reglab/statecodes huggingface dataset:
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-10. Creation of commission; members; term; conflict of interests.

There is created the State Department of Health and Human Services which shall be headed by a Director appointed by the Governor, upon the advice and consent of the Senate. The director is subject to removal by the Governor pursuant to the provisions of Section 1-3-240.
HISTORY: 1983 Act No. 83 Section 2; 1993 Act No. 181, Section 1039.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-30. Duties and limitations.

The department shall:
(1) administer Title XIX of the Social Security Act (Medicaid), including the Early Periodic Screening, Diagnostic and Treatment Program, and the Community Long-Term Care System;
(2) be designated as the South Carolina Center for Health Statistics to operate the Cooperative Health Statistics Program pursuant to the Public Health Services Act;
(3) be prohibited from engaging in the delivery of services.
HISTORY: 1983 Act No. 83 Section 2; 1993 Act No. 181, Section 1040; 2004 Act No. 263, Section 15.A, eff June 18, 2004.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-35. Medicaid waiver protections.

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 section to authorize services provided outside the South Carolina Medicaid Service Area. These provisions are contingent upon the department receiving federal approval.
HISTORY: 2014 Act No. 289 (S.825), Pt III, Section 3, eff June 23, 2014.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-40. Duties.

For all health and human services interagency programs provided for in this chapter, the department shall have the following duties:
(1) Prepare and approve state and federal plans prior to submission to the appropriate authority as required by law for final approval or for state or federal funding, or both.
Such plans shall be guided by the goal of delivering services to citizens and administering plans in the most effective and efficient ways possible.
(2) Compile and maintain in a unified, concise, and orderly form information concerning programs provided for in this chapter.
(3) Continuously review and evaluate programs to determine the extent to which they:
(a) meet fiscal, administrative, and program objectives; and
(b) are being operated cost effectively.
(4) Evaluate plans and programs in terms of their compatibility with state objectives and priorities giving specific attention to areas outlined in Section 44-6-70.
(5) Formulate for consideration and promulgation criteria, standards, and procedures that ensure assigned programs are administered effectively, equitably, and economically and in accordance with statewide policies and priorities.
(6) Inform the Governor and the General Assembly as to the effectiveness of the criteria, standards, and procedures promulgated pursuant to item (5) of this section.
(7) Develop in conjunction with other state agencies an information system to provide data on comparative client and fiscal information needed for programs.
(8) Develop a mechanism for local planning.
(9) Obtain from participating state agencies information considered necessary by the department to perform duties assigned to the department.
HISTORY: 1983 Act No. 83 Section 2; 1993 Act No. 181, Section 1041.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-45. Authority of commission to collect administrative fees associated with accounts receivable for those individuals or entities which negotiate repayment to agency.

The State Department of Health and Human Services may collect administrative fees associated with accounts receivable for those individuals or entities which negotiate repayment to the agency. The administrative fee may not exceed one and one-half percent of the amounts negotiated and must be remitted to the State Treasurer and deposited to the credit of the general fund of the State.
HISTORY: 1988 Act No. 658, Part II, Section 33; 1993 Act No. 181, Section 1042.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-50. Contracts with other agencies; program monitoring.

In carrying out the duties provided for in Section 44-6-30 the department shall:
(1) Contract for health and human services eligibility determination with performance standards regarding quality control as required by law or regulation.
(2) Contract for operation of certified Medicaid management information claims processing system. For the first year of its operation it shall contract for such system with the Department of Social Services.
(3) Contract for other operational components of programs administered under this chapter as considered appropriate.
(4) Monitor and evaluate all contractual services authorized pursuant to this chapter to assure effective performance. Any contract entered into under the provisions of this chapter must be in accordance with the provisions of the South Carolina Consolidated Procurement Code.
(5) Establish a procedure whereby inquiries from members of the General Assembly concerning the department's work and responsibility shall be answered as expeditiously and definitely as possible.
HISTORY: 1983 Act No. 83 Section 2; 1993 Act No. 181, Section 1043; 1995 Act No. 41, Section 1.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-70. Preparation of state plan and resource allocation recommendations.

A state plan must be prepared by the department for each program assigned to it and the department must also prepare resource allocation recommendations based on such plans. The resource allocation recommendations must be approved pursuant to state and federal law. The state plans must address state policy and priority areas of service with specific attention to the following objectives:
(a) Prevention measures as addressed in health and human services programs.
(b) Achievement of a balanced health care delivery system assuring that regulations, coverage, and reimbursement policies assure that while the most appropriate care is given, tailored to the client's needs, it is delivered in the most cost-effective manner.
(c) Simplification of paperwork requirements.
(d) Achievement of optimum cost effectiveness in administration and delivery of services provided quality of care is assured.
(e) Improvement of effectiveness of third party reimbursement efforts.
(f) Assurance of maximum utilization of private and nonprofit providers in administration and service delivery systems, provided quality of care is assured.
(g) Encouragement of structured volunteer programs in administration and service delivery.
HISTORY: 1983 Act No. 83 Section 2; 1993 Act No. 181, Section 1044.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-80. Annual and interim reports.

The department must submit to the Governor, the State Fiscal Accountability Authority, Revenue and Fiscal Affairs Office, and the Executive Budget Office, and the General Assembly an annual report concerning the work of the department including details on improvements in the cost effectiveness achieved since the enactment of this chapter and must recommend changes for further improvements.
Interim reports must be submitted as needed to advise the Governor and the General Assembly of substantive issues.
HISTORY: 1983 Act No. 83 Section 2; 1993 Act No. 181, Section 1045.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-90. Promulgation of regulations; other agencies to cooperate with commission.

The department may promulgate regulations to carry out its duties.
All state and local agencies whose responsibilities include administration or delivery of services which are covered by this chapter shall cooperate with the department and comply with its regulations.
HISTORY: 1983 Act No. 83 Section 2; 1993 Act No. 181, Section 1046.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-100. Personnel of commission; duties; compensation.

The department employees shall have such general duties and receive such compensation as determined by the director. The director shall be responsible for administration of state personnel policies and general department personnel policies. The director shall have sole authority to employ and discharge employees subject to such personnel policies and funding available for that purpose.
In all instances, the director shall serve as the chief administrative officer of the department and shall have the responsibility of executing policies, directives, and actions of the department either personally or by issuing appropriate directives to the employees.
The goal of the provisions of this section is to ensure that the department's business is conducted according to sound administrative practice, without unnecessary interference with its internal affairs. Public officers and employees shall be guided by this goal and comply with these provisions.
HISTORY: 1983 Act No. 83, Section 2; 1993 Act No. 181, Section 1047.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-110. Medicaid providers; boundary clarification.

A Medicaid provider, outside of the geographical boundary of South Carolina but within the South Carolina Medicaid Service Area, as defined by R. 126-300(B) of the Code of State Regulations, prior to the effective date of the amendments to Section 1-1-10, which are effective January 1, 2017, shall not lose status as a Medicaid provider as a result of the clarification of the South Carolina-North Carolina border.
HISTORY: 2016 Act No. 270 (S.667), Section 19, eff January 1, 2017.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-115. Covered Medicaid pharmacy services.

(A) Pharmacy services are a benefit under South Carolina Medicaid, subject to approval by the federal Centers for Medicare and Medicaid Services. The department shall establish a fee schedule for the list of pharmacy services.
(B)(1) The following services are covered pharmacy services that may be provided to a Medicaid beneficiary:
(a) dispensing self-administered hormonal contraceptives, as outlined and authorized in Section 40-43-230; and
(b) administering injectable hormonal contraceptives, as outlined and authorized in Section 40-43-230.
(2) Covered pharmacy services shall be subject to department protocols and utilization controls.
(C) A pharmacist shall be enrolled as an ordering, referring, and dispensing provider under the Medicaid program prior to rendering a pharmacist service that is submitted by a Medicaid pharmacy provider for reimbursement pursuant to this section.
(D) The director of the department shall seek any necessary federal approvals to implement this section. This section shall not be implemented until the necessary federal approvals are obtained and shall be implemented only to the extent that federal financial participation is available.
(E) This section does not restrict or prohibit any services currently provided by pharmacists as authorized by law including, but not limited to, this chapter or the Medicaid state plan.
HISTORY: 2022 Act No. 210 (S.628), Section 3, eff November 16, 2022.
Editor's Note
2022 Act No. 210, Sections 1, 4, and 6, provide as follows:
"SECTION 1. This act shall be referred to as the 'Pharmacy Access Act'."
"SECTION 4. The Board of Medical Examiners and the Board of Pharmacy must issue a written joint protocol pursuant to Section 40-43-240 not later than six months after the passage of this act."
"SECTION 6. Except as otherwise specifically provided, this act takes effect upon the issuance of a written joint protocol pursuant to SECTION 4 of this act."
The written joint protocol was issued on November 16, 2022.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-132. Legislative findings and intent.

The General Assembly finds that:
(1) There are citizens who cannot afford to pay for hospital care because of inadequate financial resources or catastrophic medical expenses.
(2) Rising health care costs and the growth of the medically indigent population have increased the strains on the health care system with a growing burden on the hospital industry, health insurance companies, and paying patients.
(3) This burden has affected businesses, which are large purchasers of health care services through employee insurance benefits, and taxpayers in counties which support public hospitals, and it causes the cost of services provided to paying patients to increase in a manner unrelated to the actual cost of services delivered to them.
(4) Hospitals which provide the bulk of unreimbursed services cannot compete economically with hospitals which provide relatively little care to indigent persons.
(5) Because of the complexity of the health care system, any effort to resolve the problem of paying for care for medically indigent persons must be multifaceted and shall include at least four general principles:
(a) Funds must be made available to assure continued access to quality health care for medically indigent patients.
(b) Cost containment measures and competitive incentives must be placed into the health care system along with the additional funds.
(c) The cost of providing indigent care must be equitably borne by the State, the counties, and the providers of care.
(d) State residents must be guaranteed access to emergency medical care regardless of their ability to pay or county of residence.
It is the intent of the General Assembly to:
(1) assure care for the largest possible number of its medically indigent citizens within funds available by:
(a) expanding the number of persons eligible for Medicaid services, using additional state and county funds to take advantage of matching federal funds;
(b) creating a fund based on provider and local government contributions to provide medical assistance to those citizens who do not qualify for Medicaid or any other government assistance and who do not have the means to pay for hospital care; and
(c) mandating access to emergency medical care for all state residents in need of the care;
(2) Provide incentives for cost containment to providers of care to indigent patients by implementing a prospective payment system in the Medicaid and Medically Indigent Assistance Fund programs;
(3) monitor efforts to foster competition in the health care market place while being prepared to make adjustments in the system through regulatory intervention if needed;
(4) promote market reforms, as the single largest employer in the State, by structuring its health insurance program to encourage healthy lifestyles and prudent use of medical services; and
(5) reduce where possible or maintain the current rate schedules of hospitals to keep costs from escalating.
HISTORY: 1985 Act No. 201, Part II, Section 19 (preamble).
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-140. Medicaid hospital prospective payment system; cost containment measures.

(A) To provide cost containment incentives for providers of care to Medicaid recipients, the department shall convert the Medicaid hospital reimbursement system from a retrospective payment system to a prospective payment system by October 1, 1985. The prospective payment system includes, at a minimum, the following elements:
(1) a maximum allowable payment amount established for individual hospital products, services, patient diagnoses, patient day, patient admission, or per patient, or any combination thereof. This payment must be based on hospital costs rather than hospital charges and must be adjusted at least every two years to reflect the most recent audited cost data available. The department shall set by regulation those circumstances under which a hospital may seek an exception. The maximum allowable payment amount must be weighted to allow for the costs of medical education and primary, secondary, or tertiary care considerations;
(2) payment on a timely basis to the hospital by the commission or patient or both, of the maximum allowable payment amount determined by the commission; and
(3) acceptance by the hospital of the maximum payment amount as payment in full, which includes any deductible or copayment provided for in the state Medicaid program.
(B) The department shall at the same time implement other cost containment measures which include, but are not limited to:
(1) utilization reviews for appropriateness of treatment and length of stay;
(2) preadmission certification of nonemergency admissions;
(3) mandatory outpatient surgery in appropriate cases;
(4) a second surgical opinion pilot study; and
(5) procedures for encouraging the use of outpatient services.
The department, to the fullest extent possible, shall utilize information required in this subsection in the form hospitals are presently submitting the information to other governmental agencies or in the form hospitals are presently utilizing the information within the hospital.
HISTORY: 1985 Act No. 201, Part II, Section 19C; 1989 Act No. 189, Part II, Section 35A; 1993 Act No. 181, Section 1048.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-146. County assessments for indigent medical care; penalties for failure to pay assessments in timely manner.

(A) Every fiscal year the State Treasurer shall withhold from the portion of the Local Government Fund allotted to the counties a sum equal to fifty cents per capita based on the population of the several counties as shown by the latest official census of the United States. The money withheld by the State Treasurer must be placed to the credit of the commission and used to provide Title XIX (Medicaid) services.
(B) County governments are assessed an additional thirteen million dollars annually for use as matching funds for Medicaid services. Of these funds, seven and a half million dollars must be deposited into the Medicaid Expansion Fund created by Section 44-6-155.
The department shall assess each county its share of the thirteen million dollars based on a formula which equally weighs the following factors in each county: property value, personal income, net taxable sales, and the previous two years of claims against the medically indigent assistance fund or program against county residents. If a trust fund has been established in a county to fund indigent care in the county, contributions on behalf of the county must be credited against the county assessment.
(C) Within thirty days of the first day of the state's fiscal year, and on the first day of the other three quarters, each county shall remit one-fourth of its total assessment to the department. The department shall allow a brief grace period during which late payments are not subject to interest or penalty.
Any county which fails to pay its assessment within the time allotted must pay, in addition to the assessment, a penalty of five percent of the assessment and interest at one and one-half percent per month from the date the assessment was originally due to the date of the payment of the assessment and penalty. The department may in its discretion waive or reduce the penalty or interest or any part thereof.
HISTORY: 1989 Act No. 189, Part II, Section 35B; 1991 Act No. 171, Part II, Section 22K; 1993 Act No. 181, Section 1049.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-155. Medicaid Expansion Fund.

(A) There is created the Medicaid Expansion Fund into which must be deposited funds:
(1) collected pursuant to Section 44-6-146;
(2) collected pursuant to Section 12-23-810; and
(3) appropriated pursuant to subsection (B).
This fund must be separate and distinct from the general fund. These funds are supplementary and may not be used to replace general funds appropriated by the General Assembly or other funds used to support Medicaid. These funds and the programs specified in subsection (C) are exempt from any budgetary cuts, reductions, or eliminations caused by the lack of general fund revenues. Earnings on investments from this fund must remain part of the separate fund and must not be deposited in the general fund.
(B) The department shall estimate the amount of federal matching funds which will be spent in the State during the next fiscal year due to the changes in Medicaid authorized by subsection (C). Based on this estimate, the General Assembly shall appropriate to the Medicaid Expansion Fund state funds equal to the additional state revenue generated by the expenditure of these federal funds.
(C) Monies in the fund must be used to:
(1) provide Medicaid coverage to pregnant women and infants with family incomes above one hundred percent but below one hundred eighty-five percent of the federal poverty guidelines;
(2) provide Medicaid coverage to children aged one through six with family income below federal poverty guidelines;
(3) provide Medicaid coverage to aged and disabled persons with family income below federal poverty guidelines;
(4) [reserved];
(5) [reserved];
(6) [reserved];
(7) provide up to two hundred forty thousand dollars to reimburse the Revenue and Fiscal Affairs Office and hospitals for the cost of collecting and reporting data pursuant to Section 44-6-170;
(8) [reserved].
(D) Any funds not expended for the purposes specified in subsection (C) during a given year are carried forward to the succeeding year for the same purposes.
HISTORY: 1989 Act No. 189, Part II, Section 35D; 1991 Act No. 105, Sections 4, 5; 1993 Act No. 130, Section 2; 1993 Act No. 181, Section 1051; 1998 Act No. 419, Part II, Section 41C.
Code Commissioner's Note
Pursuant to the directive to the Code Commissioner in 2018 Act No. 246, Section 10, "Revenue and Fiscal Affairs Office" was substituted for all references to "Office of Research and Statistics of the Revenue and Fiscal Affairs Office".
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-160. Target rate of increase for net inpatient charges; excessive increases; penalties.

(A) By August first of each year, the department shall compute and publish the annual target rate of increase for net inpatient charges for all general hospitals in the State. The target rate of increase will be established for a twelve-month period from October first through September thirtieth of the following year. Once established, the target rate of increase must not be amended during the year except as provided in subsection (B) of this section. The department shall monitor the performance of the hospital industry to contain costs, specifically as evidenced by the annual rate of growth of net inpatient charges. If the department determines that the annual rate of increase in net inpatient charges for the hospital industry has exceeded the target rate of increase established for that year, the department shall appoint an expert panel for the purpose of analyzing the financial reports of each hospital whose net inpatient charges exceeded the target rate of increase. The panel's review shall take into consideration service volume, intensity of care, and new services or facilities. The panel shall consist of at least three members who have broad experience, training, and education in the field of health economics or health care finance. The panel shall report its findings and recommendations, including recommended penalties or sanctions, to the department. The department shall decide what, if any, penalty it will impose within three months of receiving all necessary data.
(B) The department may impose penalties or sanctions it considers appropriate. Penalties must be prospective. Financial penalties are limited to a reduction in a hospital's target rate of increase for the following year. Any reduction in a hospital's target rate of increase for the next year must not be greater than the amount the hospital exceeded the industry's target rate of increase for the previous year. Once a hospital is sanctioned, it must be reviewed annually until it succeeds in remaining below its target rate of increase.
HISTORY: 1985 Act No. 201, Part II, Section 19C; 1989 Act No. 189, Part II, Section 35E and K; 1993 Act No. 181, Section 1052.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-175. Repealed.

HISTORY: Former Section, titled Annual reports to be provided to Office of Research and Statistics of the Revenue and Fiscal Affairs Office, had the following history: 1994 Act No. 485, Section 1. Repealed by 2018 Act No. 246, Section 9, eff July 1, 2018.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-180. Confidentiality of patient records; controlled dissemination of data; violations and penalties.

(A) Patient records received by counties, the department, or other entities involved in the administration of the program created pursuant to Section 44-6-150 are confidential. Patient records gathered pursuant to Section 44-6-170 are also confidential. The Revenue and Fiscal Affairs Office shall use patient-identifiable data collected pursuant to Section 44-6-170 for the purpose of linking various data bases to carry out the purposes of Section 44-6-170. Linked data files must be made available to those agencies providing data files for linkage. No agency receiving patient-identifiable data collected pursuant to Section 44-6-170 may release this data in a manner such that an individual patient or provider may be identified except as provided in Section 44-6-170. Nothing in this section may be construed to limit access by a submitting provider or its designee to that provider's information.
(B) A person violating this section is guilty of a misdemeanor and, upon conviction, must be fined not more than five thousand dollars or imprisoned not more than one year, or both.
HISTORY: 1985 Act No. 201, Part II, Section 19C; 1989 Act No. 189, Part II, Section 35G; 1993 Act No. 130, Section 4; 1993 Act No. 181, Section 1054.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-190. Applicability of Administrative Procedures Act; compliance with Medicaid disclosure rules.

The department may promulgate regulations pursuant to the Administrative Procedures Act. Appeals from decisions by the department are heard pursuant to the Administrative Procedures Act, Administrative Law Judge, Article 5, Chapter 23 of Title 1 of the 1976 Code.
The department shall promulgate regulations to comply with federal requirements to limit the use or disclosure of information concerning applicants and recipients to purposes directly connected with the administration of the Medicaid program.
HISTORY: 1985 Act No. 201, Part II, Section 19C; 1990 Act No. 450, Section 3; 1993 Act No. 181, Section 1055.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-200. Falsification of information; penalties.

(A) A person who commits a material falsification of information required to determine eligibility for the Medically Indigent Assistance Program is guilty of a misdemeanor and, upon conviction, must be fined not more than five hundred dollars or imprisoned for not more than one year, or both.
(B) Unless otherwise specified in this chapter, an individual or facility violating this chapter or a regulation under this chapter is guilty of a misdemeanor and, upon conviction, must be fined not more than one hundred dollars for the first offense and not more than five thousand dollars for a subsequent offense.
HISTORY: 1985 Act No. 201, Part II, Section 19C; 1989 Act No. 189, Part II, Section 35H; 1993 Act No. 130, Section 5.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-220. Notice requirements on nursing home admission applications.

All applications for admission to a nursing home must contain a notice, to be signed by the applicant, stating:
"Eligibility for Medicaid-sponsored long-term care services is based on income and medical necessity. To qualify for assistance through the Medicaid program, a nursing home patient must need intermediate or skilled nursing care as determined through an assessment conducted by Medicaid program staff. The fact that a patient has already been admitted to a nursing home is not considered in this determination. It is possible that a patient could exhaust all other means of paying for nursing home care and meet Medicaid income criteria but still be denied assistance due to the lack of medical necessity.
"It is recommended that all persons seeking admission to a nursing home be assessed by the Medicaid program prior to admission. This assessment will provide information about the level of care needed and the viability of community services as an alternative to admission. The department may charge a fee, not to exceed the cost of the assessment, to persons not eligible for Medicaid-sponsored long-term care services."
HISTORY: 1987 Act No. 184 Section 5; 1993 Act No. 181, Section 1056.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-300. Repealed.

HISTORY: Former Section, titled Child development services to be established, had the following history: 1989 Act No. 189, Part II, Section 43 sub 3; 1993 Act No. 181, Section 1057. Repealed by 2023 Act No. 36, Section 1, eff May 16, 2023.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-310. Repealed.

HISTORY: Former Section, titled Expansion of existing child development services, had the following history: 1989 Act No. 189, Part II, Section 43 sub 4; 1993 Act No. 181, Section 1058. Repealed by 2023 Act No. 36, Section 1, eff May 16, 2023.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-320. Repealed.

HISTORY: Former Section, titled Appropriations, had the following history: 1989 Act No. 189, Part II, Section 43 sub 5; 1993 Act No. 181, Section 1059. Repealed by 2023 Act No. 36, Section 1, eff May 16, 2023.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-400. Definitions.

As used in this article:
(1) "Department" means the Department of Health and Human Services.
(2) "Nursing home" means a facility subject to licensure as a nursing home by the Department of Health and Environmental Control and subject to the permit provisions of Article 2, Chapter 7 of Title 44 and which has been certified for participation in the Medicaid program or has been dually certified for participation in the Medicaid and Medicare programs.
(3) "Resident" means a person who resides or resided in a nursing home during a period of an alleged violation.
(4) "Survey agency" means the South Carolina Department of Health and Environmental Control or any other agency designated to conduct compliance surveys of nursing facilities participating in the Title XIX (Medicaid) program.
HISTORY: 1990 Act No. 449, Section 4; 1993 Act No. 181, Section 1060; 1998 Act No. 419, Part II, Section 45A.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-420. Enforcement actions; considerations; proportionality to violations.

When the department is notified by the survey agency that a nursing home is in violation of one or more of the requirements for participation in the Medicaid program, it may take enforcement action as follows:
(1) if the nursing home is dually certified for participation in both the Medicare and Medicaid programs, the department shall coordinate any enforcement action with federal authorities and shall defer to the actions of these federal authorities to the extent required by federal statute or regulation;
(2) if the nursing home is only certified for participation in the Medicaid program and is not certified for participation in the Medicare program, the department may take any enforcement action authorized under federal statute or regulation that would have been available for use by federal authorities if the nursing home had been dually certified;
Any enforcement actions taken solely by the department under item (2) must be proportionate to the scope and severity of the violations and also shall take into account the factors considered by federal authorities in similar enforcement actions. Dually certified nursing homes and nursing homes only certified for participation in the Medicaid program must be subjected to comparable enforcement actions for comparable violations.
HISTORY: 1990 Act No. 449, Section 4; 1993 Act No. 181, Section 1062; 1998 Act No. 419, Part II, Section 45B.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-470. Fines; use of funds collected.

Any use of funds collected by the department as a result of the imposition of civil monetary penalties or other enforcement actions must be for a purpose related to the protection of the health and property of residents of nursing homes that participate in the Medicaid program. These funds may be used for the cost of relocating residents to other nursing homes, if necessary, and also may be used to reimburse residents for personal funds lost as a result of violations of the requirements for participation in the Medicaid program by the nursing home. In addition, these funds may be used for other costs directly associated with enforcement or corrective measures at facilities found to be out of compliance with the requirements for participation in the Medicaid program or for any other purpose that enhances or improves the health and quality of life for residents. These requirements for the use of funds collected also apply to funds received by the department that are collected as the result of enforcement actions directed by federal authorities.
HISTORY: 1990 Act No. 449, Section 4; 1993 Act No. 181, Section 1066; 1998 Act No. 419, Part II, Section 45C.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-530. Federal jurisdiction.

Before instituting an action under this article, the Department of Health and Human Services shall determine if the Secretary of the United States Department of Health and Human Services has jurisdiction under federal law. In such cases, it shall coordinate its efforts with the secretary to maintain an action against the nursing home. In an action against a nursing home owned and operated by the State of South Carolina, the secretary has exclusive jurisdiction.
HISTORY: 1990 Act No. 449, Section 4; 1993 Act No. 181, Section 1069.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-540. Authority for rulemaking, and to ensure compliance with Medicaid participation.

The department is authorized to promulgate regulations, pursuant to the Administrative Procedures Act, to administer this article, and to ensure compliance with the requirements for participation in the Medicaid program.
HISTORY: 1990 Act No. 449, Section 4; 1998 Act No. 419, Part II, Section 45D.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-610. Citation of article.

This article may be cited as the "Gap Assistance Pharmacy Program for Seniors (GAPS) Act".
HISTORY: 2003 Act No. 59, Section 1, eff June 18, 2003; 2006 Act No. 233, Section 1, eff February 21, 2006.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-620. Definitions.

For purposes of this article:
(1) "Department" means the South Carolina Department of Health and Human Services.
(2) "Prescription drugs" means outpatient prescription drugs that have been approved by the United States Food and Drug Administration. "Prescription drugs" do not include experimental drugs and over-the-counter pharmaceutical products.
(3) "Program" means the Gap Assistance Pharmacy Program for Seniors (GAPS) created pursuant to this article.
(4) "Medicare Part D Prescription Drug Plan" means a Prescription Drug Plan that has been approved by the Centers for Medicare and Medicaid Services (CMS) to provide Medicare Part D prescription drugs to Medicare beneficiaries in South Carolina.
(5) "GAPS Participating Medicare Part D Prescription Drug Plan" means Prescription Drug Plans that have executed a contract with the department to provide prescription drug coverage to eligible individuals during the annual Medicare Part D coverage gap.
HISTORY: 2003 Act No. 59, Section 1, eff June 18, 2003; 2006 Act No. 233, Section 1, eff February 21, 2006.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-630. Creation of GAPS program; purpose.

(A) There is created within the Department of Health and Human Services the Gap Assistance Pharmacy Program for Seniors (GAPS) program. The purpose of this program is to coordinate, beginning January 1, 2006, with Medicare Part D Prescription Drug Plans to provide to low-income seniors in this State assistance with costs for prescription drugs during the annual Medicare Part D coverage gap.
(B) The program must provide assistance with prescription drugs that:
(1) have been approved by the United States Food and Drug Administration; and
(2) are included in the enrollee's selected GAPS participating Medicare Part D Plan formulary.
HISTORY: 2003 Act No. 59, Section 1, eff June 18, 2003; 2006 Act No. 233, Section 1, eff February 21, 2006.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-640. Administration of program; assistance of other agencies or organizations; enrollment fee.

(A) This program must be administered by the Department of Health and Human Services. The department may designate, or enter into contracts with, other entities including, but not limited to, other states, other governmental purchasing pools, and nonprofit organizations to assist in the administration of this program.
(B) The department may establish an enrollment fee that must be used to fund the administration of this program.
(C) When requested by the department, other state agencies shall provide assistance or information necessary for the administration of this program.
HISTORY: 2003 Act No. 59, Section 1, eff June 18, 2003; 2006 Act No. 233, Section 1, eff February 21, 2006.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-650. Eligibility; benefits.

(A) To be eligible to enroll in this program a person must:
(1) have attained the age of sixty-five years;
(2) be a resident of this State;
(3) be enrolled in a GAPS participating Medicare Part D Drug Plan;
(4) satisfy annual income, resources, and other criteria established by the department;
(5) pay the enrollment fee, if any, as established by the department.
(B) An enrollee is entitled to benefits under this program during the coverage gap when the enrollee's annual prescription drug costs have reached the point that standard Medicare Part D benefits are no longer available. The GAPS benefits terminate when the enrollee's annual out-of-pocket prescription drug expenses have reached the point that catastrophic Medicare Part D benefits become available.
HISTORY: 2003 Act No. 59, Section 1, eff June 18, 2003; 2006 Act No. 233, Section 1, eff February 21, 2006.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-660. Evaluation of cost effectiveness; annual report.

(A) The department shall maintain data to allow evaluation of the cost effectiveness of the program.
(B) Beginning with fiscal year 2006-2007, the department shall include in its annual report, a report on the GAPS program.
HISTORY: 2003 Act No. 59, Section 1, eff June 18, 2003; 2006 Act No. 233, Section 1, eff February 21, 2006.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-710. Treating application of person deemed ineligible because of Medicaid qualifying trust as undue hardship case.

If an applicant for Medicaid for nursing home care would be ineligible because a trust established for the applicant was deemed a Medicaid qualifying trust or resources in the trust were deemed an improper transfer of resources, the person's application must be treated as a case of undue hardship under federal law if all of the criteria in Section 44-6-720 are met. For the purposes of this section, 'Medicaid qualifying trust' has the same meaning as set forth in 42 U.S.C. Section 1396a(k).
HISTORY: 1993 Act No. 164, Part II, Section 74A.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-720. Requirements for qualifying for undue hardship waiver.

(A) To be considered for a waiver due to undue hardship, the applicant must meet all other applicable eligibility criteria for assistance. If the federal "transfer of resources" rule set forth in 42 U.S.C. Section 1396p(c), as amended, applies to the applicant, then no undue hardship waiver may be granted until the period of ineligibility has expired. For the purposes of this subsection, the maximum length of ineligibility is extended to sixty months from the date of any improper transfer.
(B) The trust established for the applicant must meet the following criteria:
(1) the applicant's monthly gross income from all sources, without reference to the trust, exceeds the income eligibility standard for Medicaid then in effect but is less than the average private pay rate for nursing home care for the State;
(2) the property used to fund the trust is limited to monthly unearned income owned by the applicant, including any pension payment;
(3) the applicant and the state Medicaid program are the sole beneficiaries of the trust;
(4) the entire income and corpus of the trust, or as much as may be distributed each month without violating federal requirements for federal financial participation, must be distributed each month for expenses related to the applicant's nursing home care that are approved under the Medicaid program, except that:
(a) an amount reasonably necessary to maintain the existence of the trust, as approved by the Medicaid program, may be retained in the trust; and
(b) deductions may be distributed from the trust to the same extent deductions from the income of a nursing home resident who is not a trust beneficiary are allowed under the Medicaid program, which shall include:
(i) monthly personal needs allowance;
(ii) payments to the beneficiary's community spouse or dependent family members as provided and in accordance with state and federal law;
(iii) specified health insurance costs and special medical services provided under Title XIX of the federal "Social Security Act", 42 U.S.C. Section 1396a(r), as amended; and
(iv) other deductions provided in regulations of the State Health and Human Services Finance Commission;
(5) upon the death of the beneficiary, a remainder interest in the corpus of the trust passes to the State Health and Human Services Finance Commission. The commission shall remit the state share of the trust to the general fund; and
(6) the trust is not subject to modification by the beneficiary or the trustee without the approval of the state Medicaid program.
HISTORY: 1993 Act No. 164, Part II, Section 74A.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-725. Promissory notes received by Medicaid applicant or recipient.

Any promissory note received by a Medicaid applicant or recipient or the spouse of a Medicaid applicant or recipient in exchange for assets which if retained by the applicant or recipient or his spouse would cause the applicant or recipient to be ineligible for Medicaid benefits, shall, for Medicaid eligibility purposes, be deemed to be fully negotiable under the laws of this State unless it contains language plainly stating that it is not transferable under any circumstances. A promissory note will be considered valid for Medicaid purposes only if it is actuarially sound, requires monthly installments that fully amortize it over the life of the loan, and is free of any conditional or self-canceling clauses.
HISTORY: 2008 Act No. 353, Section 2, Pt 4.B, eff July 1, 2009.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-730. Promulgation of regulations to implement article and comply with federal law; amendment of state Medicaid plan consistent with article.

The State Health and Human Services Finance Commission shall promulgate regulations as are necessary for the implementation of this article and as are necessary to comply with federal law. In addition, the commission shall amend the state Medicaid plan in a manner that is consistent with this article.
HISTORY: 1993 Act No. 164, Part II, Section 74A.
2023 South Carolina Code of Laws › Title 44 - Health › Chapter 6 - Department Of Health And Human Services › Section 44-6-910. Health facilities recognized and designated as providers for underserved patients; when hospital in urban area considered "rural".

(A) Federally Qualified Health Centers (FQHC's), Rural Health Clinics (RHC's), and Rural Hospitals are recognized and designated as essential community providers for underserved patients which include Medicaid and Medicare recipients, the underinsured, and the uninsured. These populations require more extensive services by community-based providers, and the FQHC's, RHC's, and Rural Hospitals have extensive experience and knowledge in providing quality, cost-effective care for these populations. The State shall include these essential community providers as contracted entities in any formulation of the state health care system. The inclusion of FQHC's, RHC's, and Rural Hospitals as contracted entities in the state health care system recognizes the importance of these providers to South Carolina and assures that the reimbursement to these essential community providers will be funded through cost-based reimbursement or a capitated fee based on reasonable costs.
(B) A hospital located in an urban area (MSA County), can be considered "rural" for the purposes of the Medicare Rural Hospital Flexibility Program if it meets the following criteria:
(1) enrolled as both a Medicaid and Medicare provider and accepts assignment for all Medicaid and Medicare patients;
(2) provides emergency health care services to indigent patients;
(3) maintains a twenty-four hour emergency room;
(4) staffs fifty or less acute care beds; and
(5) located in a county with twenty-five percent or more rural residents, as defined by the most recent United States decennial census.
HISTORY: 1994 Act No. 497, Part II, Section 82; 2004 Act No. 260, Section 1, eff July 6, 2004.