South Carolina Medicaid DME Manual: Member Advocacy Delivers Wins, and a November 2 Deadline to Finish the Job

South Carolina providers have until November 2, 2026 to comment on the updated Durable Medical Equipment (DME) Services Manual and DME Fee Schedule, which take effect for dates of service on or after December 1, 2026. The South Carolina Department of Health and Human Services (SCDHHS) released the drafts on October 5 in Medicaid Bulletin 26-040.

The new draft shows what coordinated advocacy can do. AAHomecare and SCMESA [Staff: insert full name] submitted detailed joint comments on the earlier draft, met with SCDHHS to thoroughly review the comments submitted and SCDHHS adopted a large share of them. Several important issues remain open, and a few new provisions would make it harder for South Carolina Medicaid members to get the equipment they need. The next four weeks are our window to fix them.

Built on relationships and hard work

These results did not happen by accident. They reflect the strong, collaborative working relationship that AAHomecare and SCMESA have built with SCDHHS leadership and program staff — a relationship grounded in open communication, practical solutions and a shared commitment to South Carolina Medicaid members.

They also reflect many hours of review and preparation on behalf of AAHomecare, SCMESA and NCART (National Coalition for Assistive and Rehab Technology) members. Providers and manufacturers worked through the draft manual in detail, flagged where provisions would disrupt patient care or operations, and turned their real-world experience into more than 100 specific comments and proposed edits. SCDHHS's willingness to listen, and our members' willingness to do the work, made the difference.

Key dates

Comments are due in 27 days. All dates below are from MB# 26-040, posted October 5, 2026.

Webinar registration links are in the bulletin, and recordings will be posted on the SCDHHS Provider Training Resources page. Note that the first webinar falls after the comment deadline, so don't wait for it to submit feedback. For members enrolled in a Medicaid MCO, the bulletin notes that the MCOs handle authorization, coverage and reimbursement for these services.

The draft manual no longer lists code-level units, frequencies and quantities; those now sit in the draft fee schedule. Review both documents.

What AAHomecare and SCMESA won

SCDHHS accepted many of the joint recommendations, cutting paperwork and expanding access across product categories:

• Medicaid Certificate of Medical Necessity eliminated. The Standard Written Order (SWO) is now the single order document.
• Complex Rehab Technology recognized. CRT is defined, largely in our proposed language, and CRT suppliers are an enrollable provider type with a RESNA-certified ATP requirement.
• Oxygen and ventilators excluded from capped rental, with rentals approved before December 1, 2026 staying on their current schedule.
• Telehealth face-to-face encounters allowed, with a link to the state's face-to-face list rather than item lists in the manual.
• Medicare-aligned proof of delivery, including the option to use the shipping date as the date of service.
• Replacement and repair relief: a five-year reasonable useful lifetime, patient attestation for replacement, one-month loaner rental (K0462) during repairs, and no new prescription for CRT replacement parts.
• Oxygen supplier changes no longer block a new rental period or useful lifetime.
• New and updated coverage criteria for standers and gait trainers, adaptive car seats, power wheelchair batteries, headrests and seating, immediate post-surgical prostheses, and respiratory equipment — including dentist-fit oral appliances billed by DME suppliers and ventilators for OSA when other therapy fails.
• Fewer barriers: the adults-only limit on bath items is gone, shipping restrictions are narrowed, and coinsurance and deductibles are no longer swept into payment-in-full rules.

What we still need to fight for

The draft also contains provisions that would strain providers and put access at risk. These are the priorities heading into the November 2 deadline.

1. Lifetime warranties on power wheelchair components. The draft requires a lifetime warranty on controllers, motors, gearboxes, joysticks, and cushions and seating. No manufacturer offers that. We asked SCDHHS to tie supplier warranties to the manufacturer's warranty; as written, suppliers would cover failures no one will reimburse.
2. Prior authorization for CRT repairs. Every wheelchair repair still needs PA. People who rely on CRT can't wait when a part fails. We will again urge a cost threshold below which repairs proceed without PA.
3. Reimbursement for manually priced items. SCDHHS kept 85% of MSRP, but invoice-priced items would be paid at cost plus 10%, capped at $1,000 per service, with no sales tax. That does not cover the cost of sourcing, configuring and supporting CRT components. We are seeking cost plus 25% with no cap.
4. PA for items Medicare doesn't cover. For dually eligible members, the draft dropped language limiting PA to services Medicaid already requires PA for. Low-cost items such as transfer benches could get swept in.
5. CPAP coverage gap. The criteria list only mild OSA (AHI/RDI 5–14 with symptoms). Members with moderate-to-severe OSA (AHI/RDI 15 or greater) need to be covered explicitly.
6. Other fixes: correct the HFCWO wording for COPD ("may not qualify" should read "may qualify"); extend SWO validity to 13 months to match 13-month capped rentals; align the KJ modifier and SWO description rules; clarify that suppliers can contact established patients about items tied to their current orders; reconsider raising the incontinence-supply minimum age from three to four; and add Power Operated Vehicle criteria.
7. Fee schedule items. With frequencies moved out of the manual, we will press for standers as purchase items (E0637, E0638, E0641, E0642), oxygen contents codes E0441–E0444, the incontinence quantity chart, and other code-level requests in the draft fee schedule.

How members can help

AAHomecare and SCMESA will file joint follow-up comments, but SCDHHS needs to hear directly from the providers who serve South Carolina Medicaid members. Your real-world examples carry weight.

• Submit your own comments to MedicaidStatePlan@scdhhs.gov by November 2, 2026. Focus on how the warranty, repair PA and pricing provisions would affect your patients and operations.
• Register for the webinars on November 10 and December 3 to stay current as the manual is finalized.

The gains in this draft came from providers and manufacturers speaking with one voice. Let's finish the job before December 1.