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Proposed Public Notice for PRTF Carve-In

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following proposed actions regarding Psychiatric Residential Treatment Facility (PRTF) services provided under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective on or after January 1, 2017, the SCDHHS proposes to amend the South Carolina Title XIX State Plan to include PRTF services and providers in the Coordinated Care benefit provided by SCDHHS' contracted Managed Care Organizations (MCOs). MCO members will access PRTF services through the MCO plan to which they are assigned. Individuals not assigned to a MCO will continue to access PRTF services through the SCDHHS Medicaid fee-for-service benefit. PRTFs serve beneficiaries 21 years of age and younger.

SCDHHS anticipates that inclusion in the coordinated care benefit of the PRTF service will initially be budget neutral, but will ultimately lead to cost savings through increases in coordination of care, better utilization management and review, and reduced institutional costs. However, the Department proposes to rebase PRTF rates based upon the most recent cost report data available (2015), applying a trend factor using CMS market basket data, and excluding any ancillary services that may had been provided by individual practitioners/providers/suppliers and reflected in the 2015 PRTF cost reports. The ancillary services incurred by SC Medicaid PRTF beneficiaries effective on or after January 1, 2017 will be provided under arrangement with contracted/enrolled providers. The proposed rate actions listed above are anticipated to improve access for beneficiaries and carry a projected annualized cost of approximately $1.3 million (total dollars).

Copies of this notice are available at each county SCDHHS office and at for public review. Additional information regarding these proposed actions is available upon request at the address cited below.

Written comments may be sent to Division of Behavioral Health, SCDHHS, Post Office Box 8206, Columbia, South Carolina 29202-8206. Comments may also be submitted to Written and e-mailed comments must be received by October 7, 2016.

Any written comments submitted may be reviewed by the public at the SCDHHS, Division of Behavioral Health, Jefferson Square Building, 1801 Main Street, Columbia, South Carolina, Monday through Friday between 9 a.m.-5 p.m.

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