Hospitals

Hospitals

Preferred Drug List Update, Exceptions to Prescription Limit, Update to Synagis® (palivizumab) Reimbursement, Preferred Brand Medications and Certificate of Medical Necessity for Home Infusion Pharmacies

I. Preferred Drug List Update

The following revisions to the South Carolina Department of Health and Human Services (SCDHHS) Preferred Drug List (PDL) are effective with dates of service on or after January 1, 2014:

 

ANTIPARASITICS, TOPICAL

Preferred

Non-Preferred

PERMETHRIN, OTC†

Synagis

 

Effective for dates of service on or after October 15, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will increase the rate for Synagis® to the current Average Wholesale Price (AWP) minus 18%. The new rate for the 100mg vial will be $2,429.18.  The 50mg vial will be reimbursed at $1,286.44.

Clarification Bulletin: Long Acting Reversible Contraceptives provided in an Inpatient Hospital Setting

 

On January 19, 2012, the South Carolina Department of Health and Human Services (SCDHHS) issued a bulletin titled “Long Acting-Reversible Contraceptives (LARCs) provided in a Hospital Setting”.  In that bulletin, the agency indicated that coverage for LARCs would be considered an add-on benefit to the Diagnostic Related Group (DRG) reimbursement for all dates of service on or after March 1, 2012.

Enhanced Physician Payment Reimbursement

 

The South Carolina Department of Health and Human Services (SCDHHS) recently received final CMS approval for its proposed payment methodology for the Affordable Care Act (ACA) Primary Care Physician rate increase for both the Fee for Service (FFS) and Managed Care Organizations (MCOs).  SCDHHS continues its work on this project to ensure that it is implemented accurately, quickly and within the CMS mandates for these enhanced payments.  

South Carolina Medicaid Preferred Drug List

 

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after July 22, 2013. 

LAXATIVES & CATHARTICS

Preferred

Non-Preferred

Discount for NCQA's PCMH Recognition Program

 

The South Carolina Department of Health and Human Services (SCDHHS) is a 2013 National Committee for Quality Assurance (NCQA) Recognition Program Sponsor for Patient Centered Medical Homes (PCMH).

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.

Adjusting Your Enhanced Physicians ACA Attestation Period

 

The South Carolina Department of Health and Human Services (SCDHHS) has implemented policy to assist providers who have attested for the Affordable Care Act (ACA) Enhanced Physician Program.  Some providers may need to terminate the effective dates of inclusion into this program, effective January 1, 2013 through December 31, 2014.  The following are two instances where a provider may need to end his/her enrollment.

Examples:

2013 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 2013 Medicare Rates for Dually Eligible Medicaid members.

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