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.

The South Carolina Pharmacy Association (SCPhA) is seeking a new Chief Executive Officer. The selection process will begin in July 2022 and continue until the best candidate is identified. Questions may be directed to the Selection Committee c/o Jennifer Baker, SCPhA Immediate‐Past President & Search Committee Chair at scpharmacyjlb@gmail.com

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

Governor Henry McMaster (R) signed SB628 on May 23, 2022. The hormonal contraceptives bill, which was amended to include Central Fill, will take effect upon the issuance of written joint protocol by the Board of Medical Examiners and the Board of Pharmacy, not later than six months from passage.  

Also in South Carolina, the Department of Health, and Human Services (SCDHHS) has announced it is seeking feedback on its draft “South Carolina Medicaid Quality Strategy.” The draft document is available here on SCDHHS’ website. The agency will collect public comments on the draft document until June 18, 2022. 

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

The South Carolina Board of Medical Examiners recently met and approved the updated Joint Pharmacist Immunization Protocol. The protocol now includes the updated ACIP (Advisory Committee on Immunization Practices) recommendations for Pneumococcal vaccines. You can view a copy here.

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 for one week in May 2022 to accommodate the state holiday observed May 10, 2022. 

Tuesday, May 10, 2022, is designated as a South Carolina state holiday. Due to this holiday, claims must be submitted by 5 p.m. Sunday, May 8, 2022, to be included with the payment scheduled for Friday, May 13, 2022. Payments will run Monday, May 9, 2022. Electronic remittance advice may be available one day earlier than normal. Payments will be dated Friday, May 13, 2022. 

Also in South Carolina, The Board of Pharmacy has been made aware that licensees are receiving scam phone calls from individuals impersonating state Board of Pharmacy inspectors and investigators. Licensees should be cautious of providing confidential or payment information over the phone without verifying the source is legitimate.   

Scammers are calling pharmacists and telling them that their facility or individual license is under investigation. Scammers may also claim that they are working with the Food and Drug Administration (FDA) or Drug Enforcement Administration (DEA) on a case, and further claim that the licensee is under investigation for suspicious activity or drug trafficking. In either case, the scammers claim that the licensee will face disciplinary action, a revoked license, or arrest if they do not immediately pay a fine over the phone.   

Additionally, many scammers are “spoofing” the phone number used to make the call, making it appear that the phone number is from a legitimate source. Scammers may even give a fake name and a fraudulent inspector identification number as “proof” of identity. If the call sounds suspicious, hang up and call the South Carolina Board of Pharmacy directly at 803-896-4700 or contact the Board at Contact.Pharmacy@llr.sc.gov.  

If a licensee receives a scam call from someone impersonating a state Board inspector or investigator, please report it immediately to Ray Trotter at Ray.Trotter@llr.sc.gov.  

If the scammer is impersonating an FDA or DEA inspector, please make a report to the respective agency. In addition, the licensee may also report scam calls to the Federal Communication Commission’s consumer complaint program. Please provide as many details about the scam call as possible. 

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