Effective on or after July 1, 2017, Autism Spectrum Disorder (ASD) treatment services will be added to the South Carolina Medicaid State Plan.
ASD treatment services will be available both for fee-for-service (FFS) beneficiaries and for managed care organization (MCO) members.
Medically necessary ASD treatment services are available for Medicaid beneficiaries between the ages of 0 to 21 who have an established ASD diagnosis via a comprehensive psychological assessment.
Providers can begin the enrollment process on April 21, 2017. To enroll as an ASD provider in the South Carolina Medicaid program, the provider must qualify as a Licensed Independent Practitioner (LIP), Board Certified Behavior Analyst (BCBA) or Board Certified Assistant Behavior Analyst (BCaBA). In order to enroll as an Applied Behavior Analysis (ABA) provider, the applicant must have a National Provider Identifier (NPI) number which can be obtained at https://nppes.cms.hhs.gov/NPPES/Welcome.do , and complete the online Medicaid provider enrollment application with South Carolina Department of Health and Human Services (SCDHHS). Once the online provider enrollment application has been submitted and screened, SCDHHS will contact the Administrative Service Organization (ASO), South Carolina Department of Disabilities and Special Needs (SCDDSN). The ASO will review and approve prospective ABA providers.
On or after April 21, 2017, you may access the online enrollment application at https://providerservices.scdhhs.gov/ProviderEnrollmentWeb/to begin enrolling as an ABA provider.
If you are enrolling as an individual, the table below identifies fields that must be selected within the enrollment application.
|Enrollment Type||Provider Type Description||Specialty Description||Taxonomy Code|
|Individual||Other Medical Professionals|
|Individual||Other Medical Professionals||Board Certified Assistant Behavioral Analyst||106E00000X|
If you are enrolling as a group practice, the table below identifies fields that must be selected within the enrollment application.
|Enrollment Type||Provider Type Description||Provider Specialty||Taxonomy Code|
|Organization||Groups||Multiple Specialty Group||193400000X|
Enrolled Medicaid LIPs are also eligible to provide ASD services following registration in the ASD provider network through SCDDSN. To begin this process, contact the SCDHHS’ Division of Behavioral Health at email@example.com. Providers seeking to become LIPs should follow the procedures outlined in the LIP manual.
Please visit https://www.scdhhs.gov/ProviderRequirements for more information on provider enrollment.
Providers may also choose to contract and enroll with any of the state’s contracted MCOs. Providers must be enrolled with SCDHHS in order to participate with any of the MCOs. Providers can find contact information for each MCO at https://www.scdhhs.gov/resources/health-managed-care-plans/managed-care/managed-care-health-plan-contact-information.
All ASD services for FFS beneficiaries must receive prior authorization through the SCDHHS ASO.
Providers must verify eligibility and contact the applicable MCO for prior authorization, when required, before rendering services to MCO-enrolled beneficiaries. Both Medicaid and managed care eligibility can be verified at the SC Medicaid Web Portal, https://portal.scmedicaid.com/login.
As of July 1, 2017, the following codes will be billable for medically necessary ASD services rendered by enrolled ASD network providers. The fee schedule will be available on the SCDHHS website, https://www.scdhhs.gov/resource/fee-schedules, after April 21, 2017.
|Procedure Code||Service Description||Qualifications|
|0359T||Behavior Identification Assessment (ABA)||BCBA/BCaBA|
|0368T & 0369T||Adaptive Behavior Treatment with Protocol Modification||BCBA/BCaBA|
|0360T & 0361T||Observational Behavioral Follow-up Assessment||BCaBA/RBT II (bachelor degree + RBT + 500 hours of line therapy experience)|
|0362T, 0363T |
|Exposure Behavioral Follow-up Assessment||RBT I (RBT certification)|
|Adaptive Behavior Treatment by Protocol|
|0370T||Family Adaptive Behavior Treatment Guidance||BCBA/BCaBA|
|H2019||Therapeutic Behavioral Services (non-ABA)||Ph.D./Psy.D., LISW, LMFT, LPC, LPES|
|90791||Behavior Assessment (non-ABA)||Ph.D./Psy.D., LISW, LMFT, LPC, LPES|
|96101||Psychological Testing||Ph.D./Psy.D., LPES|
Should you have any questions regarding this bulletin, please contact the SCDHHS Division of Behavioral Health at (803) 898-2565.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.