SECTION 33 - J02-DEPARTMENT OF HEALTH AND

HUMAN SERVICES

     33.1.     (DHHS: Recoupment/Restricted Fund)  The Department of Health and Human Services shall recoup all refunds and identified program overpayments and all such overpayments shall be recouped in accordance with established collection policy.  Further, the Department of Health and Human Services is authorized to maintain a restricted fund, on deposit with the State Treasurer, to be used to pay for liabilities and improvements related to enhancing accountability for future audits.  The restricted fund will derive from prior year program refunds.  The restricted fund shall not exceed one percent of the total appropriation authorization for the current year.  Amounts in excess of one percent will be remitted to the general fund.

     33.2.     (DHHS: Long Term Care Facility Reimbursement Rate)  The Department, in calculating a reimbursement rate for long term care facility providers, shall obtain for each contract period an inflation factor, developed by the Revenue and Fiscal Affairs Office.  Data obtained from Medicaid cost reporting records applicable to long term care providers will be supplied to the Revenue and Fiscal Affairs Office.  A composite index, developed by the Revenue and Fiscal Affairs Office will be used to reflect the respective costs of the components of the Medicaid program expenditures in computing the maximum inflation factor to be used in long term care contractual arrangements involving reimbursement of providers.  The Revenue and Fiscal Affairs Office shall update the composite index so as to have the index available for each contract renewal.

     The department may apply the inflation factor in calculating the reimbursement rate for the new contract period from zero percent up to the inflation factor developed by the Revenue and Fiscal Affairs Office.

     33.3.     (DHHS: Medical Assistance Audit Program Remittance)  The Department of Health and Human Services shall remit to the State Auditor’s Office an amount representing fifty percent (allowable Federal Financial Participation) of the cost of the Medical Assistance Audit Program as established in the State Auditor’s Office of the Budget and Control Board Section 102.  Such amount shall also include appropriated salary adjustments and employer contributions allocable to the Medical Assistance Audit Program.  Such remittance to the State Auditor’s Office shall be made monthly and based on invoices as provided by the State Auditor’s Office of the Budget and Control Board.

     33.4.     (DHHS: Third Party Liability Collection)  The Department of Health and Human Services is allowed to fund the net costs of any Third Party Liability and Drug Rebate collection efforts from the monies collected in that effort.

     33.5.     (DHHS: Medicaid State Plan)  Where the Medicaid State Plan has been altered to cover services that previously were provided by one hundred percent state funds, or that have been requested to be added by other state agencies, the department can bill other agencies for the state share of services provided through Medicaid.  In order to comply with Federal regulations regarding allowable sources of matching funds, state agencies are authorized to make appropriation transfers to the Department of Health and Human Services to be used as the state share when certified public expenditures are not allowed for those state agency Medicaid services.  The department will keep a record of all services affected and submit periodic reports to the Senate Finance and House Ways and Means Committees.

     33.6.     (DHHS: Medically Indigent Assistance Fund)  The department is authorized to expend disproportionate share funds to all eligible hospitals with the condition that all audit exceptions through the receipt and expenditures of these funds are the liability of the hospital receiving the funds.

     33.7.     (DHHS: Registration Fees)  The department is authorized to receive and expend registration fees for educational, training, and certification programs.

     33.8.     (DHHS: Fraud and Abuse Collections)  The Department of Health and Human Services may offset the administrative costs associated with controlling fraud and abuse.

     33.9.     DELETED

     33.10.   (DHHS: Medicaid Eligibility Transfer)  The South Carolina Department of Health and Human Services (DHHS) is hereby authorized to determine the eligibility of applicants for the South Carolina Medicaid Program in accordance with the State Plan Under Title XIX of The Social Security Act Medical Assistance Program.  The governing authority of each county shall provide office space and facility service for this function as they do for DSS functions under Section 43-3-65.

     33.11.   (DHHS: Franchise Fees Suspension)  Franchise fees imposed on nursing home beds and enacted by the General Assembly during the 2002 session are suspended.

     33.12.   (DHHS: Program Integrity Efforts)  The Department of Health and Human Services is instructed to expand its program integrity efforts by utilizing resources both within and external to the agency including, but not limited to, the ability to contract with other entities for the purpose of maximizing the department’s ability to detect and eliminate provider fraud.

     33.13.   (DHHS: Post Payment Review)  The department is directed to perform post payment reviews as permitted under Medicaid regulations to ensure compliance with the Hyde Amendment provisions as it relates to the performance of medically necessary services under the Medicaid program.  The results of such reviews shall be available to the General Assembly upon request in a format that meets the requirements of the Health Insurance Accountability and Portability Act (HIPAA) and Medicaid confidentiality regulations.

     33.14.   (DHHS: Long Term Care Facility Reimbursement Rates)  The department shall direct staff to complete and submit its Medicaid State Plan Amendment for long term care facility reimbursement rates to the Director of the Department of Health and Human Services by August first of each year.  The Director shall review the plan and submit to the Federal Government on or before August fifteenth of each year provided the State Appropriations Act has been enacted by that date.  All additional requests for information from CMS concerning the plan shall be promptly submitted to CMS by the Department of Health and Human Services.

     33.15.   (DHHS: Nursing Services to High Risk/High Tech Children)  The Department of Health and Human Services shall continue a separate classification and compensation plan for Registered Nurses (RN) and Licensed Practical Nurses (LPN) who provide services to Medically Fragile Children, who are Ventilator dependent, Respirator dependent, Intubated, and Parenteral feeding or any combination of the above.  The classification plan shall recognize the skill level that these nurses caring for these Medically Fragile Children must have over and above normal home-care or school-based nurses.

     33.16.   (DHHS: Medicaid Cost and Quality Effectiveness)  The Department of Health and Human Services shall establish a procedure to assess the various forms of health care delivery systems to measure cost effectiveness and quality.  These measures must be compiled on an annual basis on identifiable benchmarks.  These measures must broadly address agency program areas and initiatives using national and state measures.  Cost effectiveness shall be determined in an actuarially sound manner and data must be aggregated in a manner to be determined by a third party.  The methodology must use appropriate case-mix and actuarial adjustments.  The department shall issue an annual healthcare report of statewide measures deemed appropriate by the department required under state and federal guidelines.  The report shall be formatted in a clear, concise manner in order to be easily understood by Medicaid beneficiaries and other stakeholders.  The annual results of the cost effectiveness calculations, quality measures and the report cards shall be made public on the department’s website by December thirty-first for the prior state fiscal year.

     33.17.   (DHHS: SCHIP Enrollment and Recertification)  The Department of Health and Human Services shall enroll and recertify eligible children to the State Children’s Health Insurance Program (SCHIP) and must use available state agency program data housed in the Revenue and Fiscal Affairs Office, to include the Department of Social Services’ Food Stamp program and the Department of Education’s Free and Reduced Meal eligibility data.  Use of this data and cooperative efforts between state agencies reduces the cost of outreach and maintenance of eligibility for SCHIP.

     33.18.   (DHHS: Carry Forward)  The Department of Health and Human Services is authorized to carry forward cash balances from the prior fiscal year into the current fiscal year for any earmarked or restricted trust and agency, or special revenue account or subfund.  The department shall submit a comprehensive reporting of all cash balances brought forward from the prior fiscal year.  The report shall, at a minimum, for each account or subfund include the following: the statutory authority that allows the funds to be carried forward, the maximum authorized amount that can be carried forward, the general purpose or need for the carry forward, the specific source(s) of funding or revenue that generated the carry forward, and a detailed description of any pending obligations against the carry forward.  The report must be submitted to the President Pro Tempore of the Senate, Chairman of the Senate Finance Committee, Speaker of the House of Representatives, and Chairman of the House Ways and Means Committee, within fifteen days after the Comptroller General closes the fiscal year.

     33.19.   (DHHS: Medicaid Provider Fraud)  The department shall expand and increase its effort to identify, report, and combat Medicaid provider fraud.  The department shall publish on its’ agency homepage by April first, of the current fiscal year, the results of these efforts, the funds recovered, and information pertaining to prosecutions of such cases, including pleas agreements entered into.

     33.20.   DELETED

     33.21.   (DHHS: GAPS)  The requirements of Title 44, Chapter 6‑610 through Chapter 6-660 shall be suspended for the current state fiscal year.

     33.22.   (DHHS: Disproportionate Share - DMH)  For the current fiscal year, the department is directed to transfer funds to the Department of Mental Health to make up any shortfall in disproportionate share funding due to rule changes from the Center for Medicare and Medicaid Services from the latest federal fiscal year amount.  The department must also take any necessary action, including the submission of an amendment to the State Medicaid Plan, to minimize the impact of disproportionate share funding redistribution to the Department of Mental Health in future years.

     33.23.   DELETED

     33.24.   (DHHS: Contract Authority)  The Department of Health and Human Services is authorized to contract with community-based not-for-profit organizations for local projects that further the objectives of department programs.  The department shall develop policies and procedures and may promulgate regulations to assure compliance with state and federal requirements associated with the funds used for the contracts and to assure fairness and accountability in the award and administration of these contracts.  The department may require a match from contract recipients.  The department shall report to the Chairman of the Senate Finance Committee and the Chairman of the House Ways and Means Committees on the contracts administered.

     33.25.   DELETED

     33.26.   (DHHS: Medicaid Accountability and Quality Improvement Initiative)  From the funds appropriated and authorized to the Department of Health and Human Services, the department is authorized to implement the following accountability and quality improvement initiatives:

     (A)   Healthy Outcomes Initiative - The Department of Health and Human Services may tie Disproportionate Share Hospital (DSH) payments to participation in the Healthy Outcomes Initiative and may expand the program as DSH funding is available. 

     (B)    To improve community health, the department may explore various health outreach, education, patient wellness and incentive programs.  The department may pilot health interventions targeting diabetes, smoking cessation, weight management, heart disease, and other health conditions.  These programs may be expanded as their potential to improve health and lower costs are identified by the department. 

     (C)    Rural Hospital DSH Payment - Medicaid-designated rural hospitals in South Carolina may be eligible to receive up to one hundred percent of costs associated with uncompensated care as part of the DSH program.  Funds shall be allocated from the existing DSH program and shall not exceed $25,000,000 total funds.  To be eligible, rural hospitals must participate in reporting and quality guidelines published by the department and outlined in the Healthy Outcomes Initiative.  In addition to the requirements placed upon them by the department, rural hospitals must actively participate with the department and any other stakeholder identified by the department, in efforts to design an alternative health care delivery system in these regions.

     (D)   Primary Care Safety Net - The department shall implement a methodology to reimburse safety net providers participating in a hospital Healthy Outcomes Initiative program to provide primary care, behavioral health services, and pharmacy services for chronically ill individuals that do not have access to affordable insurance.  Qualifying safety net providers are approved, licensed, and duly organized Federally Qualified Health Centers (FQHCs, entities receiving funding under Section 330 of the Public Health Services Act, and FQHC Look‑A-Likes), Rural Health Clinics (RHCs), local alcohol and drug abuse authorities established by Act 301 of 1973, Free Clinics, other clinics serving the uninsured, and Welvista.  The department shall formulate a methodology and allocate at least $5,000,000 for innovative care strategies for qualifying safety net providers.  The department shall formulate a separate methodology and allocate at least $8,000,000 of funding to FQHCs at least $4,000,000 for documented capital needs for FQHCs , at least $2,000,000 for of funding for Free Clinics, and at least $2,000,000 of funding for local alcohol and drug abuse authorities created under Act 301 of 1973.

     (E)    Rural and Underserved Area Provider Capacity - The department shall incentivize the development of primary care access in rural and underserved areas through the following mechanisms:

              (1)    the department shall leverage Medicaid spending on Graduate Medical Education (GME) by implementing methodologies that support recommendations contained in the January 2014 report of the South Carolina GME Advisory Group;

              (2)    the department shall develop a program to leverage the use of teaching hospitals to provide rural physician coverage, expand the use of Telemedicine, and ensure targeted placement and support of OB/GYN services in at least four counties with a demonstrated lack of adequate OB/GYN resources by June 30, 2015; and

              (3)    during the current fiscal year the department shall contract with the MUSC Hospital Authority in the amount of $14,000,000 to lead the development and operation of an open access South Carolina Telemedicine Network.  Working with the department, the MUSC Hospital Authority shall collaborate with Palmetto Care Connections to pursue this goal.  No less than $2,000,000 of these funds shall be allocated toward support of Palmetto Care Connections and other hospitals in South Carolina.  MUSC Hospital Authority must provide the department with quarterly reports regarding the funds allocation and progress of telemedicine transformation efforts and networks.  MUSC Hospital Authority shall publish a summary report to the General Assembly indicating the overall progress of the state’s telemedicine transformation by March 1, 2015.  In addition, the department shall also contract with the MUSC Hospital Authority in the amount of $1,000,000 to further develop statewide teaching partnerships.

     (F)    To be eligible for funds in this proviso, providers must provide the department with patient, service and financial data to assist in the operation and ongoing evaluation of both the initiatives resulting from this proviso, and other price, quality, transparency and DSH accountability efforts currently underway or initiated by the department.  The Revenue and Fiscal Affairs Office shall provide the department with any information required by the department in order to implement this proviso in accordance with state law and regulations.

     (G)   The department shall publish quarterly reports on the agency’s website regarding the department’s progress in meeting the goals established by this provision.

     33.27.   (DHHS: Medicaid Healthcare Initiatives Outcomes)  Prior to February 15 of the current fiscal year, the Director of the Department of Health and Human Services shall make a presentation to the House Ways and Means Healthcare Budget Subcommittee on the outcomes of Medicaid healthcare initiatives enacted during the current fiscal year to improve the well being of persons enrolled in the Medicaid program and receiving services from Medicaid providers.

     33.28.   (DHHS: Medicaid Non-Emergency Medical Transportation)  The Department of Health and Human Services (department) shall procure transportation services upon the expiration of the current Medicaid non-emergency medical transportation contracts using a service model that maximizes efficiencies and cost effectiveness; improves health care outcomes; and improves member experience regarding quality and satisfaction in the Medicaid transportation program while using qualified transportation providers.

     The department shall develop the policies, procedures and transportation provider performance standards with input from stakeholders.  The department shall provide oversight of the implementation and operation.

     The department shall collect financial and utilization data and any other data necessary to continually monitor and evaluate the cost effectiveness and productivity of the transportation services provided.

     33.29.   (DHHS: Carry Forward Authorization)  For the current fiscal year, the Department of Health and Human Services is authorized to carry forward and expend any General Fund balances for the Medicaid program.  Within thirty days after the close of the fiscal year, the department shall report the balance carried forward to the Chairman of the Senate Finance Committee and the Chairman of the House Ways and Means Committee.

     33.30.   (DHHS: Healthy Connections Prime)  The Department of Health and Human Services is instructed to request from the Centers for Medicare and Medicaid Services, a delay in the July 1, 2014 implementation of its demonstration for dual eligible (Medicare/Medicaid) beneficiaries known as Healthy Connections Prime.  The requested date to begin enrollment will be no earlier than January 1, 2015.

     33.31.   DELETED

     33.32.   DELETED

     33.33.   (DHHS: Hospital Transformation Plans)  The Department of Health and Human Services shall develop and manage a program to help qualifying hospitals transition to more sustainable models of service delivery that meet the needs of their community and reduce reliance on inpatient admissions, surgery or high-tech diagnostics.  This includes encouraging new long-term partnerships between rural hospitals and community, tertiary and teaching facilities to ensure seamless, timely and high quality clinical care for patients in rural areas of the state.  Notwithstanding the provisions in its existing regulations, for the current fiscal year, the Department of Health and Environmental Control, may in its discretion, make exceptions to applicable licensing standards and regulations where it is determined that the exception will assist in the successful implementation and operation of the plans developed by the Department of Health and Human Services pursuant to this provision; the health, safety, and well-being of the community will not be compromised by the exception; and provdied that the standard is not specifically required by statute.  The program shall provide funding that fully or partially offsets the one-time costs of these transitions.  The department shall develop the methodology for funding award amounts and distribution and may prioritize funding to target hotspots of poor health and/or limited health care access.  Total state funds available statewide for transition funding shall not exceed $15,000,000 and the department shall leverage federal funds or other funding mechanisms to maximize resources as appropriate and approved by CMS.  The department shall provide reports detailing progress on transformation efforts to the Chairman of the Senate Finance Committee and the Chairman of the House Ways and Means Committee by January 1, 2015 and by June 1, 2015.

     33.34.   (DHHS: Armed Services Home and Community-Based Waiver)  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 member is stationed.  Consequently, a person on a waiver waiting list would return to the same place on the waiting list when the family returns to South Carolina.  Furthermore, the eligible family member previously enrolled in a waiver program and who received active services would be reinstated into the waiver program once Medicaid eligibility is established, upon their return to South Carolina.  It is not the intent of this provision to authorize services provided outside the South Carolina Medicaid Service Area.  These provisions are contingent upon the department receiving federal approval.

     33.35.   (DHHS: Child Support Enforcement System)  The department shall transfer up to three million dollars to the Department of Social Services for the development of the Child Support Enforcement System.  These funds cannot be used to pay any litigation cost associated with the development of this system.