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South carolina department of health and human services medicaid policy and procedures manual


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101.12.01 Case File Requests (Rev. 10/01/13)

A Medicaid case file may be requested by any Department of Health and Human Services staff as well as staff from Medicaid Eligibility Quality Assurance (MEQA) and Payment Error Rate Measurement (PERM).





Procedure for Case File Request from DHHS Staff (such as Office of General Counsel (OGC), Third Party Liability (TPL), Division of Appeals)
Originating Location:
Once DHHS staff makes a request via phone, e-mail, or fax,

  • Within 10 days of the date of the request, the originating location will complete Section I of the DHHS Form 3205 ME, Case Request/Transfer Form, for each requested case file.

  • The originating location will include the completed DHHS Form 3205 ME with the physical case file when it is sent to the requestor.

    • The originating location will ensure the security and confidentiality of case file information while the case file is in transit.

    • Case files will be packaged such that unauthorized personnel cannot readily access protected health information. All packaging will be marked “Confidential.”

    • Case files will be transported either by a contracted courier service or by United States Postal Service.


Receiving Party (DHHS Staff):

  • The receiving party will complete Section II of the DHHS Form 3205 ME upon receipt of the case file. They will acknowledge receipt of the case file by returning a copy of the DHHS Form 3205 ME to the originating location via courier or fax within (3) working days.

  • The receiving party will return the original case file to the originating location within 15 (working) days. The original DHHS Form 3205 ME with Sections I and II completed, must be attached to the case file.

  • The originating location will return a copy of the DHHS Form 3205 ME to DHHS staff within (3) working days acknowledging that cases have been received.


Procedures for Medicaid Eligibility Quality Assurance (MEQA) and Payment Error Rate Measurement (PERM) Staff:

  • MEQA staff will email the DHHS Form 3205-A ME, MEQA/PERM Request for Records, requesting cases for the review.

  • Within 10 days of the date of the request, the originating location will send original case files via DHHS courier to the State DHHS office for pick up by MEQA staff.

  • Case files will be packaged such that unauthorized personnel cannot readily access protected health information while the case file is in transit. All packaging will be marked “Confidential.”

  • MEQA staff will copy the case files and send the original case files, along with a DHHS Form 3205-A ME, directly back to the originating location within five (5) working days.

  • The originating location will sign Section II of the DHHS Form 3205-A ME to acknowledge that the cases have been received and return a copy of the form to MEQA staff.






101.13 Rights of Applicants/Beneficiaries (Eff. 10/01/05)

Any individual applying for and/or receiving assistance has certain rights and responsibilities relating to receipt of Medicaid benefits. This section describes the rights and responsibilities of applicants/beneficiaries.



101.13.01 Opportunity to Apply (Eff. 10/01/05)

Any individual who requests assistance, including those who are clearly ineligible, must be allowed to apply immediately. Eligibility workers must make a reasonable effort to assist the applicant in establishing eligibility.



101.13.02 Civil Rights and Non-Discrimination (Eff. 10/01/05)

Persons applying for, or receiving benefits or services under, any program administered by or through the State Department of Health and Human Services (DHHS), shall not be discriminated against in any manner. The following non-discrimination laws apply to Medicaid:




  • Title VI of the Civil Rights Act of 1964 prohibits discrimination based on race, color, or national origin.

  • Title V, Section 504 of the Rehabilitation Act of 1973, as amended, prohibits discrimination based on handicap.

  • Title II, Section 202 of the Americans with Disabilities Act of 1990, guarantees equal opportunity for qualified individuals with disabilities in employment, public accommodations, transportation, public service, state and local government services and communications. This Act requires that interpreters be available for applicants/beneficiaries, if needed.

  • The Age Discrimination Act of 1975 prohibits discrimination based on age.

Any individual who feels that he/she has been subjected to such discrimination may file a signed, written complaint within 180 days of the alleged discriminatory act, by mailing the complaint to:


South Carolina Department of Health and Human Services

Attn: Agency Director

Post Office Box 8206

Columbia, South Carolina 29202-8206


All complaints will be investigated in accordance with state and federal laws and regulations.

Table of Contents

101.13.03 Confidentiality of Information (Rev. 10/01/13)

The South Carolina Medicaid program will adhere to state laws and federal regulations on the protection of the confidentiality of information about applicants/beneficiaries. Specifically refer to Title 42, Code of Federal Regulations at Part 431 and the applicable provisions of State Regulations at SC Code Ann. R. 126-170 et seq. Information obtained during the application process or contained in records of beneficiaries or former beneficiaries is confidential and must be safeguarded. Medicaid will also adhere to the Health Insurance Portability and Accountability Act (HIPAA) when it comes to confidentiality of information about applicant/beneficiaries. Protected information is of two general types: financial and medical, both of which may be disclosed without beneficiary authorization only for purposes directly connected with the administration of the program that include:




        • Establishing eligibility;

        • Determining the amount of medical assistance;

        • Providing or arranging for services for a given beneficiary; and,

        • Prosecution or civil or criminal proceeding related to the administration of the State Plan.


Protected/Safeguarded Information
Eligibility and medical information which must be safeguarded includes, but is not limited to, the following:
1. Eligibility information

  • Name and address of applicants/beneficiaries

  • Social Security Number

  • Date of Birth

  • Social and economic conditions or circumstances

  • Evaluation of personal information such as financial status, citizenship, residence, age and other demographic characteristics

  • Information received for verifying income eligibility and amount of benefits. (Refer to Chapter 104, Appendix P)

  • Information received in connection with the identification of a liable third-party resource


2. Medical information

  • Medical data, including diagnosis and history of diseases or disabilities

  • Medical services provided

  • Medical status, psycho behavioral status, and functional ability

  • Results of laboratory tests

  • Medication records




Note: Medical information/evaluation provided by the Department of Mental Health (DMH) and/or the Veterans Administration (VA) is not to be released to anyone without the approval of DMH and/or VA. In addition, alcohol and drug abuse information is subject to special confidentiality standards.

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