Hospitals

Hospitals

Hepatitis C Virus (HCV) Pharmacy Benefit Carve Out

Effective with dates of service on or after July 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will carve out coverage for medications used to treat Hepatitis C Virus (HCV) from the Managed Care Organization (MCO) benefit. Pharmacy claims for these medications for Medicaid members enrolled in a Medicaid Managed Care Organization (MCO) will be covered through the Fee-For-Service (FFS) pharmacy program. All FFS coverage rules, prior authorization requirements and preferred drug classifications will apply.

642 Edit Claims Update; Partial Solution Implemented

The technical issue causing a 642 edit error in the claims processing system is corrected. However, previously submitted claims cannot be automatically reprocessed. Hospital outpatient claims that rejected due to the 642 edit must be resubmitted. The South Carolina Department of Health and Human Services (SCDHHS) apologizes for any inconvenience.

Coverage of Hydroxyprogesterone Injection

On December 20, 2013, the South Carolina Department of Health and Human Services (SCDHHS) issued Medicaid Bulletin 13-047 regarding hydroxyprogesterone caproate.  On July 3, 2014, the Food and Drug Administration issued updated guidance in regards to hydroxyprogesterone caproate.  In the new guidance, the FDA provided that its March 2011 statement related to hydroxyprogesterone caproate was superseded by its June 2012 statements in which the FDA “recommended using an FDA-approved drug product, such as Makena, instead of a compounded drug except when there is a specific medical need (e.g.

2015 Medicare Deductible, Coinsurance and Medicaid Blood Deductible Rates for Dual-Eligible (Medicaid and Medicare) Members

The South Carolina Department of Health and Human Services (SCDHHS) has updated its reimbursement calculations for Medicare Deductible, Coinsurance and Blood Deductibles to reflect the new 2015 Medicare Rates for Dual-Eligible (Medicaid and Medicare) members.

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.

South Carolina Medicaid Preferred Drug List

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after August 1, 2014. 

ANTIHISTAMINES, MINIMALLY SEDATING

Pulse Oximetry Policy

Effective on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will update its policy to recognize the South Carolina Department of Health and Environmental Control (DHEC) Pulse Oximetry Screening test on newborns to detect congenital heart defects.  Pulse oximetry is a noninvasive test that estimates the percentage of hemoglobin in blood that is saturated with oxygen.   

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.

Self-Administered Oxygen-Hospital Discharges

Effective June 1, 2014, South Carolina Department Health and Human Services will amend the non-emergency transportation policy for self- administered oxygen dependent beneficiaries discharged from inpatient hospitals or emergency rooms.  This policy change affects Hospitals, Physicians, Ambulance and Durable Medical Equipment (DME) providers.  This policy change will also be posted in the Hospital, Physicians Laboratories and Medical Professional, Ambulance and Durable Medical Equipment manuals located on the SCDHHS website: www.scdhhs.gov.  

2014 Medicare Deductible, Coinsurance and Medicaid Blood Deductible Rates for Dually Eligible Medicaid Members

 The South Carolina Department of Health and Human Services (SCDHHS) has updated its reimbursement calculations for Medicare Deductible, Coinsurance, and Blood Deductibles to reflect the new 2014 Medicare Rates for Dually Eligible Medicaid members.

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