The Department of Health and Human Services (SCDHHS) will operate on an updated schedule for Healthy Connections Medicaid claims submission and payments to accommodate the December 2024 and January 2025 holidays. Due to observance of the Christmas holiday, December 19 at 5:00 pm is the deadline to submit claims for payment date December 27. Electronic remittance advice will be available December 24. Payments will be dated December 27, as usual. Due to observance of the New Year’s holiday, December 27 at 5:00 pm is the deadline to submit claims for payment date January 3. Electronic remittance advice will be available December 31. Payments will be dated January 3rd, as usual. The schedule will return to the normal payment cycle on January 3, 2025.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Effective for dates of service on or after January 1, 2025, the Department of Health and Human Services (SCDHHS) will require prior authorization (PA) for the physician-administered drugs to ensure use is consistent with the medication’s indication(s) and appropriate clinical guidelines. This change only applies to medications administered to Healthy Connections Medicaid members enrolled in the Medicaid fee-for-service (FFS) program.

The list of physician-administered drugs for which a PA is required when administered to a FFS Medicaid member is available in the Procedure Codes section of the Physicians Services Provider Manual on the SCDHHS website. The list in the manual will be updated with the additional physician-administered drugs requiring a PA beginning January 1, 2025. The list of additional drugs is available online.

Requests for PA and questions about this bulletin should be submitted to Prime Therapeutics at https://gatewaypa.com or by calling (800) 424-8219 between 8:00 am-5:00 pm Monday-Friday.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Board of Pharmacy has approved the updated protocol for Administration of Vaccines by pharmacists. These updates reflect changes made through HB 3988 enacted during the legislative session, which includes the ability for pharmacy technicians to administer vaccines.

Also in South Carolina, the Board of Pharmacy is accepting nominations for Board Members from the Fifth and Seventh Congressional Districts. The fifth district is made up largely of Cherokee, York, Chester, Union, Fairfield, Lancaster, Kershaw, Lee and Sumter counties. The Seventh District is primarily made up of Chesterfield, Marlboro, Darlington, Florence, Marion, Dillon, Horry and Georgetown counties. For more information or to submit a nomination, email contact.pharmacy@llr.sc.gov. The Deadline to apply is November 30, 2024.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Department of Health and Human Services (SCDHHS) published a Medicaid Bulletin (MB# 24-063) related to “Ongoing Provider Revalidation”. Please recall flexibilities offered by CMS to all state Medicaid agencies during the federal COVID-19 public health emergency (PHE), allowed for the temporary suspension of the Medicaid provider enrollment revalidation process. With the conclusion of the federal PHE in 2023, the SCDHHS is required to resume the provider revalidation process. The SCDHHS restarted this process in June 2024. A list of providers scheduled for revalidation will be published on the SCDHHS website as each cohort’s revalidation period begins. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Board of Pharmacy has issued guidance on the state of emergency regarding out-of-state pharmacies and emergency refills.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Gov. Henry McMaster (R) issued Executive Order 2024-16, declaring a State of Emergency in preparation for the potential effects of Tropical Storm Debby. Tropical Storm Debby is expected to produce rainfall totals of 10 to 20 inches, with maximum amounts of 30 inches, across portions of coastal South Carolina through Friday morning. This potentially historic rainfall may result in areas of catastrophic flooding. For power outages and shelter information, visit the S.C. Emergency Business Resources Dashboard. If your business sustains any damage during the storm, please be prepared to notify ESF-24 with as much detail as possible. ESF-24 will provide updates when assistance becomes available or business recovery centers open.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Gov. Henry McMaster (R) signed HB 3988, legislation that authorizes pharmacists to administer non-flu vaccines to persons 16 years of age and older, to order and administer flu and COVID tests and to delegate both vaccine administration and the administration of tests to pharmacy technicians working under their supervision. The act took effect upon signature of the Governor.

Also in South Carolina, on July 1, 2024, the Department of Health and Environmental Control (DHEC) became two separate agencies, the Department of Environmental Services (SCDES) and the Department of Public Health (DPH). Additionally, DHEC’s retail food program and milk and dairy lab moved to the Department of Agriculture (SCDA). You can visit the linked agencies for your needs or visit the DHEC homepage to choose the correct agency website.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Effective July 1, 2024, the South Carolina Department of Health and Human Services (SCDHHS) will implement a single, state-directed pharmacy benefit preferred drug list (PDL) for all members and providers enrolled in the South Carolina Healthy Connections Medicaid program; see MB #24-016 for details.

SCDHHS recently held live training webinars to answer questions from providers about the upcoming transition to a single PDL. The training sessions were intended for prescribers and dispensers. A recording is available on SCDHHS’ website for those who were unable to attend either training webinar. A frequently asked questions document, which is available in the pharmacy section of SCDHHS’ website, has also been updated.

The single PDL is based on SCDHHS’ current fee-for-service (FFS) PDL. The current FFS PDL is available in the pharmacy section of SCDHHS’ website.

As a reminder, South Carolina’s Medicaid managed care organizations (MCOs) are responsible for the authorizations, coverage and reimbursement related to the services described in MB #24-016 for Healthy Connections Medicaid members who are enrolled in an MCO.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Department of Health and Human Services (SCDHHS) will operate on an updated schedule for Healthy Connections Medicaid claims submission and payments in June-July 2024. Due to the Independence Day holiday, June 28 is the deadline to submit claims for payment date July 5. Payments will run July 1 and electronic remittance advice will be available on July 4. Payments will be dated July 5, as usual. The schedule will return to the normal payment cycle on payment date July 5, 2024. Please refer any questions or concerns regarding this bulletin to the Provider Service Center (PSC) at (888) 289-0709.  

Also in South Carolina, effective July 1, 2024, the Department of Health and Human Services (SCDHHS) is updating and clarifying policies in the Provider Administrative and Billing Manual. These policy changes will be added to the Provider Administrative and Billing Manual available on SCDHHS’ website by July 1.

Finally in South Carolina, the Centers for Medicare and Medicaid Services (CMS) has informed the Department of Health and Human Services (SCDHHS) that Healthy Connections Medicaid providers will participate in the Payment Error Rate Measurement (PERM) program for state fiscal year 2025; see MD #24-029 for details. CMS’ PERM program was developed to measure the accuracy of Medicaid and Children’s Health Insurance Program (CHIP) payments made by states. Each state is reviewed once every three years. Samples of claims with paid dates of July 1, 2024, through June 30, 2025, will be subject to review.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.