine administration current procedural terminology (CPT) codes 90460 and 90461 for vaccines obtained through the Vaccines for Children (VFC) program to Healthy Connections Medicaid-enrolled children. The guidance included in this bulletin replaces existing SCDHHS guidance on this topic, including the agency’s Oct. 15, 2020, bulletin .

 

Prostate Cancer Screenings Added to Limited Benefit Program

The South Carolina Department of Health and Human Services (SCDHHS) today announced it will add coverage of prostate cancer screenings for members of the Family Planning limited benefit program beginning Aug. 1, 2021. For those who qualify through the limited benefit program, prostate cancer screenings for the following Current Procedural Terminology (CPT) codes will be covered:

Resuming Onsite Visits for Provider Reviews

Effective July 1, 2021, the South Carolina Department of Health and Human Services’ (SCDHHS) Program Integrity Unit (PI) will resume onsite visits for provider reviews.

In accordance with recommendations from the Centers for Disease Control and Prevention (CDC) and the South Carolina Department of Health and Environmental Control (DHEC), PI is adopting new protocols to conduct onsite reviews. These protocols will support the health and safety of the provider, their staff and the PI team.

Payment Error Rate Measurement (PERM) Program

The Centers for Medicare and Medicaid Services (CMS) has informed the South Carolina Department of Health and Human Services (SCDHHS) that the South Carolina Healthy Connections Medicaid program will participate in the Payment Error Rate Measurement (PERM) program for State Fiscal Year 2022. CMS' PERM program was developed to measure the accuracy of Medicaid and Children's Health Insurance Program (CHIP) payments made by states. Each state is reviewed once every three years. Samples of claims with paid dates of July 1, 2021, through June 30, 2022, will be subject to review.

SCDHHS Policy Updates for July 1, 2021

The South Carolina Department of Health and Human Services (SCDHHS) is announcing updates to several policies. The updates are described below and are effective for dates of service beginning July 1, 2021.  

Recognition of Licensed Addiction Counselors (LACs) as Licensed Practitioners of the Healing Arts (LPHAs)

Claim Correction (Void and Replace) Functionality in BRIDGES

The South Carolina Department of Health and Human Services (SCDHHS) has enhanced its claim correction functionality in the integrated BabyNet Reporting & Intervention Data Gathering Electronic System (BRIDGES) and Medicaid Management Information System (MMIS). This functionality is an automatic internal void and/or replace process in the integrated BRIDGES and MMIS systems, and often requires little provider interaction with the claim. Exceptions to this occur when providers request to delete or update service logs in BRIDGES as described below.

Updated Guidance for Behavioral Health Policies

The South Carolina Department of Health and Human Services (SCDHHS) is announcing updated guidance to clarify several behavioral health policies. The clarifications are described below.

Licensed Independent Practitioners

Elimination of the KEPRO Prior Authorization Requirement for BabyNet Services

Effective immediately, the South Carolina Department of Health and Human Services (SCDHHS) will recognize the Individualized Family Service Plan (IFSP) as prior authorization (PA) for all services rendered under the Individuals with Disabilities Education Act (IDEA) Part C program, commonly known as BabyNet in South Carolina.

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