All Providers

Bulletins and Information for All Medicaid Providers

Pervasive Developmental Disorder (PDD) Waiver Termination

The Centers for Medicare and Medicaid Services (CMS) issued an informational bulletin clarifying Medicaid coverage of services to children with autism on July 7, 2014. As a result of that bulletin and extensive consultation with CMS, the Pervasive Developmental Disorder (PDD) Waiver will be terminated Dec. 31, 2017.

In order to phase out the PDD Waiver in a manner that minimizes disruption to impacted beneficiaries, the process below is being implemented.

On June 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) took the following steps:

July 2017 Provider Payment Holiday Schedule

The South Carolina Department of Health and Human Services (SCDHHS) announces the following changes to the Healthy Connections Medicaid claims submission and payment schedule for one week in July 2017 in order to accommodate the South Carolina state holiday schedule.

During the week beginning July 2, 2017, payments will run Monday, July 3, and electronic remittance advices will be available Tuesday, July 4. Payments will be dated Friday, July 7, as usual. Saturday, July 1, at 5 p.m. is the final day to submit claims for payment date Friday, July 7.

Adult Immunizations

Effective for dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will cover the following vaccinations for Medicaid beneficiaries 19 years of age and older:

·        Serogroup B Meningococcal (MenB)

·        Measles, Mumps, and Rubella (MMR)

·        Varicella (VAR)

·        Measles, Mumps, Rubella, and Varicella (MMRV)

Update to Consent for Sterilization Form

Effective June 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) Form 1723: Consent for Sterilization will be replaced with Form HHS-687: Consent for Sterilization. Providers should ensure that the current version of the form is used to document consent by checking the expiration date of the form.

The new form is available in the Appendices Section of the Physicians, Laboratories and Other Professionals and Hospital Services provider manuals, published on the agency website at www.scdhhs.gov/.

Transition Guidelines for Autism Services

 As previously announced in a March 31, 2017, provider bulletin, autism spectrum disorder (ASD) treatment services will be added to the South Carolina Medicaid State Plan effective for dates of service on or after July 1, 2017.

Medicaid Policy Manual for Autism Spectrum Disorder

May 1, 2017 - The South Carolina Department of Health and Human Services (SCDHHS) released the new Medicaid Autism Spectrum Disorder (ASD) Provider Manual. This manual is effective July 1, 2017, and is to be used for program information and requirements, billing procedures and provider services guidelines. Providers should carefully review this manual in order to be compliant with policy guidelines.

The manual is organized as follows, with each section having its own table of contents:

HEDIS® Tips

Medicaid Managed Care Organizations (MCOs), who contract with the South Carolina Department of Health and Human Services (SCDHHS) for the provision of Medicaid services, request medical records from certain specific providers to comply with SCDHHS's requirements for reporting Healthcare Effectiveness Data and Information Set (HEDIS®). Thank you for cooperating with the MCOs' medical record requests and ensuring that any medical record vendors do so as well.

HEDIS® and HEDIS Record Requests

Medicaid Managed Care Organizations (MCOs), who contract with the South Carolina Department of Health and Human Services (SCDHHS) for the provision of Medicaid services, request medical records from providers to comply with SCDHHS's requirements for reporting Healthcare Effectiveness Data and Information Set (HEDIS®). Please cooperate with the MCOs' medical record requests and ensure that any medical record vendors do so as well, and/or provide the means through which an MCO may access medical records of Medicaid members.

2017 Provider Enrollment Application Fee

The Centers for Medicare and Medicaid Services (CMS) has announced the enrollment application fee amount for calendar year 2017 will be $560.00. This fee is required with any applicable Healthy Connections Medicaid provider enrollment application submitted on or after Jan. 1, 2017, and on or before Dec. 31, 2017.

State Plan Autism Spectrum Disorder Services Line Therapy Credential Requirements

Effective July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will require that all applied behavior analysis (ABA) line therapists, providing treatment services to beneficiaries who have been diagnosed with Autism Spectrum Disorder (ASD) and approved for ASD services via the ASD Interim Process and/or the SC Medicaid State Plan, hold a Registered Behavior Technician (RBT) credential.

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