Public Notice of Final Action for Autism Spectrum Disorder (ASD) Services
The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding rate increases, service limit increases, and the addition of covered codes under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Effective for dates of service on or after July 1, 2023, rates for ASD services for code 97153 (Adaptive Behavior Treatment by Protocol) will increase to $14.88/15 minute unit ($59.52/hour). Service limits for code 97156 (Family Adaptive Behavior Treatment Guidance) will increase to 96 units (24 hours) per year effective July 1, 2023.
SCDHHS will update the following rates and service limits on or after July 1, 2023:
|Code||Description||Previous Rate per Unit||Rate per Unit Beginning July 1,2023|
|97153||Adaptive behavior treatment by protocol, performed by a Registered Behavioral Technician (RBT)||$11.25/15 minute unit||$14.88/15 minute unit|
|Code||Description||Previous Annual Service Limit per Unit||Annual Service Limit per Unit Beginning July 1, 2023|
|97156||Family adaptive behavior treatment guidance||48 units per year||96 units per year|
SCDHHS will add the following new ASD procedure codes effective for dates of service on or after July 1, 2023:
|97154||Group Adaptive Behavior Treatment by Protocol, multiple patients, p erformed by a Registered Behavioral Technician (RBT)||$9.10/15 minute unit ($36.40/hour)||6 hours per day|
|97158||Group Adaptive Behavior Treatment by Protocol, multiple patients, performed by a Board-Certified Behavioral Analyst (BCBA)||$13/15 minute unit ($52/hour)||6 hours per day|
SCDHHS is making these changes to support access to ASD services, enhance the state’s provider network, and ensure services are delivered effectively. Based on the actions above, SCDHHS projects a budget impact of approximately $2.7million (total dollars) per year.
Copies of this notice are available at each South Carolina Healthy Connections Medicaid county office and at www.scdhhs.gov for public review. Additional information regarding these actions is available upon request at the address cited below.
Any written comments submitted may be reviewed by the public at SCDHHS, Bureau of Policy, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9 a.m. and 5 p.m.