Public Notice of Final Action for End-Stage Renal Disease (ESRD) Clinic Reimbursement Methodology

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding reimbursement methodology for ESRD clinics under the State Plan under Title XIX of the Social Security Act for Medical Assistance Program (Medicaid).

Effective on or after July 1, 2026, SCDHHS will amend the South Carolina Title XIX State Plan to update the reimbursement methodology for ESRD clinics to an all-inclusive rate set at 80% of the CY2025 Medicare Prospective Payment System rate. The all-inclusive rate includes the following services:

1. Dialysis treatment
2. Equipment, supplies and costs of providing care, including staff time
3. Training in facility
4. Laboratory services
5. Drugs and biologicals (including those approved by Medicare under Transitional Drug Add-on Payment Adjustment) and their oral or other form of administration.

SCDHHS is making this update to ensure better access to ESRD services.

Based on the actions above, SCDHHS anticipates an annual cost of approximately $3.9 million total dollars.

Copies of this notice are available at each South Carolina Healthy Connections Medicaid county office and at www.scdhhs.gov for public review. Additional information regarding these actions is available upon request at the address cited below.

Any written comments submitted may be reviewed by the public at the SCDHHS, Office of Health Programs, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9 a.m. and 5 p.m.

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