Waiver Compliance FAQs

Waiver Compliance Frequently Asked Questions

Please see below for the current Home and Community-based Services (HCBS) Manual and applicable scopes of services for adult day health care (ADHC), personal care (PCS) and nursing services:

See answers to frequently asked questions for the following topics:

Advanced Directives

Can you explain the advanced directive requirements?
The South Carolina Department of Health and Human Services (SCDHHS) requires providers to give all participants information about advanced directives, such as living wills or do-not-resuscitate orders. Providers must obtain a signed statement confirming the participant has received this information. The provider must keep a statement on file signed and dated by the participant and the nurse supervisor during the initial supervisory visit.

Background Checks

What constitutes a violent felony?
Violent felonies are crimes against a person.

Can we hire an aide with a misdemeanor?
Per SCDHHS policy, misdemeanors are at the discretion of the employer, which is the provider agency. Providers may hire individuals with misdemeanor convictions if they choose. However, the South Carolina Department of Public Health (DPH) regulations include additional requirements regarding allowable convictions. Providers must ensure they comply with both SCDHHS policies and DPH health regulations.

Can a two-year background check be done any day within the month it is due?
Yes. Updated background checks must be completed before the due date, which is two years from the date of the previous check.

What kind of background check is required?
A South Carolina Law Enforcement Division (SLED) background check is required for anyone who has lived in South Carolina for the last 10 years. If the employee has lived outside of South Carolina in the last 10 years, a background check must be conducted for every state in which that employee lived during the 10-year timeframe.

Backup Plan

What is the backup plan? What information must it contain?
The backup plan outlines the steps the provider’s agency will take to ensure the participant receives authorized services if their regular aide is not available. For example, if an aide calls out, providers can document in the narratives in the Phoenix Provider Portal (Phoenix) whether a backup aide was offered but the participant refused, whether the backup aide was sent or whether no backup aide was available. Participants have the right to refuse the backup aide if their regular aide is unavailable.

Compliance Process

How often are reviews completed?
Compliance reviews typically occur every 18 to 24 months. However, the timeframe may be shorter depending on the agency’s last compliance score. Agencies with a score of 400 or higher are usually reviewed again within six months. Agencies with a score below 400 are generally reviewed again within 18 to 24 months. Compliance reviews can happen at any time, so providers should ensure records are always maintained in a condition that allows them to be produced upon request, per policy requirements.

When will we receive our final review finding after the compliance review?
The timeline depends on when providers receive their first initial review finding. Providers usually have two to three weeks to submit a corrective action plan (CAP). Once SCDHHS receives the CAP, compliance staff members review it, determine if any points can be returned and complete the CAP response. Final findings must then be reviewed by the Compliance Action Committee, which meets once a month. Because of this schedule, providers may not receive final findings until the committee has met and approved of them. In most cases, providers should expect to receive final findings about six weeks after receiving their initial review findings.

What types of audits can providers expect?
Provider adherence to SCDHHS enrollment requirements, contract requirements and any applicable policy or procedure is monitored by several different offices within SCDHHS. Provider Administrative and Billing Manual, pg. 22, “Medicaid providers must make records accessible and available for review during a provider’s normal business hours or as otherwise directed, with or without advance notice by authorized entities and staff as described in this section. An authorized entity may either copy, accept a copy, or may request original records. Any requested record(s) is deemed inaccessible if not available within two (2) hours of the request when requested by an authorized entity. The health record shall be accessible at the provider’s service address as documented by the SCDHHS provider enrollment record. It is the responsibility of the provider to transport/send records to the place of service location as documented by the SCDHHS provider enrollment record.”

Have the sanctions for compliance findings changed?
Yes, sanctions have been updated.

For new providers receiving your first review:

A score between 50 and 100 requires a CAP.
A score between 100 to 399 requires a CAP and mandatory educational training.
A score of 400 or higher requires a CAP, mandatory educational training and a 90-day suspension of new referrals.

For providers undergoing routine reviews (prior review requiring the agency to take mandatory educational training):

A score between 50 and 100 requires a CAP.
A score between 100 to 399 requires a CAP and mandatory educational training.
A score of 400 or higher on a second review results in termination of the provider's Medicaid enrollment.

In addition, three consecutive review scores of 100 or more are also grounds for termination.

If the compliance review finds the right to complain or advanced directives were not completed correctly, will the provider be docked points for other clients who were updated?
No. During a compliance review, advanced directives and the right to complain documentation are evaluated only for clients in the review sample. Points are added only when required documents, the right to complain and the advance directive paperwork are missing or incorrect for one of those participants. If a deficiency is found, providers should not go back and correct older records. The compliance team will look for correct completion from the CAP moving forward. Agencies may choose to complete a new form after a review, but that is at the discretion of the agency. Routine reviews will review the new participants that have started services since the last corrective action plan was implemented.

Can the time until the next review be longer than 24 months?
Yes. Although reviews typically occur every 18 to 24 months, the timeline can be longer if the previous score was strong and higher priority reviews are needed elsewhere. However, SCDHHS may conduct a compliance review at any time, unannounced.

Is there a standard checklist all compliance officers use during reviews, or does it vary by reviewer?
Compliance officers use standardized materials for consistency across reviews. Providers receive a standardized onsite letter at the beginning of the compliance visit and reviewers follow a step-by-step guide that outlines how to answer each compliance question. If providers have questions about requirements, they can email provider-distribution@scdhhs.gov for policy-related questions or BOQTraining@scdhhs.gov for assistance from the compliance team.

Is it ok to utilize electronic record keeping?
Yes. SCDHHS no longer requires prior approval for electronic record keeping. Providers must ensure the electronic record-keeping system meets all scope requirements, including staff being able to sign with appropriate electronic signatures, daily task sheets for all services provided and an acceptable backup system to prevent data loss. Providers can also use a hybrid record keeping system, such as electronic staff records and paper participant records. Providers must be able to produce all requested records.

Why is the compliance review based on documentation?
SCDHHS has specific scopes of services regarding what documentation is required. For compliance reviews, SCDHHS looks at provider records to ensure:

Provided services are documented,
Staff met minimum requirements set by the SCDHHS, and
Administrative requirements are followed.

When the compliance team conducts a review, the sanction of recoupment is not in our allowable sanctions. The compliance team can require CAPs, training, suspensions or terminations. Program Integrity (PI) has the authority to impose recoupment as a sanction for the same documentation findings the compliance team may find if fraud, waste and abuse is suspected. PI can also report a provider for investigation if fraud is suspected.

Is your reviewer the same every time?
Not necessarily. The compliance strategic plan is created annually, and providers are assigned based on the required reviews in the strategic plan.

DPH Regulations

Can DPH do inspections between 9 a.m. and 5 p.m. when we are only required to be open from 10 a.m. until 4 p.m.?
Please visit DPH’s website to find out how DPH inspects and certifies healthcare facilities.

Are Purified Protein Derivative tests (PPDs) required?
Please visit DPH’s website to find out how DPH inspects and certifies healthcare facilities.

Employee Files

Does SCDHHS look for items in a certain order in the employee file?
Yes. SCDHHS policy requires records to be in reverse chronological order. This means the most recent or newest items are placed at the top or front of the file, and older items follow in backward succession. SCDHHS does not regulate the order in which documents appear, only that the file be in reverse chronological order.

If the personal care aide is not a certified nursing assistant (CNA), do they still need a reference check through the CNA registry?
Yes. Even if the potential employee is not a CNA, the agency is required to run a South Carolina CNA registry check. SCDHHS does not require aides be CNAs, but the registry check could show no results, an active license or an expired license. If the registry shows a revoked license, it indicates they have done something that would revoke their license and prevents them from providing services to Medicaid participants.

Does the nurse have to complete skills testing reviews for personal care aides and CNAs yearly?
Aides are required to have a competency evaluation prior to hire and after hire they must have 10 hours of in-service training per calendar year that is prorated the first year. All required training must be completed by Dec. 31 of each calendar year. The requirement resets Jan. 1. Skills testing can count toward the 10 required hours if it is documented on the Annual In-service Training Documentation form required by SCDHHS. The form must include the date, title of the training, hours earned, signature of the trainer, signature of the employee who's taking the training and a nurse supervisor’s signature.

How do we complete personal care competency evaluation and in-service documentation in Phoenix?
There is no way to complete them in Phoenix. Providers are required to complete the competency evaluation documentation form and maintain the form in the employee record.

Can employees earn training hours when participating virtually?
Yes, but providers must have at least four in-person training hours per calendar year. The remaining six hours can be completed virtually or through self-study.

Can we use our own online forms for annual trainings if the aide checks off completed topics and the registered nurse (RN) signs and dates the form?
No. As of Nov. 1, 2022, SCDHHS requires the Annual In-service Training Documentation form to be used for all in-service training documentation in the aide’s file. Any form required by SCDHHS cannot be altered in any way and will not be accepted if modified in any way.

Does administrative staff need CNA registry checks as well?
Yes. Any staff member, including administrative staff, who will have contact with Medicaid participants, must have a background check, CNA registry check and an Office of the Inspector General (OIG) Exclusion List check.

How long do employee records need to be kept in hand for audit purposes?
Providers must maintain all employee records for four years past the last billed date, as required by administrative and billing policies.

Nurse Supervisory Visits

When will the universal review start pulling data for nursing?
Phoenix automatically populates two reviews annually: Jan. 15 and July 15. The January review pulls data from July 1 to Dec. 31 of the previous year. The July review pulls data from Jan. 1 to June 30 of the current year.

A universal review populates as a part of the compliance review and will pull the data for that specific review period. The universal review will look at the initial, 30-day and ongoing supervisory visits required during the review period. It will also review if the aide was present for at least one nurse supervisory visit every 12 months.

Do supervisory nurses need to receive the same in-service hours as caregivers or do they just need an application?
For personal care services, the nurse is not required to have any kind of in-service training for that supervisory nurse. Their nursing license qualifies them to provide supervisory services.

Are nurse supervisory visit due dates determined from Phoenix or the last visit date in Electronic Visit Verification (EVV)?
Visit due dates are based on the EVV clock-ins completed by the nurse supervisor. The universal review uses EVV data to verify the initial supervisory visit, the 30-day visit and ongoing supervisory visits.

The initial supervisory visit: Must happen before the start of services. It may be on the same day services begin, but the supervisor must clock in and complete the visit before the aide arrives.
30-day visit: Must occur within 30 days of the start of services.
Ongoing visits: Due every four months, based on the last EVV clock-in date, with the deadline set as the last calendar day of that month.
Example:
- Initial visit: Feb. 10; services begin Feb. 12, the 30-day visit is due by March 14.
- If the 30-day visit happens early on Feb. 28, that is acceptable. The next supervisory visit will be due in four months from Feb. 28 and due by June 30.
- If the next visit occurs early on May 15, the following one is due four months from May 15, by the last day of that month.

In all cases, the due date is always determined from the most recent EVV clock-in.

Is the provider’s plan of care created by the registered nurse (RN) during the initial visit or are providers utilizing the plan of care completed by case manager?
For providing personal care services, your task list is what that nurse supervisor will complete during that initial supervisory visit. The task list must be based on the service plan that is provided by that case manager. Any intervention that is on the service plan that requires personal care or children’s personal care to complete should be listed as a task for the aide to complete for that participant.

For providing nursing services, the nurse supervisor must be an RN. The nurse supervisor must create a plan of care based on the physician, physician assistant or nurse practitioner’s orders. Those orders must be in place before services start. The nurse supervisor can receive verbal or physical orders from the physician, physician assistant or nurse practitioner. Physical orders must be signed on or before the effective date of the plan of care. If verbal orders are received, the nurse must sign and date the plan indicating the verbal orders were prior to the start of services. The physician, physician assistant or nurse practitioner must sign the plan of care within 30 days of the verbal order signature. The order and/or plan of care is not valid if both signatures are not correct.

Is the universal review pulling the nurse supervisory visits for nursing services?
No. The universal review in Phoenix does not link to the nurse supervisor’s use of EVV for nurse supervisory visits. It only pulls for children's personal care and adult personal care because those services have a schedule for when nursing is required. Nursing services do not have a set schedule for supervisory visits. For nursing, the RN supervisor must complete an initial supervisory visit before services begin. After that, the RN determines the ongoing supervisory schedule, as long as visits occur at least once every 90 days. During a compliance review, SCDHHS will do a manual check of EVV usage to verify the required supervisory visits.

How can we see the results for the universal view in Phoenix?
In Phoenix, open the dashboard and select the Compliance Reviews tab. This section lists all review types: universal, initial, routine or special. Your universal score for personal care and children's personal care will appear there. To view details for any review, click View next to the review you would like to see.

How do you correct a missed supervisory visit if the participant was not available?
If a participant is unavailable, such as being hospitalized or out of town, and you have documentation showing they were not receiving services when the supervisory visit was due, policy requires the missed visit to be completed within five business days of the participant becoming available again.

If the participant is still receiving services but is not responding to attempts to schedule the visit, the nurse supervisor should contact the case manager for assistance, since supervisory visits are a required part of the service and the participant must allow access.

If there is a break in services longer than 60 days, the agency must complete a new initial supervisory visit before services resume.

Can a licensed practical nurse (LPN) sign task sheets?
For personal care services, an LPN or RN can be the nurse supervisor, so an LPN can sign task sheets, conduct supervisor visits, etc. For nursing services and children’s personal care, an RN is required and an LPN cannot sign task sheets or provide any services to children's personal care participants.

Can the supervisor use a digital signature for electronic files?
Yes. Digital signatures are allowed as long as they meet the requirements outlined in the Provider Administrative and Billing Manual on pg. 27.

How are nurse visits checked for the Office of Intellectual and Developmental Disabilities (OIDD) clients?
Compliance staff members review the participant’s record to confirm that supervisory nurse visits were completed. Each file should have documentation showing the visit happened and what was reviewed during the visit.

How early can supervisory visits be completed?
Supervisory visits may be completed when they are required/needed. There is no limit to how early a supervisory visit can happen. Visits can always occur early, just not late. However, completing a visit early will move the next due date up because the timing of each supervisory visit is based on the most recent EVV clock-in.

Can a nurse practitioner be a nurse supervisor?
Yes. A nurse practitioner can be a nurse supervisor if they are currently licensed in South Carolina.

If a nurse is contracted as a travel nurse and has certification for 45 states, does the nurse need a South Carolina license in the file or is any state license acceptable?
The nurse must hold a multi-state license through the Nurse Licensure Compact and South Carolina must be included in the states covered by that license. If the nurse only has a single-state license from another state, they must also be licensed in South Carolina to provide services to Medicaid participants.

Nursing Services

How do we obtain physician orders before initiating nursing services when orders come from case managers sometimes and other times they may not?
The need for medical orders depends on the type of service.

For personal care services: No physician order is required. Licensure prohibits providers from providing skilled services. Tasks are based on the participant’s service plan and what kind of activities of daily living they need assistance with. Case managers do not issue physician orders. Providers will give a service plan and authorization.
For nursing services: These are skilled services. Before services can begin, a valid order must come from a prescribing physician, physician assistant or nurse practitioner. SCDHHS accepts any kind of prescribing orders from the doctor's office. A completed plan of care by that physician, physician's assistant or nurse practitioner is also accepted as a skilled nursing order.

Nursing services cannot start without a prescriber’s order. Sending a nurse without the appropriate nursing order puts their license at risk because skilled services may not be provided without a prescriber’s order. Nurses must obtain the prescriber order before the start of service and again at least every 90 days thereafter.

What must be submitted to the case manager for skilled nursing?
Providers must submit any records requested by the case manager. This can include, but is not limited to, the plan of care, the Private Duty Nursing Monthly Summary form, the Private Duty Nursing Supervisory Visit form and nursing notes.

What training is required for nursing services?
Nurses must receive training specific to the participant’s needs. If the participant has a tracheostomy, mechanical ventilator, gastric tube, jejunostomy tube or indwelling catheter, the nurse must be trained on how to safely care for that participant’s device and condition.

Personal Care Scopes

Is there a way to include more information about the requirements from OIDD?
OIDD is contracted with SCDHHS to provide services for specific waivers. Providers serving OIDD participants will need additional, OIDD-specific training on anything that is different. For personal care and nursing services, providers are required to follow SCDHHS’ scope of services. Currently, OIDD does not require a service plan. Instead, services must be based on an assessment received from the case manager. Because OIDD does not currently use EVV, task sheets must include time in and time out to document services provided to participants.

Does the provider need to update the service plan when the case manager updates Medicaid service yearly?
Yes. Providers are required to have an updated service plan in the participant’s record. Whenever Phoenix notifies you that the service plan has been updated, you should print it and place it in the participant’s record. The nurse supervisor should review and update that participant’s task list based on the current service plan. The aide should be informed of the updated needs of the participant. The previous service plan should be maintained in the participant’s record since tasks sheets for that period must reflect the service plan at that time.

If the provider is utilizing the Activity Tasksheet report in Phoenix and a resolution is entered, can the nurse supervisor sign the task sheet and add documentation for the resolution day or does the provider have to utilize a paper task sheet?
The nurse can update the Activity Tasksheet report with the task provided if they initial and date the changes. An updated Activity Tasksheet report or a paper task sheet must be in place for every day a resolution was submitted. The nurse supervisor must sign and date the task sheet within two weeks of service provision verifying they have reviewed the task sheet, and it must be filed in the participant’s file within 30 days.

Which form is required for competency testing?
SCDHHS has issued a required Competency Evaluation Documentation form that must be completed with the aide before hiring. SCDHHS does not provide curriculum or tests to ensure the competency of the aide. That is the responsibility of the provider. If that aide leaves the agency and comes back, they should be treated as a new hire with a new competency evaluation completed in full. The competency evaluation must be administered by either an LPN or RN. If the LPN completes the competency evaluation, the RN must sign to verify completion. No other staff can complete the evaluation, including an office manager, owner or the administrator, unless they are licensed LPNs or RNs. After hire, the annual in-service training documentation form is utilized to document the 10 hours of in-service training required per calendar year.

Is a service plan considered the plan of care for personal care and children’s personal care (CPCA)?
Yes. For personal care and CPCA services, the task list is considered a plan of care. The task list must be based on the service plan provided by the case manager and reflect the participant’s authorized needs.

The children’s personal care service does not have a set schedule, so how can you determine if services were not provided as authorized?
Phoenix will not generate a missed visit for CPCA services because there is no scheduled visit time. However, CPCA services have an authorized amount per week, and Phoenix uses that to determine compliance.

An F2 code will generate when the participant receives fewer hours than authorized.
Any hours worked beyond 40 hours in a week are not payable and will generate an F-code, indicating the services provided are more than the authorized service amount.

If an F2 code is on a claim after the week is over, it means the agency did not provide services as authorized. Providers should maintain documentation showing the case manager was notified of the reason why services were not provided as authorized.

What should we do if the participant does not want the aide to perform certain tasks listed in the service plan during the nurse’s intake?
Agencies must follow policy requiring providers to notify the case manager of any changes in a participant’s condition and refusal of service. If there is a task on the service plan the participant is refusing or if the participant is asking for a task that is not on the service plan, the agency should notify that case manager. It is then the case manager’s responsibility to reassess and determine if there are any changes required to the service plan.

In-home care agencies cannot update the service plan, but they must maintain documentation showing the case manager was notified of the participant’s request for refusal.

Can the office manager sign task sheets?
No. Policy requires the nurse supervisor to review, sign and date the task sheets within two weeks of service provision. For personal care services, the nurse supervisor can be an LPN or RN and can sign the task sheet. For children's personal care, policy requires the nurse supervisor to be an RN, so an LPN cannot conduct any supervisory tasks for that service.

If staffing has changed, do we have to submit a new organizational chart?
Policy requires agencies to update the organizational chart as needed and have it available upon request.

Can you clarify the policy for the 10-year driving record?
Transportation is not required by in-home care agencies. If an agency chooses not to provide transportation, participants who require it may select another provider. If an agency does provide transportation, it must maintain a 10-year driving record and a valid driver's license in the employee file for any aide providing transportation.

Is it expected that we will print out conversations in Phoenix and place them in the participant’s record?
No. Conversations submitted in Phoenix are considered part of the record. They do not have to be printed and placed in the physical record.

Can you go back and print a service plan?
No. Once a new service plan is issued, the old service plan is no longer available to provider agencies in Phoenix. Agencies should print the service plan when the authorization is received and again when Phoenix notifies you that a new service plan has been completed.

I have a client with a chronic condition that requires wound care. Is the aide allowed to wrap the legs and check wound care on the task sheet if trained by a nurse in wound care?
No. Wound care is considered a skilled service under DPH regulations. Personal care aides cannot provide skilled services, even if trained by a nurse. If a participant needs wound care, nursing services should be authorized and provided by a licensed nurse.

Where can providers access the new CPCA Scope of Service and forms?
Providers can access policies and forms on SCDHHS’ website, under "Providers." The HCBS Manual is listed on the Provider's Manual List.

In section one of the manual, use the forms link to find all SCDHHS forms, including the new CPCA forms.
In section three, providers can find all scopes of service.

If a client comes in as a smoker and the caregiver does not want the client to smoke, do we need a doctor's order to prohibit their smoking?
No. You cannot prohibit a client from smoking in their own home. Participants have the right to smoke, and aides must respect that right. If an aide is uncomfortable working in a home where the participant smokes, the agency may assign the aide to a different participant.

Can a stepparent be a paid caregiver for children’s personal care or personal care services for their stepchild?
It depends on the age of the participants. If the stepchild is 18 or older and has not been deemed incompetent, the stepparent can provide services. If the stepchild is under 18, the stepparent is prohibited from being the paid caregiver.

How far in advance do you have to request additional authorized hours for a participant who has a medical appointment?
Requests should be submitted prior to the provision of additional services, as far in advance as possible so authorization can be updated before the appointment.

Are waivers taking longer to be implemented?
Yes. As of Jan. 1, 2026, a waiver amendment approved by CMS places a cap on the number of participants who can be served in waivers. This means new individuals cannot be enrolled unless they meet the waiting list requirements. All new applications are assessed and then placed on the waiting list. This does not affect authorization for participants who are already enrolled. If a provider received a referral and authorization for a current waiver participant, the provider can provide services. Please see waiver document here:

If we provide personal care or CPCA and want to add respite, is a separate sign-up required?
No new enrollment application is required to add respite services. Respite can be added to a current personal care contract through a contract amendment. To request the change, email provider-distribution@scdhhs.gov. They will be able to notify you of any steps required to add the service.

SCDHHS Contacts

Who can we email if we have a policy question?
Questions around policies can be emailed to BOQTraining@scdhhs.gov.

ADHC Services

Do scope requirements for ADHC also include drivers who are part of your non-emergency medical transportation (NEMT) service?
No. NEMT is contracted through ModivCare. SCDHHS does not review NEMT drivers. ModivCare is required to review and approve any of its contracted providers. Agencies should make sure the driver has met all the minimum requirements for ModivCare.

EVV

Is OIDD getting an EVV service?
Yes. A new EVV service has been procured. They are currently in the process of ensuring the EVV system will meet SCDHHS requirements. Once the system is ready to be deployed, training will be provided. This training will be announced in a bulletin issued by SCDHHS. Providers can sign up to receive bulletins by registering their email on SCDHHS’ website.

Will a companion be able to document tasks in the new EVV system?
Currently, a companion cannot document tasks in the EVV system. If the new EVV system changes how providers document services, training will be provided.

How does a provider update the counties it serves in the Phoenix portal?
Providers can email provider-distribution@scdhhs.gov to request changes. Counties can be added or removed at any time.

What should we do if the EVV system does not allow an employee to clock in/clock out?
If there are any issues with the EVV system, the worker should contact the EVV helpdesk at (800) 441-4667 to report the issue. The EVV helpdesk is open 24 hours a day, seven days a week.

Are supervisory visits documented in Authenticare or Care Call?
Supervisory visits must be documented in the EVV systems either through Authenticare or Care Call. SCDHHS is mandated by the federal government to use EVV to verify services are provided according to scope and at the required location. The nurse supervisor must clock in utilizing either Authenticare or Care Call for every supervisory visit, but they do not have to clock out because the visit nonbillable. SCDHHS just needs to verify the supervisor was present at the correct location.

If the nurse forgets to clock in for their assessment and the provider notes it in the Phoenix portal, is the assessment recognized in the system?
No. The nurse supervisor is required to clock in to the EVV system. There is no resolution process for missed EVV clock-ins for supervisory visits.

How should providers manage excessive codes by the personal care aide?
The EVV system creates different error codes based on specific rules for provision of services. In-home care providers can run reports in Phoenix to see what codes have generated for any claim line. Each report has a key explaining any applicable error codes. Case managers are required to review any codes generated and address any patterns with the provider. Providers are expected to monitor any codes and address patterns with the aide, provide required training and ensure patterns discontinue.