Home care billing · SC
Home care billing in South Carolina
Short answer
Home care billing in South Carolina splits by payer. The five Medicaid MCOs cover home health for their members but not waiver services, state plan personal care or hospice, so Community Long-Term Care and DDSN waiver claims stay fee-for-service with SCDHHS.
Waiver and home health visits belong in HHAeXchange, and CMS applied federal match reductions to the state's personal care and home health programs during the rollout. The case manager's plan sets the units an agency may bill, and federal rule allows at most 12 months from the date of service to file. A dedicated Remitwright biller routes each claim to its payer and keeps visits matched, serving South Carolina agencies remotely. Rules for other states are on the home care billing by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Key facts for South Carolina home care billing
| Fact | In South Carolina | Source |
|---|---|---|
| Programs that pay | Community Choices Waiver (0405.R05.00); HIV/AIDS Waiver (0186.R08.00) and Mechanical Ventilator Dependent Waiver (40181.R06.00); Medically Complex Children Waiver (0675.R03.00); Intellectual Disability and Related Disabilities Waiver (0237.R06.00); Community Supports Waiver (0676.R03.00); Head and Spinal Cord Injury Waiver (0284.R06.00) | 1 |
| How it is delivered | Managed care and fee-for-service, with long-term care outside the plans | 2 |
| EVV | Open model | 3 |
| Medicare home health and hospice | Palmetto GBA, Jurisdiction M | 11 |
Programs that pay for home care in South Carolina1
Community Choices Waiver (0405.R05.00)
Personal care, attendant care, companion care through an agency or an individual, adult day health care and adult day health care nursing, respite in the home, in a community residential care facility or in an institution, residential personal care II, home delivered meals, home accessibility adaptations, personal emergency response system installation and monitoring, pest control, specialized medical equipment and supplies, telemonitoring and case management, for people 65 and older and people with physical disabilities ages 18 to 64 who meet a nursing facility level of care.
Administered under the Community Long-Term Care System that S.C. Code 44-6-30 assigns to SCDHHS. CMS counted this waiver's personal care as compliant with the EVV rule in its January 2021 determination.
HIV/AIDS Waiver (0186.R08.00) and Mechanical Ventilator Dependent Waiver (40181.R06.00)
Case management, personal care, attendant care, nursing, home delivered meals, home accessibility adaptations, pest control and specialized medical equipment and supplies in both waivers. The HIV/AIDS Waiver adds agency and individual companion care for people of any age with HIV/AIDS who meet a hospital level of care; the Mechanical Ventilator Dependent Waiver adds in-home and institutional respite and a personal emergency response system for technology dependent adults 21 and older who meet a nursing facility level of care.
Both were on CMS's compliant list for personal care EVV in January 2021, alongside Community Choices and Medically Complex Children.
Medically Complex Children Waiver (0675.R03.00)
Attendant care, nurse care coordination, respite, environmental modifications and pediatric medical day care for medically fragile children and young adults ages 0 to 21 who meet a hospital level of care.
The 2024 CMS tables tie the South Carolina Medical Homes Network, a primary care case management entity run by SC Solutions with voluntary enrollment for aged, blind or disabled children under 19, to this waiver alone.
Intellectual Disability and Related Disabilities Waiver (0237.R06.00)
Personal care, adult attendant care, adult companion services, residential habilitation, respite, waiver case management, adult day health care and nursing, behavior support, career preparation, community services, day activity, employment services, independent living skills, environmental modifications, personal emergency response system, incontinence supplies, pest control, private vehicle assessment and modifications, specialized medical equipment, supplies and assistive technology with assessment, support center services, and adult dental, vision and audiology services, for people with intellectual disabilities of any age who meet an ICF/IID level of care.
S.C. Code 44-20-240 gives the Department of Disabilities and Special Needs authority over the state's services for people with intellectual disability, related disabilities, head injuries and spinal cord injuries, with county disabilities and special needs boards as the service delivery bodies under 44-20-385. CMS found this waiver's personal care EVV non-compliant in January 2021.
Community Supports Waiver (0676.R03.00)
Personal care, respite, adult day health care and nursing, waiver case management, in-home support services, behavior support, career preparation, community services, day activity, employment services, environmental modifications, personal emergency response systems, incontinence supplies, assistive technology and appliances with assessment, private vehicle assessment and modifications, and support center services, for people with intellectual disabilities of any age who meet an ICF/IID level of care.
A DDSN waiver that CMS also listed as non-compliant for personal care EVV in January 2021, with federal match reductions from the first quarter of that year.
Head and Spinal Cord Injury Waiver (0284.R06.00)
Attendant care and personal assistance, residential habilitation, respite, nursing, occupational, physical and speech and hearing therapy, psychological services, behavioral support, waiver case management, day activity, career preparation and employment services, independent living skills, peer guidance and health education for participant-directed care, environmental modifications, personal emergency response systems, pest control, private vehicle assessment and modifications, incontinence supplies, and specialized medical equipment, supplies and assistive technology with assessment, for people with physical or other disabilities or brain injury of any age who meet a nursing facility or ICF/IID level of care.
The third DDSN waiver on CMS's January 2021 non-compliant list for personal care EVV.
How the program is delivered
Both, with long-term care outside the plans. The 2024 CMS state tables list South Carolina's Medicaid MCO program as statewide under 1932(a) authority since September 1, 1996, mandatory for aged, blind or disabled members 19 and older and voluntary under 19; the plan benefit grid includes home health but not state plan personal care, HCBS waiver services or hospice, so waiver and personal care claims bill fee-for-service to SCDHHS.2 Five plans take part: Molina Healthcare of South Carolina, First Choice by Select Health, Humana Healthy Horizons, Healthy Blue by Blue Choice and Absolute Total Care, with Maximus as enrollment broker; members have 90 days to choose a plan or are auto-assigned, and 60 days each annual enrollment period to change. The South Carolina Medical Homes Network, a primary care case management entity run by SC Solutions, enrolls only aged, blind or disabled children under 19 on the Medically Complex Children's waiver, and PACE runs in three regions through Orangeburg Senior Helping Center and Prisma Health Senior Care in the Midlands and Upstate.
Electronic visit verification
Open model. HHAeXchange is the EVV vendor for South Carolina's HCBS program and offers its EVV portal to providers at no cost; a provider that already uses another EVV vendor may keep it if that vendor integrates with HHAeXchange to aggregate visit data and meets the state's requirements under the open model, and the provider is responsible for confirming that it does.3 CMS's compliance letters trace the rollout. On January 15, 2021 CMS found South Carolina non-compliant for personal care EVV in the state plan personal care benefit and the Community Supports, Intellectual Disability and Related Disabilities, and Head and Spinal Cord Injury waivers, with federal match reductions from the first quarter of 2021 while the state expanded its legacy system, and compliant in the Community Choices, HIV/AIDS, Mechanical Ventilator Dependent and Medically Complex Children waivers. On December 29, 2023 CMS found the state's home health care services non-compliant, with reductions from the first quarter of 2024 and the state anticipating compliance by December 31, 2024. The Medicaid.gov status tables still list South Carolina as not compliant for both services, so an agency should expect EVV matching to tighten as the state closes those findings.
Services under EVV3
- HCBS waiver programs, which HHAeXchange describes the open model as covering across the state
- Home health programs, under the same HHAeXchange aggregation
Authorizations
Through the waiver's case manager and the plan they write. The CMS factsheet lists case management as a covered service in the Community Choices, HIV/AIDS and Mechanical Ventilator Dependent waivers and nurse care coordination in the Medically Complex Children Waiver, all administered under the Community Long-Term Care System that S.C. Code 44-6-30 assigns to SCDHHS; the Intellectual Disability and Related Disabilities, Community Supports and Head and Spinal Cord Injury waivers carry waiver case management for populations under DDSN's authority, with county disabilities and special needs boards as service delivery bodies. The services and units in that plan are what an agency may bill.1 Home health for a plan member is authorized under the member's MCO contract, since the 2024 CMS tables place home health inside the plan benefit. Each plan publishes its own authorization rules, so the biller records the plan on every date of service before a home health episode starts.
Where the claims go
Waiver, state plan personal care and hospice claims go to SCDHHS fee-for-service, because the 2024 CMS tables leave those benefits out of the MCO contracts, while home health for a plan member goes to that plan. Federal rule 42 CFR 447.45 requires every state Medicaid agency to make providers file claims within 12 months of the date of service, so no South Carolina Medicaid claim can be filed later than that, and SCDHHS's provider manuals set the state's own filing and resubmission rules inside that ceiling.10 The same federal rule defines a clean claim as one with no defect, impropriety or need for outside information, and requires the agency to pay 90 percent of clean claims within 30 days and 99 percent within 90 days of receipt. Each of the five plans sets its own filing window in its provider contract, so the biller tracks the plan's deadline and the state's separately from the first date of service.
Medicare home health and hospice in South Carolina
Palmetto GBA, the A/B MAC for Jurisdiction M, processes Medicare home health and hospice claims for South Carolina along with Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, Tennessee and Texas, and also holds South Carolina's Part A and Part B work with North Carolina, Virginia and West Virginia.11 On the Medicaid side, CMS's December 29, 2023 letter found South Carolina's 1905(a)(7) home health care services not yet compliant with the Cures Act EVV requirement, whose deadline was January 1, 2023, and applied federal match reductions from the first quarter of 2024; Medicaid.gov still lists the state as non-compliant for home health EVV. Medicaid home health for plan members is a plan benefit under the 2024 CMS tables.
Common rejections in South Carolina, and the fix
Waiver visit missing from the HHAeXchange aggregator
The fixUnder the open model every visit reaches HHAeXchange, whether it was recorded in the free portal or in another vendor's system that integrates with it. The biller confirms the integration is live before go-live and works unmatched visits in the aggregator before the claim, since the state is still closing CMS's EVV findings.
Waiver or personal care claim sent to a Medicaid MCO
The fixThe 2024 CMS tables leave HCBS waiver services and state plan personal care out of the plan benefit grid, so the plan has no contract to pay them. The biller files those claims fee-for-service to SCDHHS and keeps the plan for the member's home health.
Home health claim for a plan member sent to SCDHHS
The fixHome health is inside the MCO benefit, and plan members 19 and older with aged, blind or disabled eligibility are enrolled mandatorily. The eligibility check records the plan on each date of service and the biller files to that plan under its contract.
Service billed beyond the case manager's plan
The fixCase management or waiver case management is itself a covered service in every South Carolina waiver, and the plan it produces sets the services and units. The biller reconciles delivered units to the plan before each claim and asks the case manager for a revision when visits run past it, rather than billing and hoping.
Claim filed more than 12 months after the date of service
The fix42 CFR 447.45 obliges the state to require filing within 12 months of the date of service, and SCDHHS's provider manuals and each plan contract may set shorter clocks. The biller counts every deadline from the first date of service and files waiver claims as soon as visits are matched in the aggregator.
Medically Complex Children's waiver member billed to the Medical Homes Network
The fixThe Medical Homes Network is a primary care case management entity, and the CMS tables show it covers case management only. The biller bills the child's attendant care, respite and pediatric medical day care fee-for-service to SCDHHS, with the network's role noted on the account.
Remitwright serves South Carolina home care and home health agencies remotely, inside the agency software you already use, with a dedicated biller.
FAQ
Questions from South Carolina agencies
Do we have to switch to HHAeXchange for our South Carolina waiver visits?
Why does South Carolina show as not compliant with the federal EVV rule, and what does it mean for us?
Which of our claims go to the health plan and which go to SCDHHS?
Who sets how many hours we can bill for a Community Choices or ID/RD waiver client?
How long do we have to file a Medicaid claim in South Carolina?
Who pays our Medicare home health and hospice claims in South Carolina?
Which programs pay for home care in South Carolina?
Which services fall under EVV in South Carolina?
How are home care hours authorized in South Carolina?
What do you need from us to start billing our South Carolina agency?
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