The South Carolina Department of Health and Human Services (SCDHHS) has increased the reimbursement rates for OSS providers effective for dates of service beginning July 1, 2023. Through the rate increase, all OSS providers will receive a $25 rate increase per resident, per month. The maximum payment allowed to a facility will increase from $1,620 to $1,645. The net income limit will increase from $1,699 to $1,724. The increase in the monthly amount will be reflected in the regularly scheduled check for July 2023 services issued Sept. 1, 2023.

As a reminder, facilities are responsible for ensuring residents receive their personal needs allowance (PNA). The PNA for OSS recipients who receive recurring income only through supplemental security income (SSI) will remain $79 per month. The PNA for OSS recipients who have income other than SSI will remain $99 per month.

The new daily rate per resident amounts used to calculate payments for July - December 2023 dates of service are below.

Date of Service Daily Rate per Resident July 2023 $55.61 August 2023 $55.61 September 2023 $57.47 October 2023 $55.61 November 2023 $57.47 December 2023 $55.61

The OSS payments made on behalf of residents to CRCFs are considered payment in full. Any differences caused by rounding in the payment system cannot be billed to the resident or deducted from residents’ PNA. For additional information, refer to the Optional State Supplementation Services provider manual .

Providers with questions about the rate increases announced in this bulletin should email OSS-Policy@scdhhs.gov .

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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Effective Jan. 1, 2025, Social Security (Title II-SSA) and Supplemental Security Income (SSI) benefits payments will include a 2.5% cost-of-living adjustment (COLA). The South Carolina Department of Health and Human Services (SCDHHS) is processing these COLA rebudgets for impacted members during December 2024.

Nursing facilities and community residential care facilities (CRCFs) will receive a form for impacted members. Facilities must indicate the current level of care for the member and submit the form to Blue Cross Blue Shield of South Carolina to update the member’s cost of care. Further information on the rebudgeting process and samples of the forms that facilities will receive are listed below.

Nursing Facilities

Nursing facilities will receive Form MSC002.

For facilities that bill in Phoenix, cost of care will be updated in Phoenix.

Nursing facility providers with questions about this bulletin should contact the Nursing Home Provider Liaison Center at (877) 797-5409 or NursingHomePLC@bcbssc.com .

CRCFs

CRCFs will receive Form MSC004.

Section II: A and B of Form MSC004 should be left blank for COLA updates.

The maximum payment made to a facility will increase to $1,694. The net income limit will increase to $1,777.

The personal needs allowance (PNA) for optional state supplementation (OSS) recipients who receive recurring income only through SSI will increase by $2 to $83 per month.

The PNA for OSS recipients who have income other than SSI will increase by $2 to

$103 per month.

CRCF providers with questions about this bulletin should contact OSS Provider Eligibility at OSSProElig@scdhhs.gov .

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Effective Jan. 1, 2026, Social Security (Title II-SSA) and Supplemental Security Income (SSI) benefits payments will include a 2.8% cost-of-living adjustment (COLA). The South Carolina Department of Health and Human Services (SCDHHS) processed COLA re-budgets in December 2025 for impacted members.

Nursing facilities and community residential care facilities (CRCFs) will receive a form for impacted members. Nursing facilities must indicate the current level of care for the member and submit the MSC002 form to BlueCross BlueShield of South Carolina to update the member’s cost of care. CRCFs should sign the MSC004 form and submit it to BlueCross BlueShield of South Carolina with their monthly billing. Further information on the rebudgeting process and samples of the forms that facilities will receive are listed below.

Nursing Facilities

Nursing facilities will receive Form MSC002 or MSC002PNA.

For facilities that bill in Phoenix, cost of care will be updated in Phoenix.

Nursing facility providers with questions about this bulletin should contact the Nursing Home Provider Liaison Center at (877) 797-5409 or NursingHomePLC@bcbssc.com .

CRCFs

CRCFs will receive Form MSC004. Section II: A and B of Form MSC004 should be left blank for COLA updates.

The maximum payment made to a facility will increase to $1,719. The net income limit will increase to $1,804.

The personal needs allowance (PNA) for optional state supplementation (OSS) recipients who receive recurring income only through SSI will increase by $2 to $85 per month.

The PNA for OSS recipients who have income other than SSI will increase by $2 to $105 per month.

If there is an income change or the form contains incorrect information, please contact SCDHHS at OSSProElig@scdhhs.gov to update.

CRCF providers with questions about this bulletin should contact OSS Provider Eligibility at OSSProElig@scdhhs.gov .

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Effective Jan. 1, 2024, Social Security (Title II-SSA) and SSI benefits payments will include a 3.2% cost-of-living adjustment (COLA). The South Carolina Department of Health and Human Services (SCDHHS) is processing COLA re-budgets for impacted members during December 2023.

Nursing facilities and CRCFs will receive a form for impacted members. Please note the forms received will look slightly different depending on which SCDHHS system currently holds the member’s eligibility information. Facilities must indicate the current level of care for the member and submit the form to Blue Cross Blue Shield to update the member’s cost of care. Further information on the rebudgeting process and samples of the forms facilities will receive are listed below.

Nursing Facilities

Nursing facilities will receive Form MSC002.

For facilities that bill in Phoenix, cost of care will be updated in Phoenix.

Nursing facility providers with questions about this bulletin should contact the Nursing Home Provider Liaison Center at 1-877-797-5409 or NursingHomePLC@bcbssc.com .

CRCFs

CRCFs will receive Form MSC004.

Section II: A and B of Form MSC004 should be left blank for COLA updates.

The maximum payment made to a facility will increase to $1,672. The net income limit will increase to $1,753.

The personal needs allowance (PNA) for optional state supplementation (OSS) recipients who receive recurring income only through SSI will increase by $2 to $81 per month.

The PNA for OSS recipients who have income other than SSI will increase by $2 to $101 per month.

CRCF providers with questions about this bulletin should contact OSS Provider Eligibility at OSSProElig@scdhhs.gov .

Resources Providers Can Use to Help with Medicaid Member Annual Reviews

As SCDHHS continues its federally required review of Medicaid member eligibility, a process frequently referred to as “unwinding,” it is reminding providers of resources available to them that can help with this process. SCDHHS has produced several member-facing communications and marketing items and is encouraging providers to post its “submit your review, when it’s time to renew” flyer in patient-facing areas. The flyer is available for download from SCDHHS’ website in English and in Spanish along with other provider resources on SCDHHS’ annual reviews website .

The Centers for Medicare and Medicaid Services have also produced outreach and educational resources about this process that are available on their website .

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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