Hospitals

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).

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.

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  In the new guidance, the FDA provided that its March 2011 statement related to hydroxyprogesterone caproate was superseded by its June 2012 statements in which the FDA “recommended using an FDA-approved drug product, such as Makena, instead of a compounded drug except when there is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.

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.

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.

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.   

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.

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.