The South Carolina Department of Health and Human Services (SCDHHS) is updating guidance on how providers should submit requests and inquiries related to Medicaid eligibility. The Eligibility Administrative Support Team (EAST) will no longer process inquiries via its fax or email address. Effective immediately, all provider updates and inquiries should only be submitted via the procedures outlined in this ALERT.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Joint Pharmacist Administered Vaccines Committee revised the Protocol for Pharmacist Administered Vaccines. This revision has been reviewed and approved by the SC Board of Medical Examiners. The updated protocol moves flu to age 3 and up and adds the COVID vaccine to the list of approved vaccines. The protocol can be found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
In January, the South Carolina Enterprise Information System (SCEIS) will begin issuing 1099 forms to South Carolina Healthy Connections Medicaid providers. These forms will be for the calendar year 2020. In July 2019, the South Carolina Department of Health and Human Services (SCDHHS) transitioned the payment of Medicaid claims to the State of South Carolina’s consolidated accounting system, SCEIS. SCEIS requires payments to be issued to a single bank account for each taxpayer identification number (TIN), either a Federal Employer Identification Number (FEIN) or a Social Security Number (SSN). To make the transition to SCEIS, the South Carolina Department of Health and Human Services (SCDHHS) required Healthy Connections Medicaid group providers with multiple National Provider Identifier (NPI) numbers and/or multiple Medicaid Provider Numbers associated with a single TIN to designate one NPI and Medicaid Provider Number combination (a specific provider) to receive payment through SCEIS. The payments for all providers associated with that TIN were then made to the designated bank account for the NPI and Medicaid Provider Number combination. For more information on this transition, visit https://vip.scdhhs.gov/sceis/. In January 2021, SCEIS will begin issuing 1099 forms for the calendar year 2020 to Healthy Connections Medicaid providers. The 1099 forms will be issued to the NPI and Medicaid Provider Number combination designated by the provider and will include payments for all NPIs, and Medicaid Provider Numbers associated with the TIN. Providers will be responsible for any additional required breakdown of 1099 information. If you have any questions regarding 1099s for the calendar year 2020, please contact the Provider Service Center at (888) 289-0709.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
On January 23, 2020, Centene Corporation acquired WellCare Health Plans, Inc., which included WellCare of South Carolina, a managed care organization (MCO) contracted with the South Carolina Department of Health and Human Services (SCDHHS). As a result of this acquisition, WellCare will no longer participate in SCDHHS’s Healthy Connections Medicaid managed care program. Effective April 1, 2021, existing WellCare Medicaid members will be served by Absolute Total Care. Absolute Total Care is a wholly owned subsidiary of Centene Corporation. WellCare will remain responsible for claims, appeals and hearings, and other administrative processes that occur before April 1, 2021. To satisfy its contractual requirements with SCDHHS, WellCare will keep administrative processes in place for at least 12 months after exiting the Healthy Connections Medicaid managed care program. Providers rendering services to WellCare members will continue to work directly with WellCare for all dates of service before April 1, 2021. Additional administrative information may be found on WellCare’s website.
All Healthy Connections members transferred to Absolute Total Care on April 1, 2021, will maintain a continuity of care period for up to 90 days during which time members will continue to receive all authorized services from their current providers. If providers have questions about how this acquisition may affect them, they should call WellCare Provider Services at (888) 588-9842 or Absolute Total Care Provider Services at (866) 433-6041.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The South Carolina Department of Health and Human Services (SCDHHS) has announced that it will cover the cost of COVID19 vaccine administration for Healthy Connections Medicaid members, including those enrolled in the family planning and COVID-19 testing limited benefit programs. Those without healthcare coverage can apply for the COVID-19 limited benefit program via the link below. Billing guidance for providers is also available here.
Also in South Carolina. The Board of Pharmacy issued a notice announcing revisions to the protocol for the administration of vaccines by pharmacists. The protocol addresses authorization, qualifications, limitations, consent, and recordkeeping and reporting. The document is dated December 10, 2020.
Lastly in South Carolina. Prisma Health is offering the COVID-19 Vaccine to all pharmacists in the state as pharmacists are considered to be in Phase 1A per South Carolina Department of Health and Environmental Control (SC DEHC) vaccine guidelines. If a pharmacist is not able to access the vaccine through his or her employer, he or she can reach out to COVIDVaccine@prismahealth.org to receive an invitation to register for an appointment to receive the vaccine at any of their locations. Additionally, SC DHEC has announced an update to the recipients included in Phase 1A which now includes all pharmacists and pharmacy technicians. They previously differentiated between those pharmacists and technicians who administered the COVID-19 vaccine or tests versus those who conducted normal duties. Now, all are eligible to receive the vaccine in Phase 1A.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The South Carolina Department of Health and Environmental Control (DHEC) recently updated the state’s COVID-19 Vaccine Distribution Plan. Please click here to view the updated plan. The Department also released its guidance for Phase 1a of the COVID-19 vaccine distribution plan. Click here to view the guidance.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Board of Pharmacy issued a notice to announce an amendment to update guidance regarding the federal Department of Health and Human Services’ Third Amendment that temporarily expands pharmacists’ and pharmacy interns’ ability to order and/or administer childhood vaccinations and COVID vaccines that have been authorized by the FDA to people aged three to 18, provided they comply with the applicable requirements. The guidance also addresses other topics under the Public Readiness and Emergency Preparedness (PREP) Act as they relate to state law, including an October 20 federal guidance on coverage for qualified pharmacy technicians and state-authorized pharmacy interns for childhood vaccines, COVID-19 vaccines, and testing.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Carolina House Bill 4663, was signed by Governor McMaster (R) on September 28. The bill authorizes pharmacists to administer influenza vaccinations to persons under 12. Such vaccines must be administered according to protocol issued by the Board of Medical Examiners upon recommendation of the Joint Pharmacist Administered Vaccines Committee. The bill requires the Committee to submit its initial recommendation to the Board within three months of this measure’s effective date, which will be October 18, 2020.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
According to the South Carolina Department of Health and Human Services (SCDHHS), the state plans to transition its pharmacy reimbursement methodology to include an average acquisition cost (AAC) component. The state has contracted with Mercer to conduct the survey, which will be emailed to a randomly selected group of pharmacies between September 1st – 11th and it will be requesting August data. The new AAC rates will be published and effective on November 2, 2020.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.