Highlight on South Carolina: New prescribing requirements and project to reduce pre-term births announced

South Carolina has announced a change to its Medicaid program to require verification of controlled substance usage prior to writing a prescription and a new $30 million project designed to reduce preterm births and prevent child injury for first-time mothers.

Medicaid Controlled Substance History Verification

Starting April 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will require that Medicaid providers verify members’ controlled substance prescription history by consulting the South Carolina Reporting and Identification Prescription Tracking System (SCRIPTS) database before issuing prescriptions for any Schedule II through IV controlled substances, including opioids.

SCRIPTS is administered by the South Carolina Department of Health and Environmental Control (SC DHEC), which monitors prescribing patterns. Through SCRIPTS, providers are able to view information on a patient’s filled prescriptions for controlled substances, as well as the identities of the prescriber and the dispenser. SCRIPTS is not a new database, but until now its use was optional. Under the new requirements, the failure to consult SCRIPTS may result in the loss of Medicaid payments and referral to appropriate licensing boards if the provider has serious or persistent compliance problems. For patients who require long-term use of controlled substances, SCDHHS requires that SCRIPTS be consulted when initially prescribed and at least every 90 days thereafter.

The following instances are exempt from the verification requirement: (1) issuance of less than a five-day supply of a controlled substance; (2) issuance of a controlled substance prescription to a Medicaid member who is enrolled in hospice; and (3) instances where a controlled substance is administered by a licensed health care provider, such as during an office visit or for a resident of a nursing facility.

Nurse-Family Partnership

South Carolina officials and leaders from the private sector have announced the nation’s first Pay for Success project aimed at improving health outcomes for mothers and children living in poverty. The project mobilizes $17 million from philanthropic funders and $13 million from Medicaid via a 1915(b) Medicaid Waiver awarded to the SCDHHS by CMS.

The project will expand the Nurse-Family Partnership’s evidence-based program to an additional 3,200 first-time mothers and their babies enrolled across South Carolina over the next four years, a significant increase over the 1,200 families currently benefiting from the high-impact intervention.

Under the project, vulnerable first-time mothers are coupled with registered nurses who have specialized training in maternal and child health. Through home visits that take place from early pregnancy through the child’s second birthday, the nurses support mothers in having healthy pregnancies, becoming knowledgeable and responsible parents, and giving their babies the best possible start in life.

The goals of the project are to reduce preterm births, decrease child hospitalization and emergency department usage due to injury, improve healthy spacing between births, and increase the number of first-time mothers served in the lowest-income communities. It is also hoped that through strengthening families and improving early childhood development, the project will spark multigenerational change and help break cycles of poverty.

In Pay for Success projects, also called Social Impact Bonds, funders provide upfront capital to expand social services and government pays for all or part of a program only if it measurably improves the lives of participants. In some Pay for Success projects, investors earn a small return on their investment. In this project, the funders are recycling any returns back into Nurse-Family Partnership services in South Carolina. The evaluation of the project will be led by J-PAL North America, a research center at the Massachusetts Institute of Technology.

The private and philanthropic funders for the project include: BlueCross BlueShield of South Carolina Foundation, The Boeing Company, The Duke Endowment, Greenville First Steps, and the Laura and John Arnold Foundation.