Due to the ongoing public health emergency related to the COVID-19 pandemic, South Carolina regulatory agencies have made multiple announcements regarding temporary waivers and expansion of services to aid healthcare providers and healthcare workers in their ongoing effort to combat the COVID-19 pandemic. The below information is subject to change and will be routinely updated as the public health emergency continues.
I. South Carolina Board of Medical Examiners
a. Waiver of Licensing Requirements for Out of State Providers:
The South Carolina Board of Medical Examiners is temporarily waiving South Carolina licensing requirements for physicians, physician assistants, and respiratory care practitioners licensed and in good standing in another state and whose services are determined to be necessary by the South Carolina Department of Health and Environmental Control (DHEC). The Board has indicated that this means South Carolina will permit these categories of out-of-state practitioners to treat South Carolina residents, in person or through telehealth technologies, to screen or treat patients for the coronavirus. The scope of permitted practice and treatment by these practitioners may expand during the course of the coronavirus emergency, subject to additional agency input.
Applications for a 90-day authorization to practice as either a Physician, Physician Assistant, or Respiratory Care practitioner are available here. Completed forms should be returned to medboard@llr.sc.gov.
This order is available for review here.
b. Joint Guidance Regarding Prescribing and Dispensing of Hydroxychloroquine, Chloroquine, and Azithromycin
The South Carolina Board of Medical Examiners and the South Carolina Board of Pharmacy issued guidance regarding the prescribing and dispensing of Hydroxychloroquine, Chloroquine, and Azithromycin:
- Physicians should not prescribe these drugs to themselves or family members unless faced with a bona fide emergency involving an actual diagnosis of a COVID-19 infection;
- Physicians should consider the stress placed upon the supply chain by prescribing these drugs prophylactically and that irresponsible prescribing can prevent patients actually diagnosed with COVID-19 from receiving these drugs.
- Physicians should include a bona fide diagnosis on any prescription issued for these drugs and could be subject to discipline for including an inaccurate diagnosis;
- Pharmacists should use their professional judgment in determining whether to fill such prescriptions, considering (1) the needs of patients previously prescribed these medications for conditions that have been approved by the FDA or for which have been historically used off-label to treat certain conditions and (2) the effect on the supply of these drugs prior to filling prescriptions.
This order is available for review here.
II. South Carolina Board of Nursing
a. Waiver of Licensing Requirements for Out of State Nurses
The South Carolina Board of Nursing has temporarily waived South Carolina licensing requirements for advance practice registered nurses, licensed practical nurses, and registered nurses licensed and in good standing in another state and whose services are determined to be necessary by DHEC.
This order is available for review here.
b. Suspension Enforcement of Certain Requirements Regarding NPs Engaged in Practice with Physicians in Border States
The South Carolina Board of Nursing is temporarily suspending enforcement of the requirement that an NP licensed in good standing in North Carolina and/or Georgia enter into a practice agreement or scope of practice guidelines with a physician licensed in South Carolina who is actively practicing medicine within the geographic boundaries of South Carolina in order to treat patients located in South Carolina.
Nurse Practitioners licensed in good standing in South Carolina, or for whom licensure requirements have been waived, may now treat existing patients in South Carolina via telemedicine, subject to the terms of their applicable agreements/protocols with their supervising/delegating/collaborating physicians in North Carolina or Georgia.
This order is available for review here.
c. Joint Guidance Regarding Prescribing and Dispensing of Hydroxychloroquine, Chloroquine, and Azithromycin
The South Carolina Board of Nursing and the South Carolina Board of Pharmacy recently issued the following guidance regarding the prescribing and dispensing of Hydroxychloroquine, Chloroquine, and Azithromycin:
- APRNs should not prescribe such drugs to themselves or family members unless faced with a bona fide emergency involving an actual diagnosis of a COVID-19 infection;
- APRNs should consider the stress placed upon the supply chain by prescribing these drugs prophylactically and that irresponsible prescribing can prevent patients actually diagnosed with COVID-19 from receiving these drugs.
- APRNs should include a bona fide diagnosis on any prescription issued for these drugs and could be subject to discipline for including an inaccurate diagnosis;
- Pharmacists should use their professional judgment in determining whether to fill such prescriptions – considering (1) the needs of patients previously prescribed these medications for conditions that have been approved by the FDA or for which have been historically used off-label to treat certain conditions and (2) the effect on the supply of these drugs prior to filling prescriptions.
This order is available for review here.
III. South Carolina Board of Examiners in Psychology
a. Waiver of Licensing Provisions
The South Carolina Board of Examiners in Psychology has announced that they are suspending enforcement of South Carolina licensing provisions for psychologists who are licensed out-of-state and have established client relationship with an individual now residing in South Carolina in order to allow the continuance of the therapeutic relationship by means of telecommunication. This notice is available for review here.
IV. South Carolina Medicaid
The below information is in addition to the blanket Section 1135 waivers issued by CMS as a result of the Emergency Declaration on March 13, 2020 by U.S. Department of Health and Human Services Secretary Alex Azar. A summary of these blanket waivers and additional information is available for review here.
a. South Carolina Section 1135 Waiver
South Carolina recently submitted a Section 1135 waiver application seeking a variety of administrative flexibilities related to the COVID pandemic. Portions of this application received initial approval form CMS on March 31, 2020. The following Section 1135 waivers granted by CMS below are effective March 1, 2020 and will terminate upon termination of the public health emergency.
Some of the approved Section 1135 Waiver Requests include:
- South Carolina is authorized to provisionally, temporarily enroll providers who are enrolled with another State Medicaid Agency or Medicare for the duration of the public health emergency subject to certain conditions. This waiver also applies to providers not already enrolled with another State Medicaid Agency or Medicare subject to certain conditions being met.
- CMS will allow certain facilities, including NFs, intermediate care facilities for individuals with intellectual and developmental disabilities, psychiatric residential treatment facilities, and hospital NFs, to be reimbursed for services rendered to an unlicensed facility (during an emergency evacuation or due to other need to relocate residents where the placing facility continues to render services) provided that South Carolina takes reasonable steps in the context of the current public health emergency, to ensure the health, safety, and comfort of beneficiaries and staff.
- Permitting prior-authorized services approved to be provided on or after March 1, 2020 to continue to be provided without a requirement for a new or renewed prior authorization, through the termination of the public health emergency.
The complete Section 1135 waiver request is available for review here.
b. Section 1115(a) Demonstration Waiver.
On March 27, 2020, South Carolina submitted a Section 1115(a) demonstration waiver to CMS with the goal of improving the state’s inpatient hospital capacity. This waiver has yet to be approved.
The waiver seeks to expand South Carolina’s inpatient hospital capacity by removing the financial disincentive for state correctional facilities to treat Medicaid-eligible, COVID-positive or suspected inmates in a correctional healthcare setting as opposed to a civilian healthcare setting. Ordinarily, Federal Financial Participation (FFP) is not allowed for services provided to inmates of correctional facilities unless such an inmate is treated in an inpatient capacity for at least 24 hours. South Carolina is requesting that FFP be made available for eligible inmates when inpatient care is provided in a medical facility under the control of a state correctional agency.
The waiver does not seek to expand Medicaid eligibility to inmates not currently eligible or to modify benefits available to Medicaid beneficiaries.
The Section 1115 Demonstration Waiver is available for review here.
c. Coverage of COVID-19 Testing, Waiver of Patient Cost Sharing, Enhancement of Pharmacy Benefits, Suspension of Ambulatory Care Visit Limit
- Effective for dates of service on or after February 4, 2020, SC Medicaid will reimburse for COVID-19 testing using HCPCS codes U0001 and U0002 without prior authorization or co-payment.
- Effective for dates of service on or after March 15, 2020, SC Medicaid will waive co-payments for all evaluation and management codes; pharmacies providing medications to fee-for-service beneficiaries may bypass early refill denials, as allowed by law; the annual limit of 12 ambulatory care visits is suspended; and the requirement that direct supervision by a physician, NP, or PA be provided for care delivered in infusion centers is waived.
This guidance is available for review here.
d. Telemedicine Coverage
South Carolina Medicaid has made several announcements regarding the expansion of coverage for telemedicine services.
- Temporary policy changes that provide coverage of additional telemedicine services administered by physicians, NPs, PAs, and licensed independent practitioners for certain services provided to an established patient. Click here.
- Temporary policy changes that provide coverage of additional evaluation and management services performed via telemedicine. Click here.
- Temporary policy changes that provide additional telemedicine benefits for Federally Qualified Health Centers and Rural Health Clinics. Click here.
- Temporary policy changes that expand behavioral health services covered through telemedicine. Click here.
V. Telemedicine
a. Schedule II and III Prescriptions:
The South Carolina Board of Medical Examiners is temporarily suspending enforcement on the prohibition on prescribing Schedule II and III medications via telemedicine without prior Board of Medical Examiners approval when the practitioner-patient relationship is established solely via telemedicine. The intent of this order is to encourage social distancing and to relieve burdens on the healthcare infrastructure.
The suspension of this enforcement applies to (1) physicians; (2) physician assistants (if authorized in a written scope of practice guidelines and otherwise allowed by law); and (3) advanced practice registered nurses if authorized in a written practice agreement, as authorized by the Board of Nursing, and as otherwise allowed by law. However, the practitioners must be permanently licensed in good standing in South Carolina and physically present in the South Carolina at the time care is provided.
All other aspects of the Telemedicine Act (S.C. Code Ann. 40-47-37) remain in effect and subject to Board enforcement. This includes but not limited to the South Carolina Prescription Monitoring Program. This order does not alter the standard of care for prescribing any medication or affect the practitioner’s obligation to comply with any and all rules, regulations, and statutes administered by other regulatory agencies.
This order is available for review here.
b. Medication-Assisted Treatment
The South Carolina Board of Medical Examiners issued an order temporarily permitting the use of telemedicine to initiate Medication-Assisted Treatment for patients diagnosed with an opioid use disorder via telemedicine in the following circumstances:
- For those practitioners previously approved by the Board to initiate Medication-Assisted Treatment via telemedicine without first requiring an in-person visit, such treatment may initiate via telemedicine without the need for an in-person visit provided that the initiation is documented in the patient’s chart and the practitioner sees the patient in-person within sixty days after the end of the public health state of emergency;
- Practitioners with an already established practitioner-patient relationship may provide treatment to existing patients by means of telemedicine
This order is available for review here.
c. Hospice Care Providers
The South Carolina Board of Medical Examiners has modified its policy on prescribing considerations for Hospice Care Providers. Traditionally, a licensed physician who is an employee or under contract with a Medicare-certified hospice program with a qualified hospice program director could prescribe up to a 14-day supply of medications for a certified hospice patient for the purpose of controlling symptoms prior to establishing a traditional patient-physician relationship by a direct physical examination.
In order to prevent the spread of COVID-19 to such patients, the Board has temporarily modified this policy to allow a hospice care physician to establish a physician-patient relationship via telemedicine, without the need for a direct physical examination.
This order is available for review here.
