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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 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.Publication Frequently asked questions : South Carolina Department of Health and Human Services Health Insurance Premium Payment (HIPP) Program(South Carolina State Library, 2024-02-07) South Carolina Department of Health and Human ServicesThese are some of the frequently asked questions and answers concerning the Health Insurance Premium Payment (HIPP) program in South Carolina.Publication Frequently asked questions : signing in to apply.scdhhs.gov with ID.me(South Carolina State Library, 2024-01-25) South Carolina Department of Health and Human ServicesThis document answers frequently asked questions concerning signing in to apply.scdhhs.gov with ID.me for Medicaid.Publication Safe sleep, every sleep(South Carolina State Library, 2023-07) South Carolina Birth Outcomes InitiativeThis brochure explains why safe sleep is important, how Sudden Unexpected Infant Death Syndrome can happen to anyone, how to know and share the ABC's of sleep. It also gives additional safety tips.Publication South Carolina Department of Health and Human Services FY 23-24 Proviso 33.36 – Biomedical Research Center(South Carolina State Library, 2023-12-29) South Carolina Department of Health and Human ServicesA proposal to establish a biomedical research center in accordance with the proviso has been received within the last thirty days and is currently being evaluated by the Department.Publication South Carolina Department of Health and Human Services psychiatric residency program report as directed by Proviso 33.35 of SFY 2024 Appropriations Act(South Carolina State Library, 2023-12-21) South Carolina Department of Health and Human ServicesIn accordance with Proviso 33.35 of the Appropriations Act, the Department is reporting on the disposition of funds and progress of the psychiatric residency training program operated by the Tri-County Commission on Alcohol and Drug Use.Publication Why here? Why now? : SCBOI relaunch(South Carolina State Library, 2023-11-08) South Carolina Department of Health and Human Services; Hobbs, KristineThis presentation explains why the South Carolina Birth Outcomes Initiative was relaunched.Publication SCBOI (SC Birth Outcomes Initiative) Safe Sleep Initiative (SSI)(South Carolina State Library, 2023-11-30) South Carolina Department of Health and Human ServicesThe most common preventable fatalities for infants or children under the age of one year are sleep-related, both nationally and in South Carolina. The South Carolina Safe Sleep Initiative was developed in 2014 with the purpose of promoting consistent and unified safe sleep messaging, education, and awareness statewide to eliminate preventable sleep-related infant deaths and injuries. This document contains information about the SCBOI SSI, the virtual October Safe Sleep Summit, and the current efforts and next steps.Publication 2023 South Carolina birth outcome initiative relaunch : postpartum policy updates(South Carolina State Library, 2023-11-30) South Carolina Department of Health and Human Services; Witherspoon, MD, FAAFP, Dr. Patricia W.This presentation contains postpartum policy updates for individuals who have Medicaid and become pregnant or those who qualify for Medicaid because they are pregnant.Publication Actualización de la revisión anual de elegibilidad Healthy Connections Medicaid de Carolina del Sur(South Carolina State Library, 2023-10)This flier is printed in Spanish. South Carolina Healthy Connections Medicaid paused its standard annual review process in March 2020. This was done due to the COVID-19 public health emergency (PHE). The federal government directed state Medicaid agencies to restart the standard annual eligibility review process. South Carolina’s restarted April 1, 2023. This does not mean all cases were up for review April 1. We will review groups of cases each month over the 12-month PHE unwinding period. This means some members will not receive their review form until March 2024. We will let you know when it is time for your review. This gives you time to get any needed documents.