South Carolina Administrative Code

126-405. Reinstatement. An individual or entity who has been excluded from Medicaid may be reinstated only by the Medicaid agency that imposed the exclusion. An individual or entity may submit to the State agency a request for reinstatement at any time after the date specified in…

126-425. Beneficiary Utilization. A. Definitions. (1) The Division of Program Integrity of the South Carolina Department of Health and Human Services (DHHS) is designed to safeguard against unnecessary, harmful, wasteful, and uncoordinated utilization of services by Medicaid elig…

126-500. Definitions. A. ‘‘Department’’ means the South Carolina Department of Health and Human Services. B. ‘‘County resident’’ means an individual who is a state resident and who lives in a particular county. For the purpose of determining eligibility for the MIAP, an individua…

126-505. Responsibilities for Eligibility Determination. A. The Department shall develop uniform criteria and materials for statewide use. A detailed description of the criteria, procedures, and materials which include an application form and letter of notification may be found i…

126-510. Application Process. When it is determined that an individual needs hospitalization and that he may qualify for assistance through the MIAP, the procedures stated below shall be followed. A. For nonemergency admissions, the patient shall be referred to the designee in th…

126-515. Non-Financial Eligibility Requirements. In order to be eligible for assistance from the MIAP, an individual must meet the following non- financial eligibility criteria. A. Residence. The individual shall be a resident of the State. A migrant or seasonal farm worker shall…

126-520. Financial Eligibility Requirements. The following elements are considered in determining eligibility for assistance through the MIAP. A. Family Composition. For details, refer to the definition of family at 126-500(D). If the applicant is a minor child, his stepparent is…

126-530. Services Covered by the Medically Indigent Assistance Program. A. Except as otherwise provided in this section, only inpatient hospital services which are covered by the South Carolina Medicaid Program as inpatient hospital services shall be covered by the MIAP. B. Psych…

126-535. Sponsorship From the Medically Indigent Assistance Program. A. Payments shall be made only to general hospitals. B. Individuals shall not be sponsored by the MIAP until all other means of reimbursement or service provision have been exhausted. This includes payments from…

126-540. Recovery by the Medically Indigent Assistance Program. A. The MIAP shall be reimbursed if an individual or the services delivered to that individual are later determined to be ineligible for coverage. B. The ineligible person or the person for whom ineligible services ar…

126-560. The Department shall use a prospective payment system which considers diagnostic related groupings and per diem costs to reimburse hospitals for inpatient services provided to Medically Indigent beneficiaries. A. The method for processing and payment of claims shall be a…

126-570. Grace Period. County Assessments shall be paid in accordance with the provisions of 44-6-146(C) of the 1976 Code, as amended. The grace period referred to in this section shall be ten (10) working days from the date the assessment was originally due. The assessment must …

126-710. [Deleted] HISTORY: Former Regulation, titled General, deleted by SCSR42-5 Doc. No. 4746, eff May 25, 2018.

126-720. [Deleted] HISTORY: Former Regulation, titled Scope of Program and Services, deleted by SCSR42-5 Doc. No. 4746, eff May 25, 2018.

126-730. [Deleted] HISTORY: Former Regulation, titled Persons Eligible to Receive Social Services, deleted by SCSR42-5 Doc. No. 4746, eff May 25, 2018.

126-740. [Deleted] HISTORY: Former Regulation, titled Application Procedures, deleted by SCSR42-5 Doc. No. 4746, eff May 25, 2018.

126-750. [Deleted] HISTORY: Former Regulation, titled Client Right to Appeal, deleted by SCSR42-5 Doc. No. 4746, eff May 25, 2018.

126-799. [Deleted] HISTORY: Former Regulation, titled Prior Regulations, deleted by SCSR42-5 Doc. No. 4746, eff May 25, 2018. ARTICLE 8 INTERMEDIATE SANCTIONS FOR MEDICAID CERTIFIED NURSING FACILITIES (Statutory Authority: 1976 Code Sections 44-6-90, 44-6-540)

126-800. Definitions. A. Administrator of the State Medicaid Agency means the Executive Director of South Carolina Department of Health and Human Services. B. Annual Standard Survey means an annual standard survey conducted on each nursing facility, without prior notice to the fa…

126-810. Imposition of Sanctions. The Administrator, or his designee, of the State Medicaid Agency may apply one or more of the following sanctions against a Medicaid nursing facility which has failed to correct deficiencies or make acceptable progress toward correction of defici…

126-820. Factors for Sanctions. The factors to be considered in determining sanctions shall include, but are not limited to, the following: A. Seriousness of the deficiencies involves a determination of whether the deficiencies have a direct or indirect relationship to resident h…

126-830. Assessment of Sanctions. The Administrator, or his designee, of the State Medicaid Agency may impose penalties in accordance with Section 126-840, Schedule of Sanctions of these regulations. Civil monetary penalties under each class shall be assessed based on an amount p…

126-840. Schedule of Sanctions. CLASS I DEFICIENCY: A. Violation of requirements which present an indirect relationship to resident health, safety or welfare, and which does not create a substantial and/or immediate risk to health and safety. B. Remedies/Sanctions: 1. Deny paymen…

126-850. Levying of Sanctions. Civil monetary penalties will be collected through an adjustment to reimbursement due nursing facilities or through other appropriate methods. Denial of payment under the state plan shall be made through suspension or termination of payment. ARTICLE…

126-910. Program Definitions. A. Optional State Supplementation (OSS) Program —— a State-funded program that provides a cash benefit payment that supplements an eligible individual’s countable income up to the net income limitation. This supplementation, in conjunction with the i…

126-920. Eligibility. A. An individual must meet the following requirements in order to be eligible for OSS benefits: (1) Be a resident of the State of South Carolina; (2) Has been determined by the Social Security Administration (SSA) or by the State in accordance with applicabl…

126-930. Termination, Suspension or Reduction of Benefits. Eligibility for further OSS payments shall be terminated as soon as information indicating ineligibility is reported. History: Added by State Register Volume 24, Issue No. 3, eff March 23, 2001.

126-940. Program Administration. A. Subject to the availability of funding, the OSS Program will supplement the income of eligible individuals for whom an OSS slot request has been approved. B. The Department of Health and Human Services will establish the maximum number of OSS r…

127-1.1. Repealed. HISTORY: Former Regulation, titled Notice of Protest, had the following history: Amended by State Register Volume 21, Issue No. 6, Part 2, eff June 27, 1997. Repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-1.10. Repealed. HISTORY: Former Regulation, titled Service and Notice, repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-1.11. Repealed. HISTORY: Former Regulation, titled Conflict of Interest, had the following history: Added by State Register Volume 21, Issue No. 6, Part 2, eff June 27, 1997. Repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022. RULES OF PROCEDURE FOR THE PREPARATION AND PRE…

127-1.2. Repealed. HISTORY: Former Regulation, titled Protection of Trade Secrets and Other Confidential Information, repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-1.3. Repealed. HISTORY: Former Regulation, titled Party Status, had the following history: Amended by State Register Volume 21, Issue No. 6, Part 2, eff June 27, 1997. Repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-1.4. Repealed. HISTORY: Former Regulation, titled Intervention; Appearance by Non-parties, had the following history: Amended by State Register Volume 21, Issue No. 6, Part 2, eff June 27, 1997. Repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-1.5. Repealed. HISTORY: Former Regulation, titled Representative of Parties and Intervenors, had the following history: Amended by State Register Volume 21, Issue No. 6, Part 2, eff June 27, 1997; State Register Volume 30, Issue No. 5, eff May 26, 2006. Repealed by SCSR 46-5 …

127-1.6. Repealed. HISTORY: Former Regulation, titled Failure to Appear, had the following history: Amended by State Register Volume 18, Issue No. 6, eff June 24, 1994; State Register Volume 28, Issue No. 5, eff May 28, 2004. Repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-1.7. Repealed. HISTORY: Former Regulation, titled Duty and Authority of Board Member, had the following history: Amended by State Register Volume 21, Issue No. 6, Part 2, eff June 27, 1997. Repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-1.8. Repealed. HISTORY: Former Regulation, titled Filing of Briefs and Oral Arguments, repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-1.9. Repealed. HISTORY: Former Regulation, titled Hearings on Petitions for Modification of Abatement Dates, repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-2.1. Repealed. HISTORY: Former Regulation, titled Record, repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-2.2. Repealed. HISTORY: Former Regulation, titled Transcripts, Exhibits, repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-2.3. Repealed. HISTORY: Former Regulation, titled Filing of Transcript and Exhibits, repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-2.4. Repealed. HISTORY: Former Regulation, titled Preservation of Record, repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022. RULES OF PROCEDURE FOR APPEALS TO THE REVIEW BOARD

127-3.1. Repealed. HISTORY: Former Regulation, titled Petition for Review, repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-3.2. Repealed. HISTORY: Former Regulation, titled Request for Response, repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-3.3. Repealed. HISTORY: Former Regulation, titled Oral Argument, repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.

127-3.4. Repealed. HISTORY: Former Regulation, titled Record for Appeal, repealed by SCSR 46-5 Doc. No. 5050, eff May 27, 2022.