Addition of Intensive In-home Services Using the Homebuilders® Model and Updates to Peer Support Services
Effective July 1, 2024, the South Carolina Department of Health and Human Services (SCDHHS) is making updates to the Rehabilitative Behavioral Health Services (RBHS) manual. For dates of service on and after July 1, 2024, intensive in-home services using the Homebuilders® model will be added as a covered state plan service. The agency is also updating policy regarding peer support services to increase access to these services effective July 1, 2024. The RBHS manual available on SCDHHS' website will be updated by July 1, 2024, to reflect these changes.
Intensive In-home Services
Intensive in-home services are a brief, but concentrated family-driven treatment intervention with a primary aim of reducing disruptive placements of children and youth outside of the home while also improving overall family functioning. Intensive in-home services have been covered since Jan. 1, 2024, as announced in Medicaid bulletin MB# 23-070. Effective July 1, 2024, a second intensive in-home evidence-based model, known as Homebuilders®, will be covered for Healthy Connections Medicaid members.
Homebuilders®
Homebuilders® is an intensive in-home evidence-based practice utilizing best practice strategies (e.g., motivational interviewing, cognitive and behavioral interventions, relapse prevention and skills training) for families with children birth to 18 years of age who are at imminent risk of out-of-home placement. Homebuilders® may also be provided to families that are reunifying with a child returning home from an out-of-home placement.
The Homebuilders® model has clearly defined standards that guide program implementation and clinical practice, and an ongoing training and quality enhancement system to ensure model fidelity and to provide the opportunity to evaluate the program on an ongoing basis to improve service delivery.
Homebuilders® providers are available for crisis intervention 24 hours per day, seven days per week and provide scheduled interventions at times convenient to the family.
Fidelity Requirements
Homebuilders® teams must be trained and certified through the Institute of Family Development. In order to be reimbursed by Healthy Connections Medicaid, Homebuilders® teams must deliver services with fidelity to the model, which includes training, supervision and consultation.
Rates for Services
Homebuilders® includes a bundled service rate in the form of a per diem, which takes into account costs associated with utilizing the model in the development of reimbursement. Per diem rates are reimbursed once per calendar day and cover all billable activity related to Homebuilders® provided on that calendar day. A Homebuilders® service/billable activity must be provided on the calendar day for which the claim is submitted.
Service limits are designed to enhance provider flexibility and increase access to care. Therefore, in lieu of prior authorization, reimbursement is structured to allow a standard number of per diem units and length of time to utilize those per diem units, which represents the basic frequency and intensity of services common to the average episode of care. The procedure code and reimbursement rate for this service is included in the table below.
| Service | Procedure Code | Service Limits | Unit Rate |
|---|---|---|---|
| IIHS - Homebuilders® | H2022-U4 | A total of 20 per diems delivered over a period of no more than six weeks | $386.80 |
Service units may be used in any combination to meet the intensity and frequency required based on the child/family's needs. Any additional units required beyond those listed above must be authorized by SCDHHS' Office of Behavioral Health after submission of documentation substantiating the need. Documentation must be submitted with the claim via the webtool for approval of further services.
Updates to Peer Support Services
To increase opportunities for peer support services across the state, SCDHHS is making the policy changes listed below.
- Private entities may enroll as RBHS providers and offer peer support services.
- Certification of peer support specialists will be required for all providers.
- Service descriptions will be updated, such as peer support specialist responsibilities, location of services and supervision requirements.
Private providers will be required to submit a request for prior authorization for further service delivery after reaching a limit of 216 total units (or 54 hours).
Providers who are interested in enrolling as a Healthy Connections Medicaid provider to bill for this service can learn more about the provider enrollment process here on SCDHHS' website. Additional information about how private providers can become certified to render peer support services will be added to the RBHS provider manual by July 1, 2024.
South Carolina's Medicaid managed care organizations (MCOs) are responsible for the authorizations, coverage and reimbursement related to the services described in this bulletin for Healthy Connections Medicaid members who are enrolled in an MCO.
Providers should direct questions related to this bulletin to the Provider Service Center (PSC) at (888) 289-0709 or to behavioralhealth004@scdhhs.gov. The PSC's hours of operations are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.