Public Notice of Final Actions for Inpatient Psychiatric Hospitals and Psychiatric Residential Treatment Facilities (PRTFs)
The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding rates for inpatient psychiatric hospitals and PRTFs under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Inpatient Psychiatric Hospitals
Effective for dates of service on or after July 1, 2024, SCDHHS will update the rate methodology for stand-alone inpatient psychiatric hospitals from a diagnosis-related group (DRG) methodology to a per diem. The reimbursement for acute stays in these hospitals will be $800 per member, per day.
For hospitals operated by the South Carolina Department of Mental Health, which currently are reimbursed by per diem methodology, rates will be increased to $800 per member, per day.
Inpatient psychiatric units that are part of a general acute care hospital will not be impacted by this change.
PRTFs
Effective for dates of service on or after July 1, 2024, SCDHHS will increase rates for PRTFs to a total per diem rate of $525 per member, per day.
Also effective for dates of service on or after July 1, 2024, a tiered per diem rate will be added for facilities that specialize in the treatment of autism spectrum disorder and meet SCDHHS criteria for provision of autism services in PRTF settings. The reimbursement rate for autism specialty facilities will be $788 per member, per day.
SCDHHS is making these changes to support access to behavioral health 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 $2.63 million total dollars.
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 proposed 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.