All Providers

Bulletins and Information for All Medicaid Providers

SCDHHS Hosts Non-Emergency Medical Transportation Open Forum

As the South Carolina Department of Health and Human Services (SCDHHS) nears the expiration date of the Broker contracts for Non-Emergency Medical Transportation (NEMT), the agency will host an Open Forum to receive input on the future of how SCDHHS provides the NEMT service. The meeting is open to the public and will be held on January 28, 2013 from 10:00 AM to 12:00 PM at the Department of Juvenile Justice Bill Rogers Community Connections Center (directions).

Managed Care Withholds and Incentives Initiative

 

The South Carolina Department of Health and Human Services (SCDHHS) in collaboration with our Coordinated Care Improvement Group has identified and targeted key withhold and incentive categories to assist us in measuring and supporting quality outcomes.

Alcohol and Other Drug Abuse Treatment Services Authorized or Provided by State Agencies

 

In a further effort to provide beneficiaries with comprehensive care, effective February 1, 2013, alcohol, drug, and substance abuse treatment services provided by the Department of Alcohol and Other Drug Abuse Services (DAODAS), and its thirty-three (33) subcontracted county authorities, will be part of the Managed Care Organizations (MCOs) core benefit package. DAODAS and its subcontracted county alcohol and drug abuse authorities will be required to file claims for all MCO-enrolled beneficiaries for services.

Community Health Worker in Primary Care Practices

The South Carolina Department of Health and Human Services (SCDHHS) is announcing the statewide integration of the Community Health Worker (CHW) into eligible primary care practices under the Department’s Health Access at the Right Time (HeART) initiative. The objective of the CHW program is to improve patient care and health outcomes with the aid of individuals who interface between the clinical practice and the community where patients reside.

Quality Weighted Assignments

 

The South Carolina Department of Health and Human Services (SCDHHS) will be implementing a Quality Weighted Assignment algorithm for enrollments that begin on or after January 1, 2013. Beneficiaries who are managed-care-assignable, but have not selected a health plan, will be assigned to a health plan by the enrollment broker based on this algorithm.

 

Provider Enrollment and Screening

 

In the Medicaid Bulletin dated May 9, 2012, the South Carolina Department of Health and Human Services (SCDHHS) began the process of addressing provider enrollment regulations published by the Centers for Medicare and Medicaid Services (CMS).  SCDHHS has addressed the CMS regulations and will implement the following on December 3, 2012:

 

Absolute Total Care Corrective Action Plan - Completed

 

On June 13, 2012, the South Carolina Department of Health and Human Services (SCDHHS) placed the Managed Care Organization (MCO) Absolute Total Care (ATC) on notice that a Corrective Action Plan was required in accordance with Section 13.7 of its contract with SCDHHS.

 

This bulletin is to notify all service providers that effective November 9, 2012, SCDHHS determined that ATC has successfully completed its submitted Corrective Action Plan, addressing and correcting the deficiencies and/or non-compliance issues that SCDHHS had previously identified. 

 

Logisticare - Corrective Action Plan to Address Non-compliance

 

This bulletin is to notify all service providers that the South Carolina Department of Health and Human Services (SCDHHS) has placed Logisticare on notice that a Corrective Action Plan (CAP) is required in accordance with the SCDHHS Non-Emergency Medical Transportation (NEMT) contract.

 

This CAP addresses the following contractual requirements:

 

  • The call center daily performance standards
  • The daily on-time and provider no-show performance standards
  • The timely monthly reporting standard

 

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