South Carolina State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

South Carolina Medicaid

South Carolina
Medicaid Program: South Carolina Medicaid

Medicaid Program Administrator: South Carolina Health and Human Services Dept.

Regional Telehealth Resource Center:

Southeast Telehealth Resource Center
PO Box 1408

Waycross, GA 31501
(888) 138-7210
www.setrc.us

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

South Carolina law addresses telemedicine under veterinary services, stating, “telemedicine is an audio, video, or data communication of medical information.”

Source: SC Code Annotated Sec. 40-69-20.

Telemedicine’ means the practice of medicine using electronic communications, information technology, or other means between a licensee in one location and a patient in another location with or without an intervening practitioner.

Source: SC Code Annotated Sec. 40-47-20(52).

“Telemedicine is the use of medical information about a patient that is exchanged from one site to another via electronic communications to provide medical care to a patient in circumstances in which face-to-face contact is not necessary.

In this instance, a physician or other qualified medical professional has determined that medical care can be provided via electronic communication with no loss in the quality or efficacy of the care.

Electronic communication means the use of interactive telecommunication equipment that typically includes audio and video equipment permitting two-way, real-time interactive communication between the patient and the physician or practitioner at the referring site. Telemedicine includes consultation, diagnostic, and treatment services.”

Source: SC Health and Human Svcs. Dept., Physicians Provider Manual, p. 2-54 (Aug. 2017) & Local Education Manual, p. 2-43. (Sept. 2017).

Live Video Reimbursement

No reference found. South Carolina Medicaid will reimburse for live
telemedicine and tele-psychiatry.
Eligible services:
Office or other outpatient visits;
Inpatient consultation;
Individual psychotherapy;
Pharmacologic management;
Psychiatric diagnostic interview examination and
testing;
Neurobehavioral status examination;
Electrocardiogram interpretation and report only;
Echocardiography.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Eligible services must meet these requirements:
The medical care is individualized, specific, and
consistent with symptoms or confirmed
diagnosis of the illness or injury under
treatment, and not in excess of the beneficiary’s
need;
The medical care can be safely furnished, and
no equally effective and more conservative or
less costly treatment is available statewide.
Distant site eligible, reimbursed providers:
Physicians;
Nurse practitioners.
Physician Assistants
Services provided by allied health professionals are not
covered.
Referring site presenters may be required to facilitate
the delivery of the service.
Source: SC Health and Human Svcs. Dept. Physicians Provider
Manual, p. 2-56 (Oct. 2017) & Local Education Manual, p. 2-43 to
2-47. (Sept. 2017).
These community mental health services are ineligible:
Injectables;
Nursing services;
Crisis intervention
Individual, family, group and multiple family
psychotherapy
Psychological testing which require “hands-on”
encounters;
Mental health assessment by non-physician;
and
Service Plan Development.
Source: SC Health and Human Svcs. Dept. Community Mental
Health Services Provider Manual, p. 2-126 (Jan. 1, 2017).

Store and Forward Reimbursement

No reference found. South Carolina Medicaid will not reimburse for store and
forward due to the requirement that the beneficiary must
be present and participating in the visit.
Source: SC Health and Human Svcs. Dept. Physicians Provider
Manual, p. 2-56 (Oct. 2017) & Local Education Manual, p. 2-43 to
2-47. (Sept. 2017).

Remote Patient Monitoring Reimbursement

No reference found. Medicaid Home Again Program for Community Long
Term Care.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Medical telemonitoring will be of body weight, blood
pressure, oxygen saturation, blood glucose levels, and
basic hear rate information, at a minimum. Providers
must meet certain conditions to participate.
Community Choices waiver participants must meet the
following criteria to participate:
Have a primary diagnosis of Insulin Dependent
Diabetes Mellitus, Hypertension, Chronic
Obstructive Pulmonary Disease and/or
Congestive Heart Failure; and
History of at least two hospitalizations and/or
emergency room visits in the past 12 months;
and
Have a primary care physician that approves the
use of telemonitoring service and is solely
responsible for receiving and acting upon the
information received via the service; and
Be capable of using the telemonitoring
equipment and transmitting the necessary data
or have an individual available to do so.
Services to be provided:
Unit of service is one day of direct
telemonitoring provided to/for a participant in the
participant’s place of residence.
The equipment must record at a minimum body
weight, blood pressure, oxygen saturation,
blood glucose, and basic heart rate information.
Data must be transmitted electronically and any
transmission costs shall be incurred by the
provider of the telemonitoring service.
Daily reimbursement rate is inclusive of
monitoring of data, charting data from the
monthly monitoring, visits or calls made to follow
up with the participants and/or caregiver, phone
calls made to primary care physician(s), all
installation of the equipment in the home and
training on the equipment’s use and care in the
home, including equipment removal.
Provider shall provide telemonitoring service
seven days per week for authorized time period.
Other requirements on staffing, background checks,
installation and equipment are required.
Source: SC Health and Human Svcs. Dept. Community Long Term
Care Provider Manual, p. 6-170 (Oct. 2017).

Email/Phone/FAX

No reference found. No reimbursement for email.
No reimbursement for telephone.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

No reimbursement for FAX.
No reimbursement for video cell phone interactions.
Source: SC Health and Human Svcs. Dept. Physicians Provider
Manual, p. 2-56 (Aug. 2017) & Local Education Manual, p. 2-43 to
2-47. (Sept. 2017).

Online Prescribing

A licensee shall not establish a physician-patient No reference found.
relationship by telemedicine for the purpose of
prescribing medication when an in-person physical
examination is necessary for diagnosis.
Schedule II and Schedule III prescriptions are not
permitted except for those Schedule II and Schedule III
medications specifically authorized by the board, which
may include, but not be limited to, Schedule II-
nonnarcotic and Schedule III-nonnarcotic medications.
To establish a physician-patient relationship via
telemedicine, the provider must:
Comply with HIPAA
Adhere to current standards of practice
Provide an appropriate examination
Verify the identity and location of the patient
Establish a diagnosis through the use of
accepted medical practices
Ensure availability of follow-up care
Prescribe within a practice setting fully in
compliance with the law.

Schedule II and III prescriptions are not permitted except

as specifically authorized by the board.

Source: SC Code Annotated Sec. 40-47-37.

Consent

No reference found. No reference found.

Location

No reference found. Referring sites (also known as originating sites) must be
located in the South Carolina Medical Service Area.
Eligible originating (referring) sites:
• Practitioner offices;
• Hospitals (inpatient and outpatient);
• Rural Health Clinics;
• Federally Qualified Health Centers;
• Community Mental Health Centers.
Distant (consultant) sites must be located in the SC
Medical Service Area, which is the state of SC and
areas in NC and GA within 25 miles of the SC border.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: SC Health and Human Svcs. Dept., Physicians Provider

Manual, p. 2-54 & 2-55 (Oct. 2017) & Local Education Manual, p. 2-
43 to 2-47. (Sept. 2017).

Cross-State Licensing

The physician must be licensed in South Carolina, No reference found.
however they do not need to reside in South Carolina.

Private Payers

No reference found. No reference found.

Site/Transmission Fee

No reference found. The referring site is eligible to receive a facility fee.
Source: SC Health and Human Svcs. Dept., Physicians Provider
Manual, p. 2-58 (Oct. 2017) & Local Education Manual, p. 2-43 to
2-47. (Sept. 2017).

Miscellaneous

Comments: In 2011, a new state law, SCSB 588, established a statewide system of stroke care. It requires the Department of Health and Environmental Control to distribute to emergency medical services providers a list of primary stroke centers, telemedicine stroke centers, and other certified programs.

Effective July 1, 2014 the South Carolina Department of Health and Human Services will implement a project to leverage the use of teaching hospitals to provide rural physician coverage, expand the use of telemedicine, and ensure targeted placement and support of adequate OB/GYN services.

Source: South Carolina Healthy Connections Medicaid, Provider Alert

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