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The South Carolina Department of Health and Human Services publishes a variety of documents on the Medicaid program in the state including presentations to legislative subcommittees and reports on public meetings.
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Publication Report of the Director of SCDHHS to the counties : Proviso 33.9(South Carolina State Library, 2024-11-01) South Carolina Department of Health and Human ServicesThis is the south Carolina Department of Health and Human Services report regarding the condition of space furnished to the agency by the governing authorities of SC counties. It provides a brief overview of in-depth site assessments and reports on the accessibility of each SCDHHS county location as required by the Americans with Disabilities Act.Publication South Carolina Department of Health and Human Services FY24-25 Proviso 117.113 (C) – Telehealth Report(South Carolina State Library, 2024-10-02) South Carolina Department of Health and Human ServicesThe Department of Health and Human Services shall continue to identify and implement telehealth benefits and policies that are evidence-based, cost efficient, and aligned with the needs of the Medicaid population. The department must also continue to review the temporary telephonic and telehealth flexibilities it has adopted to address the COVID-19 public health emergency and make permanent those that are suitable for inclusion in the Medicaid benefit. No later than October 1, the department shall submit a report to the Governor, the Chairman of the Senate Finance Committee, and the Chairman of the House Ways and Means Committee on policy and benefit changes it has introduced in the furtherance of this goal and as part of its ongoing effort to improve the sustainability of telehealth services.Publication Select Health of South Carolina : 2024 External Quality Review(South Carolina State Library, 2024-09-19) South Carolina Department of Health and Human Services; Constellation Quality Health (Firm)The Balanced Budget Act of 1997 requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate the MCOs’ compliance with state and federal regulations. This report contains a description of the process and the results of the 2024 External Quality Review that Constellation Quality Health conducted on behalf of the South Carolina Department of Health and Human Services. This review determines the level of performance demonstrated by Select Health of South Carolina (Select Health) since the 2023 Annual Review.Publication First Choice VIP Care Plus by Select Health of South Carolina : 2024 External Quality Review(South Carolina State Library, 2024-09-19) South Carolina Department of Health and Human Services; Constellation Quality Health (Firm)At the request of the South Carolina Department of Health and Human Services (SCDHHS), Constellation Quality Health (Constellation) conducted an External Quality Review (EQR) of First Choice VIP Care Plus by Select Health of South Carolina (Select Health) Coordinated and Integrated Care for Medicare-Medicaid recipients. This review focused on network adequacy for home and community-based services and behavioral health providers, over- and under-utilization, and care transitions. The goals of the review were to: Determine if Select Health is following service delivery as mandated in the contract with SCDHHS and in the federal regulations; Evaluate the status of deficiencies identified during the 2023 annual EQR and any ongoing quality improvements taken to remedy those deficiencies; Provide feedback for potential areas of further improvement; Validate contracted health care services are being delivered and are of good quality.Publication South Carolina Department of Health and Human Services FY24-25 Proviso 117.113 (C) – Telehealth Report(South Carolina State Library, 2024-10) South Carolina Department of Health and Human ServicesThe Department of Health and Human Services shall continue to identify and implement telehealth benefits and policies that are evidence-based, cost efficient, and aligned with the needs of the Medicaid population. The department must also continue to review the temporary telephonic and telehealth flexibilities it has adopted to address the COVID-19 public health emergency and make permanent those that are suitable for inclusion in the Medicaid benefit. No later than October 1, the department shall submit a report to the Governor, the Chairman of the Senate Finance Committee, and the Chairman of the House Ways and Means Committee on policy and benefit changes it has introduced in the furtherance of this goal and as part of its ongoing effort to improve the sustainability of telehealth services.Publication South Carolina Department of Health and Human Services Proviso 33.21 (B) of the FY 24-25 Appropriations Act(South Carolina State Library, 2024-09) South Carolina Department of Health and Human ServicesThis Report is submitted pursuant to Section 33.21 (B) (DHHS: Rural Health Initiative). The Proviso states: The department shall continue to investigate the potential use of disproportionate share, directed payment, and/or any other source of funds in order to improve access to medical services in one or more rural or underserved communities identified by the department in which such access has been determined to be unstable or at-risk. As funds are available to the department, it may establish a grant program for providers to implement sustainable delivery models or capital improvements to enhance access to health care services.Publication Managed Care Report Companion Guide(South Carolina State Library, 2024-10-01) South Carolina Department of Health and Human ServicesThis Reports Companion Guide is specifically designated for reporting formats that are either required by the Division of Managed Care or are sent to the MCO’s in relation to a department initiative. Details regarding the reports can be found in both the contract and the Managed Care Policy and Procedure Guide.Publication Letter to Henry D. McMaster from Robert M. Kerr, September 16, 2024(South Carolina State Library, 2024-09-16) Kerr, Robert M.; South Carolina Department of Health and Human ServicesThis letter is about Robert M. Kerr, Director of the South Carolina Department of Health and Human Services, retiring.Publication South Carolina Department of Health and Human Services FY 23-24 Proviso 33.23 – Report on BabyNet Federal Compliance Efforts(South Carolina State Library, 2024-09-09) South Carolina Department of Health and Human ServicesWith the funds available to the department, the Department of Health and Human Services shall report to the Governor, the Chairman of the Senate Finance Committee, and the Chairman of the House Ways and Means Committee no later than December 31, 2023 on the status of the department's efforts to bring the Individuals With Disabilities Education Act (IDEA) Part C program into compliance with federal requirements. This report must specifically address areas in which the IDEA Part C program has received low performance scores and include any relevant correspondence from the U.S. Department of Education. The report must explain the department's plan for bringing the program into compliance, including specific steps and the associated timeline.Publication State Fiscal Year 2025 Medicaid Managed Care Capitation Rate Certification(South Carolina State Library, 2024-06-07) South Carolina Department of Health and Human ServicesMilliman, Inc. (Milliman) has been retained by the State of South Carolina, Department of Health and Human Services (SCDHHS) to provide actuarial and consulting services related to the development of capitation rates for its Medicaid Managed Care Program effective July 1, 2024. This letter provides documentation for the development of the actuarially sound capitation rates. It also includes the required actuarial certification.Publication State Fiscal Year 2024 Medicaid Managed Care Capitation Rate Certification(South Carolina State Library, 2023-06-21) South Carolina Department of Health and Human ServicesMilliman, Inc. (Milliman) has been retained by the State of South Carolina, Department of Health and Human Services (SCDHHS) to provide actuarial and consulting services related to the development of capitation rates for its Medicaid Managed Care Program effective July 1, 2023. This letter provides documentation for the development of the actuarially sound capitation rates. It also includes the required actuarial certification.Publication Healthy Connections Prime FAQs for Nursing Facilities(South Carolina State Library, 2024-07-24) South Carolina Department of Health and Human ServicesHealthy Connections Prime is a program for South Carolina seniors 65 and older with Medicare and Healthy Connections Medicaid. It is designed to integrate all the services of Medicare, Medicare Part D and Medicaid into a single set of benefits fully managed by a Medicare-Medicaid Plan (MMP). Healthy Connections Prime is a demonstration project jointly administered by Centers for Medicare and Medicaid Services (CMS) and the South Carolina Department of Health and Human Services (SCDHHS). This document answers frequently asked questions by nursing facilities about Healthy Connections Prime.Publication Managed Care Report Companion Guide(South Carolina State Library, 2024-07-01) South Carolina Department of Health and Human ServicesThis Reports Companion Guide is specifically designated for reporting formats that are either required by the Division of Managed Care or are sent to the MCO’s in relation to a department initiative. Details regarding the reports can be found in both the contract and the Managed Care Policy and Procedure Guide.Publication Policy and Procedure Guide for Managed Care Organizations, 2024(South Carolina State Library, 2024-07) South Carolina Department of Health and Human ServicesThe purpose of this guide is to document the medical and Program Policies and requirements implemented by the South Carolina Department of Health and Human Services (SCDHHS) for Managed Care Organizations (MCO) wishing to conduct business in South Carolina. In the event of any confusion or disagreement as to the meaning or intent of the requirements of the Policies and Procedures contained herein, SCDHHS shall have the ultimate authority to interpret said requirements, of the Policies and Procedures, and the SCDHHS’ interpretation shall control.Publication Single Preferred Drug List (PDL) Frequently Asked Questions(South Carolina State Library, 2024-05-08) South Carolina Department of Health and Human ServicesA Preferred Drug List (PDL) is a list of outpatient drugs covered under the pharmacy benefit that healthcare payors use to encourage providers to prescribe certain drugs over others. This document answers frequently asked questions about PDLs.Publication January through June 2024 Medicaid Managed Care Capitation Rate Amendment : January 1, 2024 through June 30, 2024(South Carolina State Library, 2023-12-14) South Carolina Department of Health and Human ServicesMilliman, Inc. (Milliman) has been retained by the State of South Carolina, Department of Health and Human Services (SCDHHS) to provide actuarial and consulting services related to the development of capitation rates for its Medicaid Managed Care Program during state fiscal year (SFY) 2024. This report provides a summary of the methodology used in the development of an amendment to the certified capitation rates for the period of January 1, 2024 through June 30. 2024.Publication Healthy Connections Medicaid Single Preferred Drug List : Continuity of Care Info Sheet(South Carolina State Library, 2024-05-23) South Carolina Department of Health and Human ServicesThe South Carolina Department of Health and Human Services (SCDHHS) is moving to a single preferred drug list for all Healthy Connections Medicaid members starting on July 1, 2024.Publication Brand Name Preferred List as of July 1, 2024(South Carolina State Library, 2024-07-01) South Carolina Department of Health and Human ServicesThis list is of brand name preferred drugs is current as of 7/1/2024 and is subject to change at any time, should not be considered all-inclusive, and cannot be used for claims payment.Publication South Carolina Department of Health and Human Services FY 23-24 Proviso 117.138 – Sickle Cell Disease(South Carolina State Library, 2024-01-11) South Carolina Department of Health and Human ServicesThis Report is submitted pursuant to Section 117.138, (GP: Sickle Cell Disease). The Proviso states: From the funds appropriated to the Department of Health and Human Services, the department shall transfer $2,000,000 to the Medical University of South Carolina Hospital Authority to develop a comprehensive approach to advancing the awareness, detection, treatment, and scientific knowledge of sickle cell disease and trait within South Carolina.Publication Medicaid provider fraud : report for proviso 33.17(South Carolina State Library, 2024-04-01) South Carolina Department of Health and Human ServicesThe South Carolina Department of Health and Human Services engages in an on-going effort to prevent and identify fraud in the Medicaid program, and to recover the funds lost because of fraudulent and wasteful practices on the part of healthcare providers.