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                                                                                 Center for Connected Health Policy

           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    “Telemedicine is the use of medical information about a
            veterinary services, stating, “telemedicine is an audio,   patient that is exchanged from one site to another via
            video, or data communication of medical information.”   electronic communications to provide medical care to a
                                                               patient in circumstances in which face-to-face contact is
            Source: SC Code Annotated Sec. 40-69-20.           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. 180 (Jan. 1, 2015).

            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.
                                                               Eligible services must meet these requirements:


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM


                                                                   •   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.

                                                               Source: SC Health and Human Svcs. Dept. Physicians Provider
                                                               Manual, p. 180-182 (Jan. 1, 2015).

                                                               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. 115 (Jan. 1, 2015).

                                                               Distant site eligible, reimbursed providers:

                                                                   •   Physicians;
                                                                   •   Nurse practitioners.

                                                               Source: SC Health and Human Svcs. Dept. Physicians Provider
                                                               Manual, p. 169 (Jan. 1, 2015).
            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. 180-181 (Jan. 1, 2015).
            Remote Patient Monitoring Reimbursement

            No reference found.                                Please see “Comments” section below.
            Email/Phone/FAX
            No reference found.                                No reimbursement for email.
                                                               No reimbursement for telephone.
                                                               No reimbursement for FAX.

                                                               Source: SC Health and Human Svcs. Dept. Physicians Provider
                                                               Manual, p. 182-183 (Jan. 1, 2015).



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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Online Prescribing
            Prior to prescribing drugs to a patient, physicians first   No reference found.
            must establish a proper physician-patient relationship.
            Requirements are:

               •   Personally performing and documenting an
                   appropriate history and physical examination,
                   making a diagnosis, and formulating a
                   therapeutic plan;
               •   Discussing with the patient the diagnosis and
                   the evidence for it, and the risks and benefits of
                   various treatment options;
               •   Ensuring the availability of the physician or other
                   coverage for the patient for appropriate follow-
                   up care.

            Exceptions for prescribing for a patient whom the
            physician has not personally examined include, but are
            not limited to:

               •   Admission orders for a newly hospitalized
                   patient;
               •   Prescribing for a patient of another physician for
                   whom the prescriber is taking call;
               •   Prescribing for a patient examined by a licensed
                   advanced practice registered nurse, a physician
                   assistant or other authorized provider;
               •   Continuing medication on a short-term basis for
                   a new patient prior to the patient's first
                   appointment.

            Prescribing drugs to individuals the physician has never
            met based solely on answers to a set of questions, as is
            common in Internet or toll-free telephone prescribing, is
            prohibited.

            Source: SC Admin. Regulations Annotated Sec. 81-28.
            Consent

            No reference found.                                No reference found.
            Location
            No reference found.                                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.



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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               Source: SC Health and Human Svcs. Dept., Physicians Provider
                                                               Manual, p. 181 (Jan. 1, 2015).
            Cross-State Licensing

             No reference found.                               No reference found.
            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. 184 (Jan. 1, 2015).
            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.

                         The Bureau of Long Term Care Services offers Telemonitoring.  The objectives of the
                         Telemonitoring service are to maintain and promote the health status of Medicaid home and
                         community-based waiver participants through medical telemonitoring of body weight, blood pressure,
                         oxygen saturation, blood glucose levels, and basic heart rate information.

                         Source: SC Health and Human Svcs., Bureau of Long Term Care Services, <
                         https://www.scdhhs.gov/historic/insideDHHS/Bureaus/BureauofLongTermCareServices/doc/telemonitoring%20scop
                         e.pdf> Accessed Jul. 25, 2014.

                         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, https://www.scdhhs.gov/press-
                         release/obgyn-telemedicine-demonstration-project




























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