What types of policy changes does SC Medicaid - SCDHHS issue?

SC Medicaid - SCDHHS regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does SC Medicaid - SCDHHS update its policies?

SC Medicaid - SCDHHS typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many SC Medicaid - SCDHHS policy changes are tracked here?

This page currently tracks 50 documented SC Medicaid - SCDHHS policy changes. New items are added as they are identified.

What should I do when SC Medicaid - SCDHHS changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

PAYER POLICY CHANGES

SC Medicaid - SCDHHS Policy Changes & Prior Auth Updates

We track 50 documented policy changes from SC Medicaid - SCDHHS across SC. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original SC Medicaid - SCDHHS notice. Use the related links below to narrow results by specialty or state, or create a free alert to get new SC Medicaid - SCDHHS updates by email (daily or weekly, your choice, on every plan).

SC Medicaid - SCDHHS · Effective Dec 1, 2026High impact
Updates for Dental Services Rendered in an Ambulatory Surgical Center
South Carolina DHHS is updating reimbursement and billing guidelines for dental services rendered in ambulatory surgical centers (ASCs), effective December 1, 2026. ASC providers must use procedure code G0330 for operating room–related facility services during dental rehabilitation under anesthesia, with a limit of one billing per patient per date of service at a rate of $1,359. ASCs must submit claims with a copy of the approved authorization issued to the dental provider by SCDHHS' dental administrative services organization, or claims will be rejected.
SC Medicaid - SCDHHS · Effective Dec 1, 2026High impact
Updates to the Durable Medical Equipment Services Manual
South Carolina SCDHHS is updating its Durable Medical Equipment (DME) Services Manual and DME Fee Schedule, effective December 1, 2026. The updates will clarify covered services and clinical criteria, update documentation and medical necessity requirements, specify face-to-face encounter requirements, provide updated billing guidance, and define units, frequencies, and authorization requirements for procedure codes. Providers must review the draft manual and submit feedback by November 2, 2026, and attend training webinars on November 10 or December 3, 2026.
SC Medicaid - SCDHHS · Effective Dec 1, 2026High impact
Medicaid Ordering, Referring and Prescribing Providers: Pharmacy Update
South Carolina Medicaid is implementing a hard enforcement of ORP (Ordering, Referring, and Prescribing) provider enrollment requirements for pharmacy claims effective December 1, 2026. Starting that date, pharmacy claims submitted without the prescriber's National Provider Identifier (NPI) will be rejected and not paid. Pharmacies can request one-time claim rejection overrides by contacting the fee-for-service pharmacy technical help desk.
SC Medicaid - SCDHHS · Effective Dec 1, 2026Medium impact
Rate Updates for State Plan Services and Home and Community-based Services
South Carolina Department of Health and Human Services is increasing reimbursement rates for state plan services and home and community-based services (HCBS) through 1915(c) waiver programs. Rate increases range from $1–$15.23 per unit across personal care, nursing, and residential habilitation services for Healthy Connections Medicaid members. All billing systems and fee schedules will be updated by the effective date.
SC Medicaid - SCDHHS · Effective Dec 1, 2026Medium impact
Updates to Clinic Services Manual
The South Carolina Department of Health and Human Services (SCDHHS) is updating the Clinic Services Manual effective December 1, 2026, with clarified service definitions, clinical criteria, and billing guidelines for opioid treatment programs, dental services in ambulatory surgical centers, End-Stage Renal Disease clinics, dialysis services, and in-home dialysis. Providers must review the draft manual and can submit feedback by November 2, 2026, with educational webinars scheduled for November 12 and December 8, 2026.
SC Medicaid - SCDHHS · Effective Dec 15, 2026Medium impact
Updated Prior Authorization Expansion on Physician-administered Drugs
South Carolina Medicaid will require prior authorization for a list of physician-administered drugs when given to fee-for-service Healthy Connections Medicaid members. The drug list is published in the procedure codes section of the Physicians Services Provider Manual and is updated with the added drugs beginning December 15, 2026.
SC Medicaid - SCDHHS · Effective Oct 1, 2026High impact
Prescriber Certification of Incontinence Form Update
South Carolina Medicaid (Healthy Connections) updated the Prescriber Certification of Incontinence Form (168IS) to require capture of the prescribing provider's individual NPI on the form and all related claims. Effective December 1, 2026, incontinence supplies claims will be denied if the prescriber's NPI is not included. The billing team must ensure all 168IS forms are complete with prescriber NPI and that claims include this identifier.
SC Medicaid - SCDHHS · Effective Oct 1, 2026High impact
Updated Prior Authorization Expansion on Physician-administered Drugs
Effective October 1, 2026, South Carolina SCDHHS will require prior authorization for an expanded list of physician-administered drugs when given to Healthy Connections Medicaid fee-for-service members. The specific drugs requiring PA are listed in the SCDHHS Physicians Services Provider Manual and a supplemental document. All requests for PA must be submitted to Prime Therapeutics Management.
SC Medicaid - SCDHHS · Effective Oct 1, 2026High impact
Outpatient Hospital Drugs and Biologicals Payment Update
Effective October 1, 2026, South Carolina Medicaid will change how it reimburses outpatient hospital drugs and biologicals. These drugs will now be reimbursed using the same methodology as physician-administered drugs, and certain outpatient hospital drugs will be reimbursed as add-ons without the outpatient hospital multiplier applied. This affects billing methodology and reimbursement calculations for all outpatient drugs and biologicals at hospital facilities.
SC Medicaid - SCDHHS · Effective Aug 12, 2026High impact
Provider Revalidation Updates
South Carolina SCDHHS is implementing a two-track provider revalidation strategy to combat fraud and waste in the Healthy Connections Medicaid program. Approximately 5,713 high-risk providers have been prioritized for rapid revalidation within 12 months, which includes documentation review, site visits, and fingerprint-based background checks. Revalidation letters with unique codes have begun mailing to designated high-risk provider types.
SC Medicaid - SCDHHS · Effective Jul 1, 2026High impact
Updated Rehabilitative Behavioral Health Services and Licensed Independent Practitioners Provider Manuals
South Carolina Medicaid has released updated provider manuals for Rehabilitative Behavioral Health Services (RBHS), Office of Substance Use Services (OSUS)-affiliated providers, and Licensed Independent Practitioners (LIP) behavioral health services effective July 1, 2026. The manuals include new billing guidance sections, unified service definitions, updated ORP requirements for psychiatrists, and reorganized appendices. Three mandatory training webinars are scheduled July 8-9, 2026. The bulletin also reinforces anti-kickback compliance requirements under state and federal law.
SC Medicaid - SCDHHS · Effective Jul 1, 2026High impact
Updates to ASD Services Provider Manual
South Carolina SCDHHS has updated the ASD Services Provider Manual effective July 1, 2026, with changes to telehealth guidance, medical necessity criteria, service descriptors, and documentation requirements. A critical new anti-kickback rule prohibits reimbursement for ABA services provided by clinics or agencies owned by entities that also conducted the member's autism evaluation and diagnosis.
SC Medicaid - SCDHHS · Effective Jul 1, 2026High impact
Updated Prior Authorization Expansion on Physician-administered Drugs
Effective July 1, 2026, South Carolina SCDHHS is expanding prior authorization requirements for physician-administered drugs covered under Healthy Connections Medicaid fee-for-service (FFS) plans. Billing teams must obtain prior authorization through Prime Therapeutics before administering the newly listed drugs to FFS Medicaid members, or claims will be denied.
SC Medicaid - SCDHHS · Effective Jul 1, 2026High impact
Updates to ASD Services Provider Manual
South Carolina Medicaid is updating the Autism Spectrum Disorder (ASD) Services Provider Manual effective July 1, 2026, with significant changes to telehealth allowances, prior authorization requirements, and documentation standards. Key changes include permanent telehealth approval for CPT 97156, new prior auth requirements for CPT 97155, and elimination of telehealth for CPT 97151.
SC Medicaid - SCDHHS · Effective Jul 1, 2026High impact
Medicaid Ordering, Referring and Prescribing (ORP) Providers Update
Starting July 1, 2026, South Carolina Medicaid will reject claims that don't include the National Provider Identifier (NPI) of physicians who ordered or referred services. All providers who order, refer, or prescribe services for Medicaid members must enroll with SCDHHS as ORP providers, even if they don't submit claims directly.
SC Medicaid - SCDHHS · Effective Dec 1, 2025High impact
340B Drug Program Billing Policy Changes
Starting December 1, 2025, South Carolina providers purchasing drugs through the 340B program must include the 'TB' modifier on all Medicaid fee-for-service claims and ensure their billing numbers are on the HRSA Medicaid Exclusion file. The TB modifier must be in the second position on UB-04 claims with multiple modifiers.
SC Medicaid - SCDHHS · Effective Oct 1, 2025High impact
Updated Billing Guidance for Hospital-based Crisis Stabilization Services
South Carolina Medicaid has updated billing guidance for hospital-based crisis stabilization services in EmPATH units, eliminating the requirement for separate NPI enrollment and allowing hospitals to use their existing emergency department NPI. New procedure codes S9484 and S9485 with revenue code 919 are now required for billing these services as outpatient hospital add-on services.
SC Medicaid - SCDHHS · Effective Jul 2, 2025High impact
Medicaid Enrollment of Ordering, Referring and Prescribing (ORP) Providers and Collection of ORP Data
Federal law now requires all providers who order, refer, or prescribe services for Medicaid members to enroll with South Carolina DHHS as Medicaid providers, even if they don't bill Medicaid directly. This includes current providers and those who may serve Medicaid patients in the future.
SC Medicaid - SCDHHS · Identified Sep 24, 2026High impact
Physician-administered Drugs (PAD) Billing Guidance
SCDHHS updated its Physician-administered Drugs (PAD) billing guidance requiring all PAD claims to include a valid NDC (National Drug Code) in 5-4-2 format (11 digits total) matched to the HCPCS code. Claims without an NDC or with an invalid NDC will be rejected or subject to payment recoup. This policy applies immediately to all outpatient settings (offices, clinics, hospitals) billing South Carolina Medicaid.
SC Medicaid - SCDHHS · Effective Oct 1, 2026Medium impact
Physician Services Provider Manual Updates
South Carolina Medicaid (SCDHHS) is adding coverage for ELF testing (CPT 81517) for liver disease risk assessment in patients with MASH and related conditions, requiring prior authorization and limiting to one test per six months for members 12+. Additionally, prostate cancer screening coverage is being expanded for Healthy Connections Medicaid members age 50+, with reimbursement rates to be published by October 1, 2026.
SC Medicaid - SCDHHS · Effective Aug 1, 2026Medium impact
Addition of Intercept for Intensive In-home Services
South Carolina Medicaid is adding coverage for Intercept, an evidence-based intensive in-home behavioral health service for at-risk youth ages up to 20, effective August 1, 2026. Providers must become licensed through Youth Villages and bill using new procedure code H0037-U2 with a bundled daily rate of $309.56 per diem, limited to 48 encounters over 120 days without prior authorization; additional encounters require prior authorization with medical necessity documentation.
SC Medicaid - SCDHHS · Effective Jul 1, 2026Medium impact
Community Choices and HIV/AIDS 1915(c) Waiver Changes and Program Renewal Status
CMS has approved South Carolina's five-year renewal of the Community Choices (CC) and HIV/AIDS 1915(c) HCBS waiver programs, with all submitted changes approved. The renewal is retroactive to July 1, 2026. Billing teams should review the approved renewal applications and previously announced amendments on the SCDHHS website to identify any service coverage, benefit, or billing process changes.
SC Medicaid - SCDHHS · Effective Jul 1, 2026Medium impact
Updates to Rehabilitative Behavioral Health Services and Licensed Independent Practitioners Behavioral Health Services Provider Manuals
South Carolina Medicaid is updating provider manuals for Rehabilitative Behavioral Health Services (RBHS) and Licensed Independent Practitioners (LIP) Behavioral Health Services effective July 1, 2026. The updates unify service definitions, clarify documentation requirements, and incorporate current behavioral health best practices.
SC Medicaid - SCDHHS · Effective Jun 12, 2026Medium impact
June-July 2026 Provider Payment Schedule and Provider Service Center Holiday Hours
The South Carolina Department of Health and Human Services has implemented temporary payment schedule changes for Healthy Connections Medicaid in June-July 2026 due to federal holidays. Claims submitted by June 12, 2026, will have payments dated June 19, 2026, but ACH files delayed until June 22, 2026. The July 3, 2026 payment cycle is moved up with a June 26, 2026 submission deadline. Provider Service Center will be closed July 3, 2026.
SC Medicaid - SCDHHS · Effective May 6, 2026Medium impact
Reminder to Protect Medicaid Enrollment Information
South Carolina DHHS is reminding Medicaid providers to safeguard enrollment information, login credentials, and provider identifiers to prevent fraudulent billing and unauthorized account changes. Providers must limit access to authorized personnel, keep enrollment current, review claims for irregularities, and report any suspected compromises immediately.
SC Medicaid - SCDHHS · Effective Apr 1, 2026Medium impact
340B Drug Program Billing Policy Changes
South Carolina Medicaid requires providers to append the 'TB' modifier to all claims for drugs purchased through the 340B program, effective April 1, 2026. For primary Medicaid claims, charges cannot exceed net acquisition costs, while secondary Medicaid claims may use usual charges but must include the TB modifier.
SC Medicaid - SCDHHS · Effective Apr 1, 2026Medium impact
Reminder-340B Drug Program Billing Policy Change
Starting April 1, 2026, South Carolina Medicaid providers who purchase drugs through the 340B program must append the 'TB' modifier to all drug claims and ensure charges don't exceed net acquisition costs for primary Medicaid claims.
SC Medicaid - SCDHHS · Effective Mar 1, 2026Medium impact
Updated Prior Authorization Expansion on Physician-administered Drugs
South Carolina Medicaid is expanding prior authorization requirements for physician-administered drugs effective March 1, 2026. This change only affects fee-for-service Medicaid members and requires providers to obtain prior authorization through Prime Therapeutics Management before administering specified medications.
SC Medicaid - SCDHHS · Effective Feb 1, 2026Medium impact
Pre-admission Screening and Resident Review Updates
South Carolina DHHS is eliminating the memorandum of agreement (MOA) requirement for PASRR Level I Screening forms and introducing a revised screening form. All PASRR procedures are being consolidated into provider manuals, and the new form version becomes mandatory for all submissions.
SC Medicaid - SCDHHS · Effective Jan 1, 2026Medium impact
Audiology Services Policy Updates
South Carolina Medicaid is adding coverage for new audiology CPT codes effective January 1, 2026, including hearing aid selection, fitting, follow-up services, and bone-anchored implant programming. The policy establishes specific billing limitations, frequency restrictions, and reimbursement rates for these services.
SC Medicaid - SCDHHS · Effective Jan 1, 2026Medium impact
Dental Services Policy Updates
South Carolina Medicaid is adding coverage for new dental sedation and anesthesia codes (D9224, D9225, D9244, D9245, D9246, D9247) and orthodontic codes (D8091, D8671) effective January 1, 2026. Coverage varies by patient age and special needs status, with different reimbursement rates for children versus adults.
SC Medicaid - SCDHHS · Effective Dec 19, 2025Medium impact
December 2025–January 2026 Provider Payment Schedule and Provider Service Center Holiday Hours
South Carolina Medicaid (Healthy Connections) has updated their claims submission deadlines and payment processing schedule for the December 2025 and January 2026 holidays. Claims submission deadlines are moved earlier, and the Provider Service Center will be closed on specific holiday dates.
SC Medicaid - SCDHHS · Effective Dec 1, 2025Medium impact
Rehabilitative Behavioral Health and Substance Use Services Rate Increases
Effective for dates of service on or after Dec. 1, 2025, South Carolina Medicaid updated the reimbursement methodology and rates for Medicaid State Plan services rendered by rehabilitative behavioral health (RBHS) providers, Office of Substance Use Services-affiliated organizations and licensed independent practitioners (LIPs). The Department of Alcohol and Other Drug Abuse Services Fee Schedule will be renamed to align with the Office of Substance Use Services. The December 17, 2025 update also changed H0032 from a 15-minute timed unit to a 30-minute encounter for RBHS providers, changed H0002 from a timed unit to an untimed encounter, and corrected the H0038 peer support rate to $14.48 per unit.
SC Medicaid - SCDHHS · Effective Nov 15, 2025Medium impact
Updated Prior Authorization Expansion on Physician-Administered Drugs
South Carolina Medicaid is expanding prior authorization requirements for additional physician-administered drugs for fee-for-service Medicaid members effective November 15, 2025. Prior authorization requests must be submitted to Prime Therapeutics Management through their online portal or phone system.
SC Medicaid - SCDHHS · Effective Nov 7, 2025Medium impact
November 2025 Provider Payment Schedule and Provider Service Center Holiday Hours
South Carolina Medicaid (Healthy Connections) has updated claim submission deadlines and payment processing schedules for November 2025 Veterans Day and Thanksgiving holidays. Claims must be submitted by 5 p.m. on November 7th for November 14th payment and by 5 p.m. on November 21st for November 28th payment, with the Provider Service Center closed on specific holiday dates.
SC Medicaid - SCDHHS · Effective Nov 1, 2025Medium impact
Residential Habilitation Service Rate Increases for the Intellectual Disability/Related Disabilities and Head and Spinal Cord Injury Waivers
South Carolina DHHS is increasing reimbursement rates for residential habilitation services under Intellectual Disability/Related Disabilities and Head and Spinal Cord Injury waivers effective November 1, 2025. Rate increases range from $0.66 to $89.23 per service across various residential care tiers.
SC Medicaid - SCDHHS · Effective Oct 1, 2025Medium impact
Inpatient Hospital Services Payment Methodology - Changes to the APR-DRGs Classification System
South Carolina Medicaid is updating their inpatient hospital payment system from APR-DRGs version 32 to version 42, effective October 1, 2025. This affects how general acute care hospitals, distinct part units, and long-term acute care hospitals are reimbursed for inpatient services.
SC Medicaid - SCDHHS · Effective Oct 1, 2025Medium impact
Update to Opioid Treatment Program Service Rates
South Carolina Medicaid is significantly increasing reimbursement rates for opioid treatment programs effective October 1, 2025. The weekly bundle rates for methadone treatment (G2067) will increase from $102.04 to $193.60, and buprenorphine treatment (G2068) will increase from $133.76 to $213.03.
SC Medicaid - SCDHHS · Effective Oct 1, 2025Medium impact
Personal Needs Allowance Increase
South Carolina Medicaid is increasing the personal needs allowance for members in skilled nursing facilities and ICF/IIDs from $30 to $60 monthly effective October 1, 2025. Facilities must complete Form MSC002 to update cost of care calculations for existing residents.
SC Medicaid - SCDHHS · Effective Sep 1, 2025Medium impact
Physician Services Provider Manual Updates
South Carolina Medicaid is requiring prior authorization for three SMA genetic testing codes (81329, 81336, 81337) starting September 1, 2025, while eliminating prior authorization requirements for circumcision procedures (54161) for patients older than 28 days. Providers must maintain medical necessity documentation for circumcisions in patient records.
SC Medicaid - SCDHHS · Effective Sep 1, 2025Medium impact
Autism Spectrum Disorder Services Provider Manual Update
South Carolina Medicaid is updating medical necessity requirements for autism spectrum disorder (ASD) treatment services for members 0-21 years old. Key changes include replacing 'Comprehensive Psychological Evaluation' with 'Comprehensive Diagnostic Assessment' and adding new qualified providers and assessment tools. A new Medical Care Home Autism Assessment option is being added for primary care physicians.
SC Medicaid - SCDHHS · Effective Aug 1, 2025Medium impact
Updated Prior Authorization Expansion on Physician-administered Drugs
Effective August 1, 2025, South Carolina Medicaid will expand prior authorization requirements for physician-administered drugs for fee-for-service Medicaid members. The billing team must obtain prior authorization through Prime Therapeutics for additional drugs that will be specified in an updated list on the SCDHHS website.
SC Medicaid - SCDHHS · Effective Jul 31, 2025Medium impact
Sunsetting of the Palmetto Coordinated System of Care Waiver
The Palmetto Coordinated System of Care (PCSC) waiver for youth mental health services will be discontinued effective July 31, 2025. Medicaid members will transition to receiving behavioral health services through their managed care organizations or fee-for-service Medicaid, with case management services continuing through different providers.
SC Medicaid - SCDHHS · Effective Jul 1, 2025Medium impact
Home and Community-based Services Provider Manual Update
South Carolina Medicaid has updated its Home and Community-based Services Provider Manual with new provider standards for multiple service categories and added two new waiver services: caregiver coaching for Intellectual Disability waiver and children's attendant care (self-directed) for Medically Complex Children waiver.
SC Medicaid - SCDHHS · Effective Jun 27, 2025Medium impact
June-July 2025 Provider Payment Schedule and Provider Service Center Holiday Hours
South Carolina Medicaid is adjusting their payment schedule for June-July 2025 due to Independence Day holiday. Claims for the July 4, 2025 payment date must be submitted by June 27, 2025, with payments processing on June 30 and remittance advice available July 3.
SC Medicaid - SCDHHS · Identified Nov 3, 2026Medium impact
November 2026 Provider Payment Schedule and Provider Service Center Holiday Hours
South Carolina Healthy Connections Medicaid has adjusted claims submission deadlines and payment processing dates for November 2026 due to Veterans Day and Thanksgiving holidays. The practice must submit claims by Friday, November 6 at 5 p.m. for the November 13 payment date, and by Friday, November 20 at 5 p.m. for the November 27 payment date. The Provider Service Center will be closed on November 11 and November 26–27.
SC Medicaid - SCDHHS · Effective Jan 1, 2026Low impact
Medication Assistant Training Program
South Carolina is launching a new Medication Assistant Training Program (MATP) for unlicensed healthcare personnel in skilled nursing facilities, requiring 100 hours of training and certification. Applications for training programs will be accepted starting January 1, 2026, with detailed policies published in the Nursing Facility Services provider manual.
SC Medicaid - SCDHHS · Effective Jan 1, 2026Low impact
Social Security and Supplemental Security Income Cost-of-living Adjustment Increases and Rebudgeting of Cases
Effective January 1, 2026, Social Security and SSI benefits increased by 2.8% COLA, requiring nursing facilities and community residential care facilities to update member cost of care information through specific forms (MSC002/MSC004). Maximum facility payments increased to $1,719 and personal needs allowances increased by $2.
SC Medicaid - SCDHHS · Effective Oct 1, 2025Low impact
Updates to Adult Day Health Care Service Rates
South Carolina Medicaid is increasing the reimbursement rate for adult day health care services (HCPCS code S5102) from $72 to $80 per day for members in specific HCBS waiver programs. This rate increase applies only to Community Choices, Community Supports, and Intellectual Disability/Related Disabilities waiver participants.
SC Medicaid - SCDHHS · Effective Aug 1, 2025Low impact
Graduate Medical Education Physician Residency Incentive Program
South Carolina DHHS launched a new Graduate Medical Education Physician Residency Incentive Program providing financial incentives to hospitals that expand residency training in high-need specialties. This is an administrative program for hospitals to apply for funding, not a change to billing procedures or reimbursement rates for patient services.

Payer news

Network, contract and program news from the payers we track.

SC Medicaid - SCDHHS · Sep 15, 2026Payer news
SCDHHS Announces Year One FFY26 Rural Health Transformation Program Awards
SCDHHS has announced Year One FFY26 Rural Health Transformation Program (RHTP) awards totaling $167.3 million across 228 projects in South Carolina.
SC Medicaid - SCDHHS · Jul 31, 2026Payer news
SCDHHS Announces Rural Health Transformation Program Notices of Intent to Award
SCDHHS issued award determinations for 712 applications under the Rural Health Transformation Program (RHTP), a $200M+ CMS-funded initiative.
SC Medicaid - SCDHHS · May 8, 2026Payer news
SCDHHS Announces Rural Health Transformation Program FAQs
SCDHHS has published FAQs for the Rural Health Transformation Program grant opportunities, with applications now available on their website.
SC Medicaid - SCDHHS · Apr 2, 2026Payer news
SCDHHS Announces Rural Health Transformation Program Funding Opportunities
SCDHHS announced new grant funding opportunities through the Rural Health Transformation Program for eligible healthcare providers and organizations in South Carolina.

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Updates for Dental Services Rendered in an Ambulatory Surgical Center

Updates to the Durable Medical Equipment Services Manual

Medicaid Ordering, Referring and Prescribing Providers: Pharmacy Update

Rate Updates for State Plan Services and Home and Community-based Services

Updates to Clinic Services Manual

Updated Prior Authorization Expansion on Physician-administered Drugs

Prescriber Certification of Incontinence Form Update

Updated Prior Authorization Expansion on Physician-administered Drugs

Outpatient Hospital Drugs and Biologicals Payment Update

Provider Revalidation Updates

Updated Rehabilitative Behavioral Health Services and Licensed Independent Practitioners Provider Manuals

Updates to ASD Services Provider Manual

Updated Prior Authorization Expansion on Physician-administered Drugs

Updates to ASD Services Provider Manual

Medicaid Ordering, Referring and Prescribing (ORP) Providers Update

340B Drug Program Billing Policy Changes

Updated Billing Guidance for Hospital-based Crisis Stabilization Services

Medicaid Enrollment of Ordering, Referring and Prescribing (ORP) Providers and Collection of ORP Data

Physician-administered Drugs (PAD) Billing Guidance

Physician Services Provider Manual Updates

Addition of Intercept for Intensive In-home Services

Community Choices and HIV/AIDS 1915(c) Waiver Changes and Program Renewal Status

Updates to Rehabilitative Behavioral Health Services and Licensed Independent Practitioners Behavioral Health Services Provider Manuals

June-July 2026 Provider Payment Schedule and Provider Service Center Holiday Hours

Reminder to Protect Medicaid Enrollment Information

340B Drug Program Billing Policy Changes

Reminder-340B Drug Program Billing Policy Change

Updated Prior Authorization Expansion on Physician-administered Drugs

Pre-admission Screening and Resident Review Updates

Audiology Services Policy Updates

Dental Services Policy Updates

December 2025–January 2026 Provider Payment Schedule and Provider Service Center Holiday Hours

Rehabilitative Behavioral Health and Substance Use Services Rate Increases

Updated Prior Authorization Expansion on Physician-Administered Drugs

November 2025 Provider Payment Schedule and Provider Service Center Holiday Hours

Residential Habilitation Service Rate Increases for the Intellectual Disability/Related Disabilities and Head and Spinal Cord Injury Waivers

Inpatient Hospital Services Payment Methodology - Changes to the APR-DRGs Classification System

Update to Opioid Treatment Program Service Rates

Personal Needs Allowance Increase

Physician Services Provider Manual Updates

Autism Spectrum Disorder Services Provider Manual Update

Updated Prior Authorization Expansion on Physician-administered Drugs

Sunsetting of the Palmetto Coordinated System of Care Waiver

Home and Community-based Services Provider Manual Update

June-July 2025 Provider Payment Schedule and Provider Service Center Holiday Hours

November 2026 Provider Payment Schedule and Provider Service Center Holiday Hours

Medication Assistant Training Program

Social Security and Supplemental Security Income Cost-of-living Adjustment Increases and Rebudgeting of Cases

Updates to Adult Day Health Care Service Rates

Graduate Medical Education Physician Residency Incentive Program

Payer news

SCDHHS Announces Year One FFY26 Rural Health Transformation Program Awards ↗

SCDHHS Announces Rural Health Transformation Program Notices of Intent to Award ↗

SCDHHS Announces Rural Health Transformation Program FAQs ↗

SCDHHS Announces Rural Health Transformation Program Funding Opportunities ↗

SCDHHS Announces Year One FFY26 Rural Health Transformation Program Awards

SCDHHS Announces Rural Health Transformation Program Notices of Intent to Award

SCDHHS Announces Rural Health Transformation Program FAQs

SCDHHS Announces Rural Health Transformation Program Funding Opportunities