Public Notice of Final Action for Outpatient Hospital Drugs and Biologicals Payment Update

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

Effective on or after July 1, 2026, SCDHHS will amend the South Carolina Title XIX State Plan to update the payment methodology for outpatient hospital drugs and biologicals as follows:

• Certain outpatient hospital drugs and biologicals, designated as add-on drugs and biologicals, will be reimbursed based on the methodology outlined in Section 12.a (H) & (J) for physician-administered drugs in Attachment 4.19-B.
• These designated add-on drugs and biologicals will not be subject to the outpatient hospital multiplier.

SCDHHS is making this update to allow for separate reimbursement not subject to the outpatient hospital multiplier for specific add-on drugs and biologicals.

Based on the actions above, SCDHHS anticipates no budget impact.

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.