Community Long Term Care

During the initial response to the coronavirus disease 2019 (COVID-19) pandemic, the South Carolina Department of Health and Human Services (SCDHHS) announced multiple policy changes. Most of these policy changes were issued using emergency authorities derived from the federal public health emergency (PHE). The COVID-19 federal PHE ended May 11, 2023.

The South Carolina Department of Health and Human Services (SCDHHS) is issuing an update to Medicaid Bulletin #22-023 regarding one-time direct care retention payments. In that notification, SCDHHS indicated that payments were expected to be issued during the first week of January 2023.

*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.

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.

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.

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.

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.

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.

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:

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.