Retainer Payments-Appendix K Waiver Amendment-Frequently Asked Questions (FAQs)

Question:How should providers prove they received money from the Small Business Administration (SBA) or Paycheck Protection Program (PPP)?

Answer:An attestation for any loans or monies received during the public health emergency (PHE) is included in the required Form 950K1 and Form 950K2. Proof must be maintained by the provider in case of an audit or review. Providers who received PPP loans thatexceeded their revenue for the last full quarter prior to the public health emergency are not eligible for retainer payments.

Q: How should 301 clinics list modifiers when billing for service delivered through the telehealth flexibilities authorized during the COVID-19 public health emergency?

A: For codes 90832, 90834, 90837, 99408, H0001, H0032 and H0038, providers should bill with existing modifiers and use the second modifier field to add the GT modifier as applicable.

For code H0004, providers should bill with the GT modifier in the first modifier field.

Q: Is there an end date to COVID-19-related telehealth coverage?

A: Any modifications to telehealth policies, including the sunsetting of any telehealth flexibilities authorized in response to COVID-19, will be communicated via Medicaid bulletin(s) in a manner that allows ample notice for providers and Healthy Connections Medicaid members to plan and ensure continuity of care. Policy changes and additional guidance and resources related to the COVID-19 pandemic are available at www.scdhhs.gov/covid19.

Q. Can providers performing Applied Behavior Analysis services as parent-directed services or through remote supervision of a registered behavior technician change between the two delivery methods during the COVID-19 pandemic?

A. As the period of recommended social distancing has increased, SCDHHS will allow providers to change from parent-directed services to in-home services with an RBT receiving remote supervision by a BCBA once. The decision to switch between delivery methods must be agreed to by both the provider and the parent or guardian of the child receiving the service. Providers must document the change of circumstance in the beneficiary’s record on a clinical service note.

Q. How can applicants, beneficiaries and authorized representatives submit documents to SCDHHS electronically?

A. Applicants, beneficiaries, authorized representatives and third parties providing application assistance are now encouraged to submit documents electronically to SCDHHS using the email address 8888201204@fax.scdhhs.gov.

For third parties assisting multiple individuals, a separate secure email must be sent for each applicant or beneficiary. The secure email must include the applicant or beneficiary’s name, phone number, date of birth, Medicaid number (if applicable) and Social Security number. 

Q. Will SCDHHS allow Medicaid applicants to use “E-signatures?”

A. SCDHHS has modified the eligibility signature policy in recognition of the current challenges in obtaining physical signatures from individuals during the COVID-19 emergency response period. An applicant, or a person authorized by SCDHHS policy to apply on behalf of an individual, may “sign” an application by typing the name on the signature line and completing the “Is someone helping you fill out this application?” section of the form.

Q. Do you temporarily waive pre-authorization/pre-certification guidelines?

A. SCDHHS has extended the timeframe for submitting additional documentation from two days to seven days. The agency continues to work closely with its quality improvement organization, KEPRO, to monitor the needs of the provider community and will make additional changes should they be necessary.

For claims submitted to MCOs, providers should confirm authorization requirements with the MCO.

Q. Do you temporarily waive or extend provider enrollment time frames?

A. Providers need to be enrolled to provide services, however SCDHHS currently allows retroactive review/enrollment for emergency services, which would apply for COVID-19 services.


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