DRSC Medicaid Guide

Adult Care Home– Outpatient services of a minimum of 5 hours per day that are regularly scheduled.  Adult Day Health Care covers both health and social services.

Adult Day Health Care– Depending on the consumer’s needs, the health center provides therapeutic activities, meals, supervision, and teaches health care, etc. Transportation to/from the center might be provided as well.

Adult Day Health Care Nursing– This covers certain skilled procedures that are provided at and by the Adult Day Health Care Center.  Procedures included:  ostomy care, urinary catheter care, decubitus/wound care, tracheostomy care, tube feedings, and nebulizer treatment.

Adult Day Health Transportation– This service is for consumers receiving the Adult Day Health Care service and live within 15 miles of the health care center.  Transportation will be provided from the center to the person’s residence.

Attendant Care– This service helps clients by offering support for activities of daily living and monitoring the consumer’s medical condition.  This includes things like help with shopping, help communicating, assistance with bathing, feeding, etc.

Case Management– A case manager counsels the consumer about services and support under CLTC waivers.

Companion– This service provides short-term relief to caregivers for the consumer.

Environmental Modifications– CLTC waivers’ environmental modifications include pest control.  This service also covers modifications to the consumer’s residence that allow consumers to function with more independence.  Examples include building ramps, expanding doorways, adding bars to the shower, etc.

High Fidelity Wraparound Services– This includes a variety of community-based services to help stabilize, maintain, and strengthen the consumer’s level of function in the community. Services include assessment, person-centered planning, referral to services and monitoring of health and welfare and service delivery.

Home Delivered Meals– Nutritious meals are delivered to consumers in their homes, and all menus must be reviewed by a registered dietitian.

In-Home Respite Care– This service gives temporary care in the consumer’s home and provides temporary relief for the primary caregiver.

Individual Directed Goods and Services– Services, equipment or supplies that address an identified need in the person-centered plan in service of improving and maintaining the participant’s full membership in the community.

Nursing Home Transition Services– This service helps consumers that have been in nursing homes return to the community.  Services include helping find proper appliances, getting furniture and a one-time rent/utility assistance. 

Peer Support Services– There are two types of support service, caregiver peer support and youth peer support. These services are provided by people that have been consumers or have experience raising a child that has been a consumer.

Personal Care I– This service helps keep the consumer’s home sanitary.  It also gives short-term relief to caregivers and assists consumers with personal care.  Examples of this service include meal preparation, housekeeping, help with shopping, etc. 

Personal Care II– This service helps clients with normal daily activities like walking, bathing, dressing, toileting, grooming etc. This service also includes monitoring of the consumer’s vital signs.

Personal Emergency Response System (PERS)– An electronic device that allows covered consumers to wear a “help” button that will notify trained professionals to come help in an emergency. 

Prescription Drugs– Some DHHS waivers allow for additional prescriptions over the state plan limit.  The amount of additional prescriptions varies.

Prevocational Services– This service provides activities directed at habilitative goals, such as increasing attention span and developing motor skills.

Private Duty Nursing Services– Medical supervision provided in the consumer’s home by a licensed nurse. 

Psychiatric Medical Assessment– This service will determine whether a consumer is eligible for psychological services including counseling and treatment for assessed needs.

Respite Care– This is temporary around the clock care for consumers that are usually cared at home by family members.

Service Plan Development– Team members will meet to determine if any customized goods and/or services are required for the consumer.

Specialized Medical Equipment, Supplies, & Assistive Technology– This service allows for equipment, supplies or assistive technology that increase the consumer’s ability to do activities of daily living or to interact with their environment.

Telemonitoring– This includes remote monitoring of a person and their vitals in their home from another location.

ABD: Aged, Blind, or Disabled

ADHC: Adult Day Healthcare Center

ADL: Activity of Daily Living

ABA: Applied Behavior Analysis

ASD: Autism Spectrum Disorder

BCBA: Board Certified Behavior Analyst

BSP: Behavior Support Plan

CC: Community Choices (waiver through DHHS)

CLTC: Community Long Term Care (division of DHHS)

CMS: Centers for Medicare and Medicaid Services

CRCF: Community Residential Care Facility

CTH: Community Training Home

CS: Community Supports (waiver through Office of Intellectual and Developmental Disabilities, formerly known as DDSN)

DHHS: The South Carolina Department of Health and Human Services

DDSN: Office of Intellectual and Developmental Disabilities in SC Department of Behavioral Health and Developmental Disabilities, formerly known as The South Carolina Department of Disabilities and Special Needs

DMH: Office of Mental Health, in SC Department of Behavioral Health and Developmental Disabilities, formerly known as The South Carolina Department of Mental Health

DME: Durable Medical Equipment

DSNB: Disabilities and Special Needs Board (Prior to 4-28-25, the state agency directing  the Department of Disabilities and Special Needs which is now within the SC Department of Behavioral Health and Developmental Disabilities.)

EI: Early Intervention

EPSDT: Early and Periodic Screening, Diagnosis, and Treatment

FFS: Fee for Service

HCBS: Home and Community Based Services

HASCI: Head and Spinal Cord Injuries

IADL: Incidental Activity of Daily Living

ICF/IID: Intensive Care Facility for People Intellectual Disabilities (also called a “regional center” in South Carolina)

ID: Intellectual Disability

LOC: Level of Care

MCO: Managed Care Organization

MHC: Mental Health Center

MCC: Medically Complex Children

NEMT: Non-Emergency Medical Transportation

NF: Nursing Facility

OCR: Office of Civil Rights

PCA: Personal Care Aide

PRTF: Psychiatric Residential Treatment Facility

RD: Related Disability

SCI: Spinal Cord Injury

SD: Similar Disability (related to either a Spinal Cord Injury or a Traumatic Brain Injury)

SLP: Supervised Living Placement

TBI: Traumatic Brain Injury

Date

[Managed Care Organization Appeals Department Contact Information]

Re: Request for Reconsideration of [Denial or Reduction] of Medicaid Services

Dear Sir or Madam:

I am writing to request that [Managed Care Organization] reconsider its decision to [deny or reduce Medicaid services]. A copy of the denial is enclosed.

I feel this decision was incorrect for the following reasons: [List reasons why your denial is incorrect. Focus on showing why the person needs the service and supply any supporting documentation available from doctors and other medical professionals. You can also list any other alternatives that were tried and failed to meet the person’s needs.]

I have attempted to resolve this issue by: [List any correspondence with case managers or reviewers involved in making the decision.]

I would like: [Describe your ideal resolution, i.e., approving the denied service.]

I request for my services to continue pending the outcome of the hearing. I also request a complete copy of my case file. Please let me know if you need anything further to proceed with this request.

Thank you very much for your assistance.

Sincerely,

(Signature)

Print Name:

Address:

Telephone:

Email:

cc:

Disability Rights South Carolina

3710 Landmark Drive, Suite 208

Columbia, SC 29204

Date

Office Director

Office of Intellectual and Developmental Disabilities

P.O. Box 4706

Columbia, SC  29240

Re: Request for Reconsideration of [Denial of Eligibility, Denial of Services, Reduction of Services] for [ID/RD, HASCI, or Community Supports] Waiver

Dear Office Director:

I am writing to request that the Office of Intellectual and Developmental Disabilities reconsider its decision to [deny eligibility, deny services, or reduce services] under the [ID/RD, HASCI, or Community Supports] Waiver program.  A copy of the denial is enclosed.

I feel this decision was incorrect for the following reasons: [List reasons why your denial is incorrect. Focus on showing why the person needs the service and supply any supporting documentation available from doctors and other medical professionals. You can also list any other alternatives that were tried and failed to meet the person’s needs.]

I have attempted to resolve this issue by: [List any correspondence with case managers or reviewers involved in making the decision.]

I would like: [Describe your ideal resolution, i.e., finding that the person is eligible for a waiver, approving services, etc.]

I request for my services to continue pending the outcome of the hearing. I also request a complete copy of my case file. Please let me know if you need anything further to proceed with this request.

Thank you very much for your assistance.

Sincerely,

(Signature)

Print Name:

Address:

Telephone:

Email:

cc:

Disability Rights South Carolina

3710 Landmark Drive, Suite 208

Columbia, SC 29204

Date

Division of Appeals and Hearings

Department of Health and Human Services

P.O. Box 8206

Columbia, SC  29202

Re: Request for Medicaid Fair Hearing

Dear Sir or Madam:

I am writing to request a Fair Hearing regarding the decision of [the Department of Health and Human Services, the  Office of Intellectual and Developmental Disabilities, OR specify a Managed Care Organization] to [deny eligibility, deny services, OR reduce services] through the [Medicaid program OR specify a Medicaid Waiver]. A copy of the denial is enclosed.

I feel this decision was incorrect for the following reasons: [List reasons why your denial is incorrect. Focus on showing why the person needs the service and supply any supporting documentation available from doctors and other medical professionals. You can also list any other alternatives that were tried and failed to meet the needs of the person.]

I have attempted to resolve this issue by: [List any correspondence with case managers or reviewers involved in making the decision.]

I would like: [Describe your ideal resolution, i.e., finding that the person is eligible for a waiver, approving services, etc.]

I request for my services to continue pending the outcome of the hearing. I also request a complete copy of my case file. Please let me know if you need anything further to proceed with this request.

Sincerely,

(Signature)

Print Name:

Address:

Telephone:

Email:

cc:

Disability Rights South Carolina

3710 Landmark Drive, Suite 208

Columbia, SC 29204