Hospitals

Effective for dates of service on or after October 15, 2012, 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 $2,339.98 up from $2,192.89.  The 50mg vial will be reimbursed at $1,239.20 up from $1,161.31.

Effective on or after October 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will implement the National Correct Coding initiative (NCCI) Procedure to Procedure (PTP) edits for Durable Medical Equipment (DME).  This will affect services related to wheelchair bases (WCB), wheelchair options and accessories (WCOA), and wheelchair seating (WSC).

Effective with dates of service on or after October 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will require prior authorization (PA) for the following services and medical record pre-payment review from our Quality Improvement Organization (QIO), KePRO.

The South Carolina Department of Health and Human Services (SCDHHS) will implement the Home Again program beginning September 1, 2012.  Home Again is part of the national initiative called The Money Follows the Person Rebalancing Demonstration Program administered by the Centers for Medicare and Medicaid Services (CMS). 

1. The Purpose of the Home Again Program

The South Carolina Department of Health and Human Services (SCDHHS) will sponsor four regional trainings to introduce two new initiatives, the Nursing Facility Bed Locator (NFBL) and the Complex Care Program (CCP).

A.         Nursing Facility Bed Locator

Effective for dates of services on or after March 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) is updating its policy to include reimbursement for long acting birth control devices provided in a hospital setting.  The coverage of this service will be considered an add-on benefit and will not be included in the Diagnostic Related Group (DRG) reimbursement system.  The following codes will now be covered separately:

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after February 1, 2012. 

Effective for claims with discharge dates on or after November 1, 2011, the South Carolina Department of Health and Human Services (SCDHHS) has revised the policy for patients eligible for Administrative Days. This revision removes all references to the 50-mile limit for Nursing Home placements. The revised policy will read: