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Bulletins and Information for All Medicaid Providers

Quality Improvement Organization (QIO) Training Session

 

 

The South Carolina Department of Health and Human Services (SCDHHS) will co-sponsor provider/facility training with Keystone Peer Review Organization, Inc., (KePRO), the Medicaid Quality Improvement Organization (QIO).

 

Medicaid Providers of Adult Day Health Care Services Bulletin

 

Effective November 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will increase reimbursement for Adult Day Health Care (ADHC) services in the Community Long Term Care and Disabilities and Special Needs waiver programs. 

 

The following table lists the current procedure code utilized for each waiver:

 

Waiver

Procedure Code

Modification to Rehabilitative Therapy Checkpoint

Effective immediately, the South Carolina Department of Health and Human Services (SCDHHS) will be modifying the rehabilitative therapy checkpoint.  The checkpoint consists of combined hours of service to include speech-language pathology, occupational, and physical therapy for all individuals under age 21.

Home and Community Based Waivers Rate Increases for Personal Care Services

 

Effective September 1, 2012, The South Carolina Department of Health and Human Services (SCDHHS) will increase reimbursement for Personal Care Services in the Home and Community Based waiver programs. 

 

The following table lists the current procedure code utilized for each waiver:

 

Program

Procedure Code

Convenient Care Clinics Provider Enrollment and Place of Service Code 17

 

Effective with dates of service on or after August 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) provider enrollment policy will now allow Convenient Care Clinics (CCC) to enroll as a provider group for billing purposes. CCC’s are located in retail stores, supermarkets and pharmacies and are able to treat uncomplicated minor illnesses and provide preventative healthcare services.  They are often referred to as retail clinics, retail-based clinics or walk-in medical clinics.

 

New Services Performed by KePRO, the Quality Improvement Organization (QIO) for S.C. Medicaid

 

Effective August 1, 2012 the following will be added to the list of services that require prior authorization (PA) from KePRO.   

 

Durable Medical Equipment (DME)

 

Four Regional Provider/Stakeholder Meetings To Explore Options For Optional State Supplementation (OSS) Program

The South Carolina Department of Health and Human Services (SCDHHS), South Carolina Department of Mental Health (SCDMH), and the Adult Protection Coordinating Council will sponsor four regional stakeholder meetings focusing on issues related to Community Residential Care Facilities (CRCFs). These meetings will explore topics related to program enhancements for OSS, SCDMH funded services for consumers in CRCFs, and future initiatives improving quality of care in these facilities. The purpose of the sessions is to solicit input and program recommendations.

Hospice Care for Children in Medicaid

 

Effective immediately, the South Carolina Department of Health and Human Services will provide reimbursement for hospice services for children under 21 years of age in conjunction with curative treatment of the child’s terminal illness.

 

Section 2302 of the Affordable Care Act, entitled “Concurrent Care for Children” removes the prohibition of receiving curative treatment upon the election of the hospice benefit by or on behalf of children enrolled in Medicaid or Children’s Health Insurance Program (CHIP).  

 

Birth Outcomes Initiative Modifiers

 

In July 2011, the South Carolina Department of Health and Human Services (SCDHHS) began partnering with the South Carolina Hospital Association (SCHA), the March of Dimes, other state agencies, public and private providers and payors, consumers and advocacy groups in an effort to reduce the number of low birth weight babies born in South Carolina.  One of the first steps towards this goal was the elimination of non-medically necessary elective inductions and elective cesareans prior to 39 weeks gestation.

 

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