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.

The Department of Health and Human Services (SCDHHS) is announcing a further extension of telehealth flexibilities issued during the COVID-19 federal public health emergency (PHE). 
 
SCDHHS previously issued guidance via Medicaid bulletins announcing the status of telehealth flexibilities upon the expiration of the federal PHE (Medicaid bulletin MB# 23-018). Flexibilities were grouped as those that were made permanent, continued for one year after the expiration of the federal PHE or expired upon the end of the federal PHE May 11, 2023.  
 
Flexibilities continued for one year after the expiration of the federal PHE are now extended by SCDHHS through December 31, 2024. This extension aligns with a similar policy announced by the Centers for Medicare and Medicaid Services that extended telehealth flexibilities issued during the COVID-19 federal PHE for Medicare providers through December 31, 2024. 
 
As a reminder, these extended flexibilities, including telehealth flexibilities, were included in the applicable Medicaid provider manuals prior to the end of the federal PHE. Provider manuals can be found on the SCDHHS website. 
 
South Carolina Healthy Connections Medicaid managed care organizations (MCOs) are responsible for the coverage and reimbursement of services described in this bulletin for members enrolled in an MCO. 
 
Providers may direct any questions related to this bulletin to the Provider Service Center (PSC). PSC representatives can be reached at (888) 289-0709 from 7:30 am-5:00 pm Monday-Thursday and 8:30 am-5:00 pm Friday. Providers can also submit an online inquiry.

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

Beginning this week, having started on February 12, the South Carolina Pharmacy Association’s Professional Affairs Task Force asks that pharmacists track how many hours worked per week for the next four weeks. A survey will be sent out at the end of those four weeks to determine how many hours they were scheduled to work, how many hours were actually worked, the time paid for and how their well-being is based on those results. Please expect the survey during the second week of March. For all questions, please email info@scrx.org. 

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

DisposeRx announced a grant opportunity and is looking to identify pharmacies in the state to provide education on safe medication disposal and dispense DisposeRx packets with controlled substance prescriptions, with an emphasis on opioids. In turn, the pharmacies will receive reimbursement for educating the patients and dispensing the packets.

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

The Department of Health and Human Services (SCDHHS) consistently 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 February-April 2024 training is available online.  

Also in South Carolina, some Healthy Connections Medicaid-enrolled providers were mailed an IRS 1099-MISC form from the Department of Health and Human Services (SCDHHS). The IRS 1099-MISC form providers received in the mail in January 2024 from SCDHHS contains an error. While the dollar amount of “Medical and health care payments” listed in block six of the IRS 1099-MISC form is correct for calendar year 2023, the form indicates it is for calendar year 2022.

Corrected forms are currently being printed and will be mailed in the next two business days. Providers should receive the replacement IRS 1099-MISC forms for 2023 within the next three to seven business days.

The incorrect form showing the 2022 date should be disregarded and not used to file taxes for the 2022 or 2023 calendar years. The error occurred while printing the forms mailed to providers. The forms with the correct calendar year were submitted to the IRS.

If you have any questions, please contact the Provider Service Center at (888) 289-0709, extension four, option one. The Provider Service Center is open Monday through Thursday from 7:30 am to 5:00 pm and Friday from 8:30 am to 5:00 pm. 

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