#4 assignment

Student Name:

Deidra Manning

Assignment #3 Title:

Selection of a state regulation; The unannotated South Carolina Code of Regulations

Agency Responsible:

The South Carolina Legislative Council; The State Health and Human Services Finance Commission through the MEDICAID

Incentives and Enforcement:

The main enforcements are observed through ensuring that only the service providers enrolled in the program are the ones which provide the services, therefore enrollment is controlled and regulated Clients must be eligible for Medicaid to receive the services. The residents of South Carolina recipients of the services can be referred outside the South Carolina area, when this happens, they must have a prior approval from a state agency administering the Medicaid Program.

Technical assistance for the personnel providing the services is contained in the South Carolina State Plan for Title XIX (Medicaid), provider manuals, Medicaid Bulletins, and federal directives. This gives directives on their usage serving as a guide to their usage.

Key Aspect of the Regulation #1:

This regulation: 126-304 Community Long Term Care Home and Community Based Services.

It sets out clearly the requirements of the service receiver who should be a Medicaid eligible person, eighteen years of age or older, who has been determined by community long term care to require a skilled or intermediate level of care.this regulation has an effect on health care proffssional since they are required meet the said conditions.

(2) Home delivered meals are the in home provision of at least one meal per day to persons unable to care for their nutritional needs. This has a financial implication to the provider institution and making transport arrangements on availing the meals to the homes of the recipients.

(3) Medical day care is a group of services to restore, maintain and promote the health status through the provision of ambulatory health care and health related supportive services in a licensed medical day care center. This group of services requires that systems be put in place to receive alerts of emergence and a response team which shall be on standby to attend to the emergencies as and when they arise.

Medical social services are supportive services provided by an individual with no less than a Masters Degree in social work. The legal of academical training is essential to the personnel providing this service, because it is specific to the academical requirement of the said personnel

Personal care is the in home provision of the necessary services in support of activities of daily living, home support, medical monitoring, and client transportation services to restore, maintain and promote health status. This specifically affects the provider institution because special arrangements have to made to ensure adequate trained personnel to adequately manage the home provision of services. In terms of the equipments required they must be enough to serve nearly all served homes.

Residential care is the provision of temporary institutional care for eligible clients living at home and cared for by their families or other informal support persons. This service will provide temporary relief for the primary care givers. The families and informal support persons must be given a basic training for service provision even if they are doing for a short time.

Service management includes assessment and reassessment, level of care of determination, service planning, service coordination, and counseling. This enables the providing institution to be efficient in service provision.

Key Aspect of the Regulation #2:

 The regulation on Dental Care consists of any covered preventive, surgical, therapeutic and emergency dental service provided by a licensed dentist. Only emergency dental services are available for recipients age twentyone years and over. The person providing this service must be trained dentist and licensed, therefore the providing institution must acquire the right personnel for the same. The insurance firms equally need to provide such a cover.

Key Aspect of the Regulation #3:

 In the regulation of Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services.

Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services are available to eligible Medicaid recipients from birth through the month they turn twentyone years of age. This program covers initial screening, periodic screening, diagnosis, and treatment. All services included in the Title XIX State Plan are available to those eligible. This cover has an age limit from birth to the month they turn twenty one years, therefore the clients in this category are the beneficiaries.

Key Aspect of the Regulation #4:

 In the regulation on Hospital Services.

A. Inpatient hospital services provided by the Medicaid Program are for the care and treatment of illness, injuries or disabilities certified medically necessary by a physician and reviewed for appropriateness of admission, length of stay and ancillary services, by the utilization review mechanism established by the State Health and Human Services Finance Commission.

B. Outpatient hospital services sponsored by the Medicaid Program is ambulatory visits for the care and treatment of illness, injuries and disabilities certified as medically necessary by a physician. This does not include routine dental services. Therapy may be provided on an ambulatory basis as a continuing part of an inpatient stay.

Key Aspect of the Regulation #5:

 126-311 Laboratory and Xray Services/Tests.

Laboratory and xray services/tests must be ordered by a professional practitioner within the scope of his/her practice with the expectation of making a reasonable medical determination.

Notated Copy of the Rules:

Attach the copy of the regulation that you have marked up.  Underline, highlight or note key sections. Mark them (1), (2), (3), etc. You may use technology to mark up in PDF or print, handwrite and scan the rules. Attach when you submit the assignment.