South Carolina HCBS Waiver Updates: Consolidated Codes and Rate Increases Starting July 1

​Effective July 1, 2023, the South Carolina Department of Health and Human Services (SCDHHS) is consolidating multiple personal care and private duty nursing services into single procedure codes for personal care, private duty nursing and enhanced nursing. These service consolidations are being made to reduce the administrative burden for providers and support improved access to care. These changes affect State Plan private duty nursing services and services provided through home and community-based service (HCBS) waiver programs.

Personal care I and personal care II will become one consolidated service entitled personal care services. All services available in personal care I and personal care II will remain in the consolidated personal care service.
 
For dates of service on or after July 1, 2023, all claims for personal care services should be submitted using the procedure code T1019. The rate for personal care services will be $25/hr.
 
Medicaid nursing RN and Medicaid nursing LPN will become one consolidated service entitled nursing services. Enhanced nursing RN and enhanced nursing LPN will become one consolidated service entitled enhanced nursing services. Providers will determine whether an RN or LPN is needed based on the assessed needs of the participant and what is allowable under the scope of practice dictated in the SC Nurse Practice Act Title 40 Chapter 33.
 
For dates of service on or after July 1, 2023, all claims for private duty nursing should be submitted using the procedure code S9123. The rate for nursing services will be $42/hr.  All claims for enhanced nursing services should be submitted using the procedure code T1002. The rate for enhanced nursing services will be $45/hr.
 
Training is available for community long-term care (CLTC) and South Carolina Department of Disabilities and Special Needs (DDSN) case management providers and personal care and nursing providers. The training will cover updated policy and procedures for authorizing services and for utilizing electronic visit verification with the consolidated service codes.
 
Click here to read the full bulletin, including links to register for the trainings.