Hospitals

Hospitals

Over-The-Counter Aspirin Coverage

The American College of Obstetricians and Gynecologists (ACOG) has issued updated recommendations regarding low-dose aspirin and the prevention of preeclampsia. The South Carolina Department of Health and Human Services (SCDHHS) issues this alert to remind providers that over-the-counter (OTC) aspirin is covered by the agency when a valid prescription is authorized by a licensed practitioner. Providers are advised to follow the ACOG recommendations only if this therapy is appropriate for their patient.
 

Modification to Codes that require Filing to TPL

Effective for dates of service on or after July 1, 2017, and as required by 1902(a) (25) of the Social Security Act, the South Carolina Department of Health and Human Services (SCDHHS) will implement cost avoidance rules for the procedure codes reflected below. Service providers will be required to file claims to any liable third-party insurer before submitting a claim to SCDHHS for payment.

Tobacco Cessation Coverage

Effective with dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) is enhancing tobacco cessation coverage for full-benefit Medicaid beneficiaries to align with recommendations from the Centers for Disease Control and Prevention (CDC) and the American Lung Association (ALA). This update applies to both the fee-for-service and managed care Medicaid benefits.

The following medications will be available without prior authorization or co-payment when prescribed by a Medicaid provider:

Reimbursement Rate Update for Long Acting Reversible Contraceptives (LARCs)

Due to a recent increase in pricing of several Long Acting Reversible Contraceptives (LARCs), effective Jan. 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) has updated the reimbursement rates. Sales tax coverage has been included.

Reimbursement Rate Update for Long Acting Reversible Contraceptives (LARCs)

 

The South Carolina Department of Health and Human Services (SCDHHS) has confirmed that the state tax exemption for physician administered injectable drugs (South Carolina Sales and Use Tax Act, 12-36-2120 (80)) does not apply to intrauterine devices or contraceptive implants. To ensure continued access to these products, SCDHHS has updated the reimbursement rates indicated below, effective July 1, 2016.

 

HCPCS

Name

Previous Rate

2016: Last Chance to Begin Participation in the South Carolina Medicaid Electronic Health Records Incentive Program

In recent years, the South Carolina Department of Health and Human Services (SCDHHS) has worked to support the increase of eligible providers' adoption and use of Certified Electronic Health Record Technology (CEHRT) and health information exchange (HIE) through the South Carolina Medicaid Electronic Health Records (EHR) Incentive Program. This program provides incentive payments to eligible professionals (EP) and eligible hospitals (EH) as they adopt, implement, upgrade (AIU) or demonstrate meaningful use (MU) of CEHRT.

Rescind Physical Medicine and Therapy Policy Update; Medicaid Bulletin #14-001 Released Feb. 6, 2014

Effective immediately the South Carolina Department of Health and Human Services (SCDHHS) is rescinding the policy, bulletin 14-001 released Feb. 6, 2014, that allowed services delivered to recipients 21 years and over in place of service (62) Outpatient Rehabilitation Facility. Beneficiaries will continue to receive outpatient physical, occupational and speech therapies (PT/OT/SP) services in an outpatient hospital, clinic or office setting.

Physician Assistant Enrollment

All licensed Physician Assistants (PAs) providing services to Healthy Connections beneficiaries must be enrolled as providers with the South Carolina Department of Health and Human Services (SCDHHS). PAs providing services to Medicaid Managed Care enrolled members must also be enrolled and credentialed with the member's Managed Care Organization (MCO).

Pursuant to 42 CFR Part 455, Subpart E, all providers who refer or order items or services covered by the Medicaid program must be enrolled as described above.

Update to Policy Manual Regarding Long Acting Reversible Contraceptives (LARCs)

The South Carolina Department of Health and Human Services (SCDHHS) is updating the Hospital Services Provider Manual to reflect the Medicaid policy for immediate inpatient insertion of Long Acting Reversible Contraceptives (LARCs) and payment outside the diagnosis-related group (DRG) as published in the Aug. 13, 2013, Medicaid Bulletin, Long Acting Reversible Contraceptives Provided in an Inpatient Hospital Setting. For specific information regarding this policy, please reference the Aug.

Pharmacy Co-Payments Waiver

In an effort to improve beneficiary adherence to prescribed courses of medication, the South Carolina Department of Health and Human Services (SCDHHS) will waive the copayment for specified classes of medications effective July 1, 2015. Initially, this copayment waiver will apply to medications for the treatment of diabetes and behavioral health disorders. However, SCDHHS may modify the medications subject to the copayment waiver without further notice. Information regarding which medications are exempt from copayments will be made available on the SCDHHS Preferred Drug List (PDL).

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