Waivers

Waivers

Provider Rate Increases for Home and Community Based Waiver Services

*Jan. 5, 2023, Update: SCDHHS is updating its guidance previously published in Medicaid Bulletin 22-033 to clarify that the rate for children’s personal care state plan services (procedure code T1019) was also increased to $25.00/hr. effective Jan.

Postponement of EVV Launch for SCDDSN-operated Waiver Programs

The South Carolina Department of Health and Human Services (SCDHHS) is postponing the previously announced launch of the electronic visit verification (EVV) system for providers rendering in-home services to Healthy Connections Medicaid members participating in the three waivers operated by the South Carolina Department of Disabilities and Special Needs (SCDDSN). This includes the Community Supports (CS), Head and Spinal Cord Injury (HASCI) and Intellectual Disability and Related Disabilities (ID/RD) waivers.

Funding for One-time Direct Care Retention Payments

The American Rescue Plan Act of 2021 (ARPA) provided funding to enhance, expand or strengthen HCBS beyond what was available under states’ Medicaid programs as of April 1, 2021. The South Carolina Department of Health and Human Services’ (SCDHHS) ongoing evaluation of HCBS demonstrates that additional support is warranted to maintain an adequate direct care provider network. Nationally, health care providers are experiencing a shortage of direct care workers and this shortage is impacting each of South Carolina’s Medicaid HCBS programs.

EVV Launch for SCDDSN-operated Waivers Starts Dec. 11, 2022; Register for Training Now

Effective December 2022, South Carolina Healthy Connections Medicaid providers rendering in-home services to Healthy Connections Medicaid members participating in the three waivers operated by the South Carolina Department of Disabilities and Special Needs (SCDDSN) must use an electronic visit verification (EVV) system to capture in-home service delivery visits.

Update to Case Management Policies for HCBS Waiver Providers, Assistance in Maintaining Updated Member Contact Information

During the initial response to the ongoing coronavirus disease 2019 (COVID-19) pandemic, the South Carolina Department of Health and Human Services (SCDHHS) announced temporary policy changes designed to ensure ongoing access to care for Healthy Connections Medicaid members enrolled in HCBS waiver programs and Healthy Connections Prime.

Medically Complex Children Waiver Program Update: Increased Maximum Age Limit, Implementation of Environmental Modifications and Respite Service Provider Recruitment

The South Carolina Department of Health and Human Services (SCDHHS) is announcing the implementation of three changes to the Medically Complex Children Waiver (MCCW) program. The MCCW program serves children who meet hospital level-of-care and have chronic physical/health conditions that are expected to last longer than 12 months. MCCW participants must also meet the state-defined medical eligibility criteria, which evaluates the child's dependency on medications, medical supervision, hospitalizations, skilled nursing services, therapies and medical specialists.

Updates to State Plan Therapeutic Child Care Rates

The South Carolina Department of Health and Human Services (SCDHHS) is increasing reimbursement rates for specific therapeutic child care services included in this bulletin.

Rate Increases for Therapeutic Child Care

Effective Oct. 1, 2022, reimbursement for the below listed codes will be increased as follows:

Description

Code

Current Rate

New Rate

Updates to Adult Day Health Care Service Rates

The South Carolina Department of Health and Human Services (SCDHHS) is increasing the reimbursement rate for the adult day health care (ADHC) service provided to Healthy Connections Medicaid members participating in waiver programs operated by SCDHHS and the South Carolina Department of Disabilities and Special Needs.

Updates to Personal Care and Nursing Rates for HCBS and State Plan Services

The South Carolina Department of Health and Human Services (SCDHHS) is increasing specific reimbursement rates for the personal care and nursing services included in this bulletin for State Plan and home and community-based waiver services (HCBS).

Rate Increases for State Plan Personal Care and Nursing Services

Effective July 1, 2022, reimbursement rates for the below listed services rendered to Healthy Connections Medicaid members covered by the State Plan will be increased as follows:

Updates to Adult Day Health Care Transportation

The South Carolina Department of Health and Human Services (SCDHHS) is transitioning adult day health care (ADHC) transportation for Healthy Connections Medicaid members within 15 miles of their ADHC to the state’s non-emergency medical transportation (NEMT) broker, Modivcare. Previously, transportation for trips less than 15 miles from the ADHC was provided directly by the ADHC while transportation for trips longer than 15 miles from the ADHC was provided by either the ADHC or the NEMT broker. This change is effective for dates of service on or after July 1, 2022.

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