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SCDHHS COVID-19 Medicaid Policy Changes

SCDHHS COVID-19 Medicaid Policy Changes

As a part of the state’s preparation and response to COVID-19, the South Carolina Department of Health and Human Services (SCDHHS) announced several policy changes to protect the health and well-being of South Carolina Healthy Connections Medicaid members by ensuring ongoing access to care. The temporary policy changes outlined below will give providers needed flexibility to help ensure Healthy Connections Medicaid members continue to have access to care while supporting important social distancing measures.

Please note that while the services described below will be covered according to the effective dates listed under each policy, SCDHHS and South Carolina’s Medicaid MCOs will be able to accept and process claims for these policy changes beginning April 1, 2020. The policy changes will sunset at the appropriate time, as determined by SCDHHS, after the COVID-19 outbreak has subsided. Providers are advised that this includes temporary policy changes regarding telehealth coverage that will be communicated in a separate, forthcoming provider bulletin.

Coverage of COVID-19 Testing – SCDHHS will reimburse for COVID-19 testing, using HCPCS codes U0001 (Centers for Disease Control and Prevention [CDC]) and U0002 (non-CDC), without prior authorization or co-payment. Billing for these tests must conform to general billing standards and the definitions established for each HCPCS code. Providers should adhere to diagnosis code guidance provided by the CDC. (Effective for dates of service on or after February 4, 2020)

Waiver of Patient Cost Share – SCDHHS will waive co-payments for all evaluation and management (E/M) codes. A link to provider manuals, fee schedules, and schedule of copayments can be found here on SCDHHS’ website(Effective for dates of service on or after March 15, 2020)

Pharmacy Benefit –pharmacies providing medications to fee-for-service beneficiaries may bypass early refill denials, as allowed by law, submitting a value of “9” (Emergency Preparedness) in the Prior Authorizations Type Code (461-EU) field. (Effective for dates of service on or after March 15, 2020)  

Ambulatory Care Visit Limit – SCDHHS will suspend the annual limit of 12 ambulatory care visits. The provision of any services billed to Medicaid must meet standard requirements for medical necessity. (Effective for dates of service on or after March 15, 2020)

Infusion Centers – SCDHHS will waive the requirement that direct supervision by a physician, nurse practitioner, or physician assistant be provided for care delivered in infusion centers. All other requirements continue to apply. (Effective for dates of service on or after March 15, 2020)