Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

Practitioner Services

Prescription Drugs

Physical Therapy and Other Services

Products and Devices

Transportation Services

Other Services

Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: South Carolina (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes	$2/episode of care			Fee for service	CN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes	$2/visit			Fee for service	CN
Federally Qualified Health Center Services
Yes	$2/encounter		12 visits/year, visits count toward physician visit limit	Prospective cost based rate/visit or cost based payment	CN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes	$25/admission			Prospective payment/discharge using DRG or prospective per diem	CN
Outpatient Hospital Services
Yes	$3/non-emergency visit in ER			Fee for service	CN
Rehabilitation Services: Mental Health and Substance Abuse
Yes			Centers must be state-approved	Fee for service	CN
Rural Health Clinic Services
Yes	$2/encounter		12 visits/year, visits count toward physician visit limit	Prospective cost based rate/visit or cost based payment	CN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes				Fee for service, at 90% of anesthesiologist rate	CN
Chiropractor Services
Yes	$1/visit			Fee for service	CN
Dental Services
Yes	$3/visit		Limited to trauma care and emergency treatment for relief of pain and infection	Fee for service	CN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes				Fee for service	CN
Nurse Midwife Services
Yes	$2/visit - applicable to specified E&M services only			Fee for service	CN
Nurse Practitioner Services
Yes	$2/visit - applicable to specified E&M services only		12 visits/year, visits count toward physician visit limit	Fee for service at 80% of physician fee	CN
Optometrist Services
Yes	$2/visit - applicable to specified E&M services only		1 refractive exam/year	Fee for service	CN
Physician Services
Yes	$2/visit - applicable to specified E&M services only		12 visits/year including visits and services provided by other specified practitioners	Fee for service	CN
Podiatrist Services
Yes	$1/visit		12 visits/year, visits count toward physician visit limit	Fee for service	CN
Psychologist Services
No
Prescription Drugs
Prescription Drugs
Yes	$3/Rx		4 Rxs/month or up to 10 Rxs/month with defined overrides	AWP-10%, plus $4.05 dispensing fee for traditional pharmacies and $3.15 dispensing fee for non-traditional pharmacies	CN
Physical Therapy and Other Services
Occupational Therapy Services
No
Physical Therapy Services
No
Services for Speech, Hearing and Language Disorders
No
Products and Devices
Dentures
No
Eyeglasses
Yes		Yes	Limited to post-cataract, retinal, corneal or glaucoma surgery lenses and eyeglasses	Most products provided by state's volume purchase contractor, dispensing provider paid fee for service	CN
Hearing Aids
Yes	$3/day		Specified criteria relative to disability and/or care setting must be met	Most products provided by state's volume purchase contractor	CN
Medical Equipment and Supplies
Yes	$3/provider/day			Fee for service using a percentage of Medicare payment rates as a ceiling	CN
Prosthetic and Orthotic Devices
Yes	$3/provider/day			Fee for service using Medicare payment ceilings	CN
Transportation Services
Ambulance Services
Yes				Fee for service	CN
Non-Emergency Medical Transportation Services
Yes				See service-specific FN	CN
Other Services
Diagnostic, Screening and Preventive Services
Yes			Limited to preventive services only	Fee for service	CN
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes				Fee for service	CN
Targeted Case Management
Yes				Cost based payment	CN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes			Services for the following populations: 1, 2, 3, 4, 5, 6 & 8 - See service-specific FN	Dependent upon the services provided	CN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes	$2/visit, medical supplies are exempt from copayments		75 nursing, home health aide and therapy visits/year	Cost based payment using Medicare upper limits for visits, med supplies paid at 50th percentile of Medicare allowable charge	CN
Hospice Care
Yes			Two 90-day periods and one 30-day period with additional periods as necessary	Prospective rates based on Medicare methodology	CN
Personal Care Services
No
Private Duty Nursing Services
No
Program of All-Inclusive Care for the Elderly
Yes			See service-specific FN	Capitated payment	CN
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes			10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year	Prospective cost based per diem	CN
Inpatient Psychiatric Services, under age 21
Yes		Admission	Limited to residential treatment facilities	Prospective cost based per diem with limits	CN
Intermediate Care Facility Services for the Mentally Retarded
Yes			10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year, additional days allowed for approved rehab programs or transition to community placement	Cost based payment	CN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes			10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year, additional days allowed for approved rehab programs or transition to community placement	Prospective per diem based on cost using peer groups and assuming 96% occupancy, low volume facilities paid statewide average rate	CN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: This State has added the optional Medicaid buy-in group of disabled adults permissible through the Balanced Budget Act of 1997. These beneficiaries are allowed to continue Medicaid coverage, and receive full benefits, if their income is at or below 250 percent of the federal poverty level (FPL). Any identified copayment requirements are applicable to beneficiaries age 19 and older.