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Community Long Term Care

Community Long Term Care

Provider Revalidation Group 5

In the bulletin dated April 20, 2015, providers were informed their enrollment information must be revalidated, per the Centers for Medicare and Medicaid Service (CMS). To avoid risk of termination in the South Carolina Department of Health Human Services (SCDHHS) Healthy Connections Medicaid program, you must complete and submit an enrollment application 30 days from the date of your official revalidation notification letter. DO NOT begin the revalidation process until you receive notification.

Pre-eligibility Medical Expenses and Calculations of Recurring Income for Long Term Care Beneficiaries

Effective Oct. 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will modify the Medicaid State Plan regarding non-covered, pre-eligibility medical expenses. Medicaid policy allows non-covered medical expenses to be used to reduce a beneficiary’s recurring income for long term care services. Currently, the Medicaid State Plan does not limit the time period from which non-covered, pre-eligibility medical expenses can be applied.

CLTC Case Management Scope Revisions

The following revisions will be incorporated into the South Carolina Department of Health and Human Services (SCDHHS) Community Long Term Care (CLTC) Scope of Service for Case Management effective November 1, 2014.

CLTC is broadening the qualifications for case managers to include: (1) individuals with a bachelor's or master's degree in a health or human services field (2) Certified Case Managers. All individuals will be required to have two (2) or more years of experience in assessment and care planning with clients. (Section E.)

Estate Recovery

Effective October 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) Estate Recovery Department will increase the minimum estate asset value upon which SCDHHS can file claims to $25,000 or more. Currently, SCDHHS files claims against estates with assets valued at $10,000 or more. SCDHHS has determined that it is not cost effective to pursue estates with total assets of less than $25,000 after all priority expenses (funeral, attorney fees, etc.), have been paid.

Inpatient Psychiatric Coverage for beneficiaries 65 or older

Effective for services provided on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will allow for coverage of inpatient psychiatric care for beneficiaries of Medicare and Medicaid who are 65 or older.

Incontinence Supplies Updates

Effective July 1, 2014, incontinence supply providers will be responsible for obtaining the Physician Certification of Incontinence SCDHHS Form 168IS prior to delivering Incontinence supplies.  This policy replaces the June 18, 2013, memo titled Changes in Incontinence Supplies Authorizations, section 2 Physician’s Orders.

ADHC Service Rate Increase

 

Effective for services provided on or after July 1, 2013, The South Carolina Department of Health and Human Services (SCDHHS) will increase reimbursement for Adult Day Health Care Services. 

The following table lists the waiver program, current procedure codes,and rate utilized for each waiver:

 

Waiver

Program

Procedure Code

Increase in Hours for Nurse Aide Training & Programs New Timeframe Policy for Nurse Aide Program Testing

 

South Carolina Department of Health and Human Services (SCDHHS) will be making important changes to the South Carolina State-approved Nurse Aide Training Program (NATP) requirements. These changes will be effective as of July 1, 2013.

Referrals to Community Long Term Care (CLTC)

 

ffective January 7, 2013, the Division of Community Long Term Care (CLTC) will centralize intake activities for all programs operated by CLTC.  This includes referrals for nursing home placement, nursing home conversion, Pre-Admission Screening Resident Review (PASRR), home and community based waiver services, children’s personal care and nursing services, and Katie Beckett Medicaid Program (TEFRA).  When intake activities are centralized, referrals will no longer be accepted at the CLTC Regional Offices.  Referrals will only be accepted by one of the methods below.

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