Title 44, Health

The committee must recommend to the department therapeutic classes of drugs that should be included on a preferred drug list. For those recommended classes, the committee shall recommend the drug or drugs considered preferred within that class based on safety and efficacy. In det…

Any preferred drug list program implemented by the department must include: (1) procedures to ensure that a request for prior authorization that has no material defect or impropriety can be processed within twenty-four hours of receipt; (2) procedures to allow the prescribing phy…

A grant of prior authorization for a drug is specific to the drug, rather than the actual prescription, and extends to all refills allowed pursuant to the original prescription and to subsequent prescriptions for the same drug at the same dosage provided the time allowed by the p…

A Medicaid provider, outside of the geographical boundary of South Carolina but within the South Carolina Medicaid Service Area, as defined by R. 126-300(B) of the Code of State Regulations, prior to the effective date of the amendments to Section 1-1-10, which are effective Janu…

As used in this article: (1) "Ambulance service" means any entity defined in Section 44-61-20, which is currently certified or licensed by the Department of Health and Environmental Control pursuant to Chapter 61, Title 44, but does not include a municipal fire or police departme…

The department shall charge every ambulance service a uniform ambulance assessment fee. The fee must equal the product of the ratio of the ambulance service's net revenue to all ambulance services' net revenue statewide multiplied by the total ambulance services assessment amount…

There is created in the State Treasury the Ambulance Fee Trust Fund. This fund is separate and distinct from the general fund of the State and all other funds. Earnings and interest on this fund must be credited to it and any balance in this fund at the end of a fiscal year carri…

The department shall charge the fee described in Section 44-6-1115 only if the following conditions are met: (1) The department has received such approval from the Centers for Medicare and Medicaid Services necessary to authorize the Medicaid payments to ambulance services in acc…

Amounts in the fund described in Section 44-6-1120 shall be expended exclusively for Medicaid payments to ambulance services and shall not be used to replace payment commitments between the ambulance services and the State. The expenditures shall be established by the department …

If the Centers for Medicare and Medicaid Services does not authorize or withdraws approval of the Medicaid payments made to ambulance services in accordance with Section 44-6-1130, all monies in the fund described in Section 44-6-1120 shall be returned to ambulance services. If t…

The payment amounts to be established and distributed by the department pursuant to Section 44-6-1130 shall be developed in a manner that closes the gap between Medicaid rates and average commercial rates. The department shall consult with the South Carolina EMS Association in th…

The ambulance assessment program described in this article must be used to supplement, not supplant, general fund appropriations to support ambulance services reimbursements as of the effective date of this article. The department shall not reduce Medicaid rates for ambulance ser…

(A) Pharmacy services are a benefit under South Carolina Medicaid, subject to approval by the federal Centers for Medicare and Medicaid Services. The department shall establish a fee schedule for the list of pharmacy services. (B)(1) The following services are covered pharmacy se…

The department may impose a penalty of up to five percent of the fee for any ambulance service that fails to pay the fee within the time required by the department for each month, or fraction thereof, that such fee is overdue. If a fee has not been received by the department in a…

The department shall submit to the Centers for Medicare and Medicaid Services any and all Medicaid state plan amendments, waiver requests, preprints, and other documents required to implement or continue the implementation of this article no later than six months after enactment …

The General Assembly finds that: (1) There are citizens who cannot afford to pay for hospital care because of inadequate financial resources or catastrophic medical expenses. (2) Rising health care costs and the growth of the medically indigent population have increased the strai…

The following sections shall be known and may be cited as the "South Carolina Medically Indigent Assistance Act".

(A) To provide cost containment incentives for providers of care to Medicaid recipients, the department shall convert the Medicaid hospital reimbursement system from a retrospective payment system to a prospective payment system by October 1, 1985. The prospective payment system …

(A) Every fiscal year the State Treasurer shall withhold from the portion of the Local Government Fund allotted to the counties a sum equal to fifty cents per capita based on the population of the several counties as shown by the latest official census of the United States. The m…

(A) There is created the South Carolina Medically Indigent Assistance Program administered by the department. The program is authorized to sponsor inpatient hospital care for which hospitals shall receive no reimbursement. A general hospital equipped to provide the necessary trea…

(A) There is created the Medicaid Expansion Fund into which must be deposited funds: (1) collected pursuant to Section 44-6-146; (2) collected pursuant to Section 12-23-810; and (3) appropriated pursuant to subsection (B). This fund must be separate and distinct from the general …

(A) By August first of each year, the department shall compute and publish the annual target rate of increase for net inpatient charges for all general hospitals in the State. The target rate of increase will be established for a twelve-month period from October first through Sep…

(A) As used in this section: (1) "Office" means the Revenue and Fiscal Affairs Office. (2) "Council" means the Data Oversight Council. (3) "Committee" means the Joint Legislative Health Care Planning and Oversight Committee. (B) There is established the Data Oversight Council com…

(A) Patient records received by counties, the department, or other entities involved in the administration of the program created pursuant to Section 44-6-150 are confidential. Patient records gathered pursuant to Section 44-6-170 are also confidential. The Revenue and Fiscal Aff…

The department may promulgate regulations pursuant to the Administrative Procedures Act. Appeals from decisions by the department are heard pursuant to the Administrative Procedures Act, Administrative Law Judge, Article 5, Chapter 23 of Title 1 of the 1976 Code. The department s…

(A) A person who commits a material falsification of information required to determine eligibility for the Medically Indigent Assistance Program is guilty of a misdemeanor and, upon conviction, must be fined not more than five hundred dollars or imprisoned for not more than one y…

All applications for admission to a nursing home must contain a notice, to be signed by the applicant, stating: "Eligibility for Medicaid-sponsored long-term care services is based on income and medical necessity. To qualify for assistance through the Medicaid program, a nursing …

The department shall: (1) administer Title XIX of the Social Security Act (Medicaid), including the Early Periodic Screening, Diagnostic and Treatment Program, and the Community Long-Term Care System; (2) be designated as the South Carolina Center for Health Statistics to operate…

In administering home- and community-based waiver programs, the department shall, to the extent possible, maintain the waiver status of an eligible family member of a member of the armed services who maintains his South Carolina state residence, regardless of where the service me…

For all health and human services interagency programs provided for in this chapter, the department shall have the following duties: (1) Prepare and approve state and federal plans prior to submission to the appropriate authority as required by law for final approval or for state…

As used in this article: (1) "Department" means the Department of Health and Human Services. (2) "Nursing home" means a facility subject to licensure as a nursing home by the Department of Health and Environmental Control and subject to the permit provisions of Article 2, Chapter…

When the department is notified by the survey agency that a nursing home is in violation of one or more of the requirements for participation in the Medicaid program, it may take enforcement action as follows: (1) if the nursing home is dually certified for participation in both …

The State Department of Health and Human Services may collect administrative fees associated with accounts receivable for those individuals or entities which negotiate repayment to the agency. The administrative fee may not exceed one and one-half percent of the amounts negotiate…

Any use of funds collected by the department as a result of the imposition of civil monetary penalties or other enforcement actions must be for a purpose related to the protection of the health and property of residents of nursing homes that participate in the Medicaid program. T…

As used in this chapter: (1) "Department" means the State Department of Health and Human Services. (2) "Office" means the Revenue and Fiscal Affairs Office. (3) "Costs of medical education" means the direct and indirect teaching costs as defined under Medicare. (4) "Market basket…

In carrying out the duties provided for in Section 44-6-30 the department shall: (1) Contract for health and human services eligibility determination with performance standards regarding quality control as required by law or regulation. (2) Contract for operation of certified Med…

Before instituting an action under this article, the Department of Health and Human Services shall determine if the Secretary of the United States Department of Health and Human Services has jurisdiction under federal law. In such cases, it shall coordinate its efforts with the s…

The department is authorized to promulgate regulations, pursuant to the Administrative Procedures Act, to administer this article, and to ensure compliance with the requirements for participation in the Medicaid program.

This article may be cited as the "Gap Assistance Pharmacy Program for Seniors (GAPS) Act".

For purposes of this article: (1) "Department" means the South Carolina Department of Health and Human Services. (2) "Prescription drugs" means outpatient prescription drugs that have been approved by the United States Food and Drug Administration. "Prescription drugs" do not inc…

(A) There is created within the Department of Health and Human Services the Gap Assistance Pharmacy Program for Seniors (GAPS) program. The purpose of this program is to coordinate, beginning January 1, 2006, with Medicare Part D Prescription Drug Plans to provide to low-income s…

(A) This program must be administered by the Department of Health and Human Services. The department may designate, or enter into contracts with, other entities including, but not limited to, other states, other governmental purchasing pools, and nonprofit organizations to assist…

(A) To be eligible to enroll in this program a person must: (1) have attained the age of sixty-five years; (2) be a resident of this State; (3) be enrolled in a GAPS participating Medicare Part D Drug Plan; (4) satisfy annual income, resources, and other criteria established by t…

(A) The department shall maintain data to allow evaluation of the cost effectiveness of the program. (B) Beginning with fiscal year 2006-2007, the department shall include in its annual report, a report on the GAPS program.

A state plan must be prepared by the department for each program assigned to it and the department must also prepare resource allocation recommendations based on such plans. The resource allocation recommendations must be approved pursuant to state and federal law. The state plan…

If an applicant for Medicaid for nursing home care would be ineligible because a trust established for the applicant was deemed a Medicaid qualifying trust or resources in the trust were deemed an improper transfer of resources, the person's application must be treated as a case …