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Remote Patient Monitoring South Carolina

An order or referral is required for South Carolina Medicaid Telemonitoring services. 


Source: SC Health and Human Svcs. Dept. Provider Administrative and Billing Manual, p. 11-12 (July 1, 2019). (Accessed Sept. 2019). 


Medicaid Home Again Program for Community Long Term Care.


Medical telemonitoring must record body weight, blood pressure, oxygen saturation, blood glucose levels, and basic heart rate information. Providers must meet certain conditions to participate.


Services to be provided:


• Unit of service is one day of direct telemonitoring provided to/for a participant in the participant’s place of residence.
• The equipment must record at a minimum body weight, blood pressure, oxygen saturation, blood glucose, and basic heart rate information. Data must be transmitted electronically and any transmission costs shall be incurred by the provider of the telemonitoring service.
• Daily reimbursement rate is inclusive of monitoring of data, charting data from the monthly monitoring, visits or calls made to the home to follow up with the participants and/or caregiver, phone calls made to primary care physician(s) that are necessary while the participant is receiving the telemonitoring service, all installation of the equipment in the home and training on the equipment’s use and care in the home, including equipment removal.
• Provider shall provide telemonitoring service seven days per week for all authorized time periods.


Source: SC Health and Human Svcs. Dept. Community Long Term Care Provider Manual, p. 6-206 to 6-207 (Aug. 2019). (Accessed Sept. 2019). 

Community Choices waiver participants must have a primary diagnosis of:


• Insulin Dependent Diabetes Mellitus; 
• Hypertension; 
• Chronic Obstructive Pulmonary Disease; and/or 
• Congestive Heart Failure


Source: SC Health and Human Svcs. Dept. Community Long Term Care Provider Manual, p. 6-206 (Aug. 2019). (Accessed Sept. 2019). 


Provider Limitations


Providers must:
• Have equipment that records at a minimum the participant’s body weight, blood pressure, oxygen saturation, blood glucose levels, and basic heart rate information. 
All agencies must also have nursing personnel and health care professionals able to carry out specific duties.
• Agree to participate in all components of the Care Call payment system and have the capability to receive and respond to authorizations for service in an electronic format.
• Have at least one year of experience or otherwise demonstrate competency in the provision of this service. 


Source: SC Health and Human Svcs. Dept. Community Long Term Care Provider Manual, p. 6-205 (Aug. 2019). (Accessed Sept. 2019).

 
Other Restrictions


Community Choices waiver participants must meet the following criteria to participate:


• Have a primary diagnosis of Insulin Dependent Diabetes Mellitus, Hypertension, Chronic Obstructive Pulmonary Disease and/or Congestive Heart Failure; and
• History of at least two hospitalizations and/or emergency room visits in the past 12 months; and
• Have a primary care physician that approves the use of telemonitoring service and is solely responsible for receiving and acting upon the information received via the service; and
• Be capable of using the telemonitoring equipment and transmitting the necessary data or have an individual available to do so.


Other requirements on staffing, background checks, installation, equipment, conduct of service and administration are required.


Source: SC Health and Human Svcs. Dept. Community Long Term Care Provider Manual, p. 6-205 to 6-206 (Aug. 2019). (Accessed Sept. 2019).