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.

Effective for dates of service on or after August 1, 2024, the Department of Health and Human Services (SCDHHS) will require prior authorization (PA) for the physician-administered drugs in the document linked below 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 fee-for-service (FFS) Medicaid 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 August 1, 2024. The list of additional drugs is available online.

Requests for PA and questions about this bulletin should be submitted to Magellan Rx Management at https://MRxGateway.com or by calling 1-800-424-8219 between 8:00 am-5:00 pm Monday-Friday.

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

The Department of Health and Human Services (SCDHHS) regularly offers free Healthy Connections Medicaid training to enrolled Healthy Connections Medicaid providers and their billing agents. These recurring trainings are conducted by SCDHHS’ contracted vendors. Information about the upcoming June-August 2024 training is listed below.

Medicaid eLearning Provider Workshops
SCDHHS’ contracted vendor provides web-based training, presentations and other materials on a variety of topics to ensure enrolled providers have an understanding of processes and programs.

To register for a workshop or find additional training resources, please visit www.medicaidelearning.com or call the Provider Service Center (PSC) at (888) 289-0709. The PSC’s hours of operation are 7:30 am-5:00 pm Monday-Thursday and 8:30 am-5:00 pm Friday. 

Also in South Carolina, with the conclusion of the federal PHE in 2023, the South Carolina Department of Health and Human Services (SCDHHS) is required to resume the provider revalidation process. SCDHHS will restart this process in June 2024.

In order to revalidate or renew the provider enrollment record with the state Medicaid agency, an enrollment revalidation application must be submitted. The provider revalidation process is designed to confirm or update a provider’s demographic and other information including National Provider Identifier, mailing address and service location address(es). There are no exemptions from revalidation.

Consistent with federal regulations (42 CFR §455.414), state Medicaid agencies must complete revalidation of enrollment for all providers, regardless of provider type, at least every five years. However, provider types designated by either CMS or SCDHHS as “high-risk” providers are required to revalidate every three years. High-risk providers include durable medical equipment (DME), home health agencies, targeted case management, rehabilitative behavioral health services and licensed independent practitioner rehabilitative services. High-risk providers may also require a physical site visit or fingerprint-based criminal background check (FCBC). For more information on high-risk providers, please review the Provider Enrollment and Screening Requirements FAQs.  

Impacted providers will receive an official revalidation notification letter in the mail. The notification contains a unique revalidation number necessary to begin and complete the revalidation process. To avoid risk of termination from the Healthy Connections Medicaid program, providers must complete the revalidation process. The first step in the revalidation process is completing the online enrollment revalidation application within 30 days. Providers will be notified when the cohort window is open for their specific provider type to begin the process. Providers must not attempt to begin the revalidation process until they have received notification. 

Provider revalidation for cohort one begins June 17, 2024. The revalidation window for cohort two and future cohorts will be announced in subsequent provider bulletins that will be published approximately 30 days prior to the start of the respective revalidation windows.

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 Department of Health and Human Services (SCDHHS) will cover, for a limited time, imported benzathine benzylpenicillin (Extencilline) for use in outpatient medical drug claims when billed with HCPCS code J0561 and at an outpatient pharmacy (point-of-sale). This policy change to provide temporary coverage is to address the ongoing shortage of Bicillin® L-A (penicillin G benzathine injectable suspension). A letter with important prescribing information for Extencilline has been provided to healthcare providers.   

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

The General Assembly adjourned sine die on May 10 as required by South Carolina law. Per the sine die resolution, bills with conference committees appointed can meet to work on conference reports. NACDS’ priority legislation, H. 3988 (PREP (Pre exposure Prophylaxis) codification) was amended in the Seante, but the House did not concur with Senate changes, sending the bill to conference committee. Assigned Conferees are Senators Cromer, Martin and Hutto and Representatives Mark Smith, Davis, and W. Jones.  

Also in South Carolina, on May 8, the Department of Health and Human Services (SCDHHS) announced it will implement a single, state-directed pharmacy benefit preferred drug list (PDL) for all providers enrolled in the Healthy Connections Medicaid program. This change, which was announced in Medicaid bulletin MB# 24-016, is effective July 1, 2024.

As announced in MB# 24-016, SCDHHS will host two live provider training webinars on May 22 from 7:30 am-9:00 am and from 12:30 pm -2:00 pm. These provider training sessions will be geared toward prescribers and dispensers. The training will include subject matter expert panelists to answer questions about the transition to the single PDL.

Providers can register for the training webinars at this registration link. Providers can submit questions about the transition to the single PDL when registering for one of the webinars.  

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 providers enrolled in the Healthy Connections Medicaid program. SCDHHS currently operates a PDL exclusively for Medicaid members who are enrolled in the fee-for-service (FFS) Medicaid program, while each managed care organization (MCO) maintains and operates its own independent PDL. 

The single PDL that will become effective July 1, 2024, will be based on SCDHHS’ current FFS PDL, which is available on the pharmacy section of SCDHHS’ website. A list of frequently asked questions (FAQs) is also available on pharmacy section of SCDHHS’ website. SCDHHS will host two live provider training sessions via online seminar on May 22 from 7:30 am-9:00 am and from 12:30 pm-2:00 pm. Registration information for the provider training webinars, updates to the FAQs and other provider training resources will be announced via a provider bulletin. Providers should email any questions related to this bulletin to SCDHHS’ Office of Pharmacy Services. 

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