Provide Quality Improvement / Medical Utilization Review for Medicaid Beneficiaries and Providers
The South Carolina Department of Health and Human Services (SCDHHS) is the single state agency in South Carolina responsible for the administration of the Medical Assistance Program under Title XIX of the Social Security Act. Participants in this program include approximately 192 contracted hospitals and 10,128 physicians. There are approximately 870,227 South Carolina residents eligible for services sponsored by Medicaid. Funding is provided by both the state and federal governments (approximately 1:3 match). Behavioral health participants currently include approximately eleven (11) Residential Treatment Facilities, sixty-one (61) Group Homes Facilities and nine (9) Therapeutic Foster Care Programs. New provider enrollments may occur.
In addition, Medicaid administrative funding is available for review of behavioral health residential and community based treatment services for children.
The United States Department of Health and Human Services has allocated funds under Title XIX of the Social Security Act to SCDHHS for the provision of hospital utilization review services for eligible persons in accordance with 42 CFR Part 456Utilization Control, and the South Carolina State Plan for Medical Assistance. SCDHHS intends to contract with a Quality Improvement Organization (QIO) to perform these reviews.
