SCAM ALERT

Healthy Connections Medicaid team members and managed care plans will never ask for money, gift cards or something else of monetary value via text, email or a phone call. If someone contacts you asking for something of monetary value to get or keep Medicaid coverage, please report it by contacting the Medicaid fraud hotline at (888) 364-3224 Monday through Friday from 8:30 a.m. to 5 p.m. or by sending an email to FraudRes@scdhhs.gov.

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Waiver QA, Training, and Compliance

The Waiver QA, Training, and Compliance team conducts ongoing monitorship of provider compliance with SCDHHS policies and scopes of services. 

Waiver Compliance  

Compliance reviewers conduct unannounced site visits to personal care, adult day health care, and private duty nursing providers. Reviewers will request a sample of staff and participant records in addition to administrative records. During the site visit, reviewers will scan any paper files and give the provider a secure drop link to upload any electronic records. Per the Administrative and Billing Manual providers have 2 hours from the request to submit any requested documents. Reviewers will allow the providers until 5:00 pm on the date of the site visit to upload any electronic records. Records will be reviewed after the site visit to ensure that they meet the scope of services. Service Scopes can be located in the Home and Community Based Services (HCBS) Manual in Section 3: Eligible Providers. Compliance review scoring and sanctioning process can be located in the Home and Community-based Services (HCBS) Provider Manual in Section 4: Quality Assurance.

Providers can email provider-distribution@scdhhs.gov with any policy related questions. Compliance questions can be sent to LTLCompliance@scdhhs.gov Currently enrolled providers can email BOQTraining@scdhhs.gov to request training at any time.

Case Management Quality Assurance and Training

Case Management Training is conducted for new case managers on the every other month. Training is designed to assist case management agencies with ensuring new case managers understand their responsibilities for service counseling, service planning, service coordination, monitorship, and re-evaluation for waiver participants in the Community Choices, HIV/AIDs, and Mechanical Ventilator Dependent Waivers. New case managers must meet the enrollment requirements as outlined in the Case Management Scope of Services that can be located in the Home and Community Based Services (HCBS) Manual in Section 3: Eligible Providers. Case Management agencies must demonstrate that the new case manager has met the experience requirements as outlined prior to training. Providers can email CMTraining@scdhhs.gov with any questions.

  • Upcoming Training Opportunities
    • 2026 New Case Manager Trainings
      • March 9, 2026 through March 13, 2026  
        • New Case Manager Requests will be open from January 5, 2026 through February 28, 2026  
    • June 8, 2026 through June 12, 2026  
      • New Case Manager Requests for June training will be open from April 1, 2026 through May 31, 2026  
    • September 14, 2026 through September 18, 2026  
      • New Case Manager Requests  for September training will be open from July 1, 2026 through August 31, 2026  
    • December 7, 2026 through December 11, 2026  
      • New Case Manager Requests for December training will be open from October 1, 2026 through November 31, 2026.   
  • Past Training

External Waiver Quality Assurance

Medically Complex Children's (MCC) Quality Assurance

Reviewers conduct desk reviews of care coordination records to monitor compliance with the MCC Waiver requirements as outlined in the MCC Waiver Document. Reviewers review records in Phoenix Case Management system to ensure level of care, service planning and monitorship, and health and wellbeing waiver requirements are met.

On Demand Training (Coming Soon)