South Carolina Reimbursement Programs for ASTs
Published On: Aug 02, 2011
(i.e., HCBS Elderly and/or Physically Disabled Adult Waivers)
SC- Choice (for elderly/disabled individuals)
Types of Technology Reimbursed/Definition (i.e., Personal Emergency Response System (PERS), Medication Dispensing, Home Telehealth, Remote Monitoring, etc.)
Durable Medical Equipment (Includes PERS): Provides equipment and supplies that give therapeutic benefits, life-sustaining nutrition, or allow a person to perform certain tasks that they couldn’t because of a medical condition. Durable medical equipment is medical equipment that can withstand repeated use and is suitable for use in the home.
DME/PERS Service: $36.00/month
DME/PERS Installation: $36.00 one-time
Telemonitoring Service (Home Telehealth)
The Telemonitoring service is available to Community Choices participants to maintain and promote their health status through medical telemonitoring of body weight, blood pressure, oxygen saturation, blood glucose levels, and basic heart rate information.
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.
Conditions of Participation – Providers
Providers must have equipment that records at a minimum the participant’s body weight, blood pressure, oxygen saturation, blood glucose levels, and basic heart rate information. All agencies must also have nursing personnel and health care professionals able to carry out the duties of the service described below.
Providers must agree to participate in all components of the Care Call monitoring and payment system and have the capability to receive and respond to authorizations for service in an electronic format.
Providers must have at least one (1) year of experience or otherwise demonstrate competency in the provision of this service.
Conditions of Participation – Community Choices Waiver Participants
Community Choices waiver participants must meet the following criteria in order to be considered for the telemonitoring service:
Have a primary diagnosis of Insulin Dependent Diabetes Mellitus, Hypertension, Chronic Obstructive Pulmonary Disease, and/or Congestive Heart Failure; and
Have a 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 the telemonitoring service and is solely responsible for receiving and acting upon the information received via the telemonitoring service; and
Be capable of using the telemonitoring equipment and transmitting the necessary data or have an individual available to them that is capable of utilizing the telemonitoring equipment and transmitting data to the telemonitoring provider.
At a minimum, CLTC shall perform a re-assessment of the telemonitoring service need at re-evaluation of level of care. The re-assessment by CLTC shall be done to assess whether or not any of the above conditions have changed and to assess the continuing need for the service.
Telemonitoring: $10/day (no maximum number of days per year)
South Carolina Reimbursement Policy Notes: South Carolina’s telemonitoring service started as a reimbursed SC Choice waiver service in February 2009. Currently there are 99 open authorizations for the service. The decision was made to institute the service by executive staff at SCDHHS with the goal of reducing hospital and emergency room visits.
Source: Home TeleHealth, page 7