South Carolina Code of Regulations Chapter 126 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
Introduction
Chapter 126 of the South Carolina Code of Regulations governs the operations of the Department of Health and Human Services (DHHS), which administers Medicaid, the Medically Indigent Assistance Program (MIAP), and other health and human services programs in the state. The regulations are authorized under Section 44-6-90 of the South Carolina Code of Laws. The most recent amendments were effective as of May 25, 2018.
Key Articles and Provisions
Article 1 – Administration
Section 126-125 – General: Prohibits discrimination in DHHS programs based on race, color, national origin, handicap, or age, in compliance with federal civil rights laws.
Section 126-152 – Appeal Procedure: Outlines the process for individuals to appeal DHHS decisions, requiring a notice of appeal within 30 days of the agency's written notice
Article 3 – Medicaid
Section 126-310 – Hospital Services: Defines inpatient and outpatient hospital services covered by Medicaid, emphasizing medically necessary care certified by a physician.
Section 126-360 – General Requirements: Establishes eligibility criteria for Medicaid, including U.S. citizenship or lawful immigration status and South Carolina residency.
Article 4 – Program Evaluation
Section 126-401 – Sanctions: Lists administrative sanctions DHHS may impose on Medicaid providers for abuse or fraud, including educational interventions, claim reviews, and termination.
Section 126-425 – Beneficiary Utilization: Describes measures to address misuse of Medicaid services by beneficiaries, including restrictions and rights to appeal.
Article 5 – Medically Indigent Assistance Program (MIAP)
Section 126-510 – Application Process: Details the application process for MIAP, distinguishing between emergency and nonemergency admissions and specifying eligibility determination procedures.
Article 9 – Optional State Supplementation (OSS) Program
Section 126-920 – Eligibility: Sets forth eligibility requirements for the OSS program, including residency, disability status, and income/resource limitations.
Case Law and Judicial Interpretations
While specific case law directly interpreting Chapter 126 regulations is limited, the South Carolina Supreme Court has addressed issues related to health and human services regulations in various contexts. For instance, in Doe v. South Carolina Department of Health and Environmental Control, 2005 WL 3200861 (S.C. Ct. App. 2005), the court examined the application of state regulations in the context of public health services. Such cases illustrate the judiciary's approach to interpreting and applying administrative regulations within the framework of state law.
Conclusion
Chapter 126 of the South Carolina Code of Regulations establishes comprehensive guidelines for the administration of health and human services programs by the DHHS. Through its detailed provisions on administration, Medicaid, program evaluation, and assistance programs, it ensures that services are delivered efficiently and equitably to eligible individuals. While direct case law interpreting these specific regulations is limited, the foundational legal principles established in broader administrative law continue to influence their application and enforcement.
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