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Public Notice: Comprehensive Preconception Care Model Waiver

The South Carolina Department of Health and Human Services (SCDHHS) will submit a Section 1115 Demonstration Waiver application to the Centers for Medicare and Medicaid Services (CMS) to adopt a Preconception Care (PCC) Model for family planning, pursuant to Title XIX of the Social Security Act Medical Assistance Program (Medicaid). The waiver application is available for public review and comment at https://msp.scdhhs.gov/pcc.

To continue efforts to improve the health and well-being of mothers, infants and children enrolled in the Medicaid program, SCDHHS intends to amend and enhance its family planning benefit to encompass a broader scope of preconceptive care in a manner that aligns with clinical evidence and nationally accepted treatment guidelines. This effort represents a shift from the traditional model of focus on contraception and care during the prenatal period to a model that includes and ensures the delivery of high quality care during the preconceptive period.

The primary focus of this demonstration waiver is to offer more comprehensive coordination of preconceptive care coverage to existing Medicaid beneficiaries, creating a more complete and coordinated healthcare delivery model. The proposed demonstration waiver employs a more robust and focused care model (e.g., the PCC model) to ensure the coordination of family planning and reproductive health care with primary care services and chronic disease management for both full- and limited-benefit Medicaid beneficiaries. To achieve this enhanced level of coordination, SCDHHS intends to implement a series of policies to ensure the delivery of integrated care that addresses overall healthcare needs, focusing on the early identification and treatment of chronic disease.
To adopt a comprehensive PCC model, SCDHHS proposes the following:

  • The enhancement of the benefit available to individuals enrolled in the optional family planning eligibility group to include: (1) additional primary care outpatient services; (2) a limited pharmacy benefit, focused on drugs that treat chronic disease known to affect reproductive health and birth outcomes; and (3) substance use disorder (SUD) treatment services.
    Note: SCDHHS anticipates the adoption of these enhancements through the family planning-related service option of the state’s standard State Plan authority, and does not intend to seek waiver authority for this component.
  • Leveraging a focused network of providers for the provision of family planning benefits. Specific requirements for providers who participate in this network will include the ability to screen for and treat the entire scope of PCC, including regularly managing diabetes, hypertension, heart disease, depression, and substance use disorder. To effectively ensure that qualified providers participate in the delivery of preconception care, this application requests waiver of Section 1902(a)(23) of Title XIX of the Act.

SCDHHS anticipates that adopting the PCC model and steering utilization of family planning and related services toward providers who routinely and expertly provide the full spectrum of care inherent to that model will improve the health outcomes of the population using family planning and related services. To evaluate the degree to which this transition in health care delivery models improves outcomes, SCDHHS anticipates the use of the following evaluation parameters:

  • NICU admission rates
  • Mean gestational age
  • Mean birth weight
  • Incidence of neonatal abstinence syndrome (NAS)
  • Maternal morbidity and mortality
  • Initiation of medically necessary caesarian
  • Diabetes
  • Hypertension
  • Depression
  • Maternal substance use

SCDHHS expects no change in enrollment and no significant change in short term care expenditures as a result of this waiver.

Communication
A copy of this notice and the Transitioning to Preconception Care draft waiver application are available at the following locations:

  • Electronic Access: www.scdhhs.gov (under the “Public Notice,” “Waiver” and “PCC Waiver” sections)
     
  • Hardcopies: 
    a. All Healthy Connections County Offices (See Attachment A)
    b. SCDHHS lobby at 1801 Main Street, Columbia, S.C.

Additionally, information on the proposed waiver will be discussed during three public meetings. See details below:

  • Date: Tuesday, May 22, 2018
    Time: 10 a.m.-noon
    Location: Greenville County Public Library (25 Heritage Green Place, Greenville, SC 29601)
     
  • Date: Friday, June 1, 2018
    Time: 10 a.m.-noon       
    Location: BlueCross BlueShield of South Carolina (8901 Farrow Road, Building 200, Columbia, SC 29203)
     
  • Date:  Monday, June 4, 2018
    Time: 10 a.m.-noon
    Location: Charleston County Public Library – Main Branch (68 Calhoun Street, Charleston, SC 29401)

            
Additionally, a live webinar will take place Thursday, May 24, 2018 at 1 p.m. Information on registering for the webinar will be available at https://msp.scdhhs.gov/pcc/.

Public Comments and Responses
SCDHHS wants to hear from the public about the proposed PCC waiver program to serve Medicaid beneficiaries during their reproductive years.

If you have a question or comment, please submit it by June 6, 2018:

  • Online: https://msp.scdhhs.gov/pcc/
     
  • Email: PCCWaiver@scdhhs.gov
     
  • Mail: South Carolina Department of Health and Human Services
             ATTN: PCC Waiver
             Post Office Box 8206
             Columbia, SC  29202-8206   
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