South Carolina Medicaid pays for in-home personal care and related services through 4 programs, including the Community Choices Waiver and the HIV/AIDS Waiver. SCDHHS administers and operates Community Choices, HIV/AIDS and Ventilator waivers through Community Long Term Care (intake 888-971-1637); the CS, ID/RD and HASCI waivers are operated by OIDD with SCDHHS as administrative authority. A 2023 bulletin merged personal care levels 1 and 2 into one personal care service (T1019). An EVV launch for the DDSN-operated waivers was postponed in 2022; confirm current EVV status and state plan adult personal care coverage with SCDHHS.
Which South Carolina waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Community Choices Waiver
Population
Frail elderly (65 and older) and adults 18-64 with physical disabilities who meet nursing facility level of care.
Services covered
personal care services
attendant care
companion care (agency and individual)
in-home respite
institutional respite
CRCF respite
adult day health care
home delivered meals
personal emergency response system
pest control
case management
Billing format
Personal care is billed as T1019; SCDHHS has used an EVV system (Care Call) for CLTC waivers since 2002, with Phoenix used for service monitoring and billing to MMIS.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
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