On May 16, Gov. Henry McMaster (R) signed into law NACDS’ priority PBM reform legislation Senate Bill 520. The measure takes effect January 1, 2024; however, the Department of Insurance is prohibited from performing audits of PBMs before January 1, 2025. South Carolina’s regular legislative session has adjourned Sine Die; however, Governor McMaster has called the legislature back into special session to discuss abortion legislation. 

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

Brian Clark, a South Carolina pharmacist with experience in a broad range of pharmacy roles as well as service in state and national professional associations, has been named chief executive officer of the South Carolina Pharmacy Association effective April 1. Clark, director of operations at Riley’s Drugs in Lexington, SC, will lead the association that serves as the public face and voice of all sectors of the state’s pharmacy community, from students and technicians to pharmacists.

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

Effective for dates of service on or after March 1, the South Carolina Department of Health and Human Services (SCDHHS) will discontinue the hemophilia program arrangement with the South Carolina Department of Health and Environmental Control (SCDHEC). Factor services may be provided by any fee-for-service (FFS) enrolled pharmacy provider. Pharmacy reimbursement utilizes the standard basis of payment for the FFS pharmacy benefit at the lowest of:

• The actual acquisition cost (AAC) plus a professional dispensing fee (PDF) of $10.50; 
• The states’ maximum allowable cost plus a PDF of $10.50; or, 
• The usual and customary charges to the public. 

Providers rendering care to Healthy Connections Medicaid members enrolled in FFS Medicaid should direct any questions related to this transition to the Magellan Medicaid Administration call center at (866) 254-1669. The call center is available 24 hours per day. For more information, click here.  

Also in South Carolina, a stolen prescription pad alert has been issued. Please be very cognizant of any controlled substance prescriptions from Kraemer Women’s Care. Please call (803)-956-4018 to verify a prescription before filling.  

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

After evaluating utilization data and consulting with the state’s managed care organizations (MCOs), the provider community and other stakeholders, SCDHHS (South Carolina Department of Health and Human Services) is announcing updates to the policy changes it previously issued. The updates announced in this bulletin are specific to the temporary flexibilities that were created during the COVID-19 PHE (Public Health Emergency) and do not impact other agency policies that existed prior to the PHE unless specifically indicated. The changes announced today will take effect once the current federal PHE has expired. While the exact end-date is not yet known, providers are advised that the Secretary of the U.S. Department of Health and Human Services previously announced that the federal PHE will remain in effect until at least April 11. 

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

Centers for Medicare and Medicaid Services (CMS) has announced the enrollment application fee amount for calendar year 2023 will be $688. This fee is required by CMS with any applicable Healthy Connections Medicaid provider enrollment application.  

The South Carolina Department of Health and Human Services (SCDHHS) will collect the application fee before executing a provider agreement. The fee applies to initial enrollment, reactivation, revalidation, or addition of a new practice location. SCDHHS has contracted with the SC.gov Enterprise Payment System to facilitate collection of the application fee. Payments may be made by debit, credit, or e-check. Paper checks will not be accepted. More information on payment options can be found by visiting www.scdhhs.gov/provider and selecting, “Online Application Fee Payment.”  

The provider enrollment application fee is only applicable to providers CMS has identified as institutional providers. South Carolina Healthy Connections Medicaid recognizes and enrolls the following institutional providers: Ambulatory Surgery Centers, Community Mental Health Centers, Comprehensive Outpatient Rehabilitation Facilities, Durable Medical Equipment, End Stage Renal Disease Facilities, Federally Qualified Health Centers, Home Health Agencies, Hospice, Hospitals, Independent Clinical Laboratories, Pharmacies, Skilled Nursing Facilities and Rural Health Clinics. For more information, please see the Bulletin.  

Also in South Carolina, the South Carolina Department of Social Services (SCDSS) is announcing an end to the federally approved Supplemental Nutrition Assistance Program (SNAP) emergency allotments (supplements) to all South Carolina households effective January 31. Since March 2020, the assignment of emergency SNAP allotments (supplements) has brought all authorized households up to the maximum benefit allotment, based on household size. 

January 2023 has been approved by the United States Department of Agriculture Food and Nutrition Services as South Carolina’s “transition” month, prior to going back to normal SNAP benefit allotments for all households. 

Effective February 1, all SNAP households will go back to receiving their regular monthly benefit amount.

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

The South Carolina 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 2022 holidays. 

December 2022 

Due to observance of the Christmas holiday, Monday, December 19, at 5:00 p.m. is the deadline to submit claims for payment date Friday, December 23. Payments will run Tuesday, December 20, and electronic remittance advice will be available Thursday, December 22. Payments will be dated Friday, December 23, as usual. 

Monday, December 26, at 5:00 p.m. is the deadline to submit claims for payment date Friday, December 30. Payments will run Tuesday, December 27, and electronic remittance advice will be available Thursday, December 29. Payments will be dated Friday, December 30, as usual. 

January 2023 

Due to observance of the New Year’s Day holiday, Monday, January 2, at 5:00 p.m. is the deadline to submit claims for payment date Friday, January 6. Payments will run on Tuesday, January 3, and electronic remittance advice will be available Thursday, January 5. Payments will be dated Friday, January 6, as usual. The schedule will return to the normal payment cycle on payment date Friday, January 6, 2023. 

Provider Service Center (PSC) Holiday Hours 

The PSC will be closed Friday, December 23, and Monday, December 26, in observance of the Christmas holiday, and on January 2, 2023, in observance of the New Year’s Day holiday. 

Please refer any questions or concerns about this alert to the PSC at 888-289-0709. The PSC’s regular hours of operations are 7:30 a.m. – 5:00 p.m. Monday-Thursday and 8:30 a.m.- 5:00 p.m. Friday. 

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

To comply with provisions of the Families First Coronavirus Response Act, the South Carolina Department of Health, and Human Services (SCDHHS) paused the typical annual eligibility review process for the state’s Healthy Connections Medicaid members effective January 27, 2020. When the current federal COVID-19 public health emergency (PHE) ends, state Medicaid agencies will be required to resume reviewing the eligibility of all Medicaid members. For more information, click here. 

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

Effective for dates of service on or after Sept. 15, 2022, the South Carolina Department of Health, and Human Services (SCDHHS) will expand coverage for additional pneumococcal immunizations for Healthy Connections Medicaid members 19 years of age and older under the pharmacy and medical benefit.  

SCDHHS will reimburse providers for the administration of the immunizations in accordance with the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) Adult Immunization Schedule for the following Healthcare Common Procedure Coding System (HCPCS) codes:  

• Pneumococcal 15-valent conjugate vaccine (PCV15): HCPCS Code 90671 
• Pneumococcal 20-valent conjugate vaccine (PCV20): HCPCS Code 90677 

The new codes will be reflected on the Physicians Fee Schedule and updates to the Physicians Services provider manual will be available by Sept. 15, 2022. 

Pharmacy reimbursement utilizes the standard basis of payment for the fee-for-service pharmacy benefit at the lowest of: 

• The actual acquisition cost (AAC) plus a professional dispensing fee (PDF) of $10.50; 
• The state’s maximum allowable cost plus a PDF of $10.50; or, 
• The usual and customary charges to the public. 

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

Don’t miss the FREE module on preventing Type 2 Diabetes in South Carolina. This course is designed to help you use the South Carolina Provider Toolkit to evaluate, test, treat and refer patients with prediabetes to an in-person or online evidence-based diabetes prevention program. To learn more, click here to view the flyer.

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