Retroactive Rate Increases for ID/RD, CS and HASCI Waiver Services, and Early Intervention Services
The South Carolina Department of Health and Human Services (SCDHHS) is retroactively increasing reimbursement rates for the specific services included in this bulletin. This includes early intervention services and services provided through the Intellectual Disability/Related Disabilities (ID/RD), Community Supports (CS) and Head and Spinal Cord Injury (HASCI) waivers operated by the South Carolina Department of Disabilities and Special Needs (SCDDSN).
SCDDSN-operated Waiver Services Rate Increases
Effective July 1, 2022, reimbursement for the codes listed below will be increased as follows:
| Service Description | Code | Modifier | Previous Rate per Unit | NewRate per Unit |
|---|---|---|---|---|
| Residential 3 Person High Mgt.* | T2016 | U8 | $427.93 | $442.78 |
| T2016 | U7 | $364.38 | $377.03 | |
| Residential 4 Person Tier 3* | T2016 | U6 | $308.36 | $319.06 |
| Residential 4 Person Tier 2* | T2016 | U5 | $263.55 | $272.69 |
| Residential 4 Person Tier 1* | T2016 | U4 | $223.55 | $231.31 |
| Residential SLP II* | T2016 | U3 | $91.84 | $95.03 |
| Residential CTH Tier 2* | T2016 | U2 | $112.43 | $116.31 |
| Residential CTH Tier 1* | T2016 | U1 | $81.75 | $84.59 |
| Adult Attendant Care | S5125 | U1 | $4.05 | $4.21 |
| Adult Companion Services | S5135 | $3.63 | $3.76 | |
| Behavior Support | H0023 | $30.00 | $31.14 | |
| Career Prep* | T2014 | $36.93 | $38.34 | |
| Community Services* | H2016 | $36.93 | $38.34 | |
| Day Activity* | T2020 | $36.93 | $38.34 | |
| Employment Services – Group* | H2026 | $36.93 | $38.34 | |
| Employment Services – Individual* | H2025 | $24.74 | $25.69 | |
| Independent Living Skills | H2014 | $8.46 | $8.79 | |
| Respite in Home | T1005 | $4.05 | $4.21 | |
| Respite in Home (Group of 2) | T1005 | UB | $2.53 | $2.63 |
| Respite in Home (Group of 3) | T1005 | UC | $1.62 | $1.68 |
| Service Description | Code | Modifier | Previous Rate per Unit | NewRate per Unit |
|---|---|---|---|---|
| Support Center Services* | S5151 | $31.29 | $32.49 | |
| WCM With Travel* | T1016 and T1017 | U1 | $27.28 | $28.32 |
| WCM Without Travel* | T1016 and T1017 | U2 | $16.77 | $17.41 |
| Residential Habilitation SLP – 1* | T2017 | $18.69 | $19.40 | |
| Attendant Care - Agency | S5125 | U2 | $4.83 | $5.02 |
| Attendant Care - Boards | S2125 | U3 | $3.74 | $3.88 |
| Attendant Care UAP | S5125 | U1 | $4.05 | $4.21 |
| Health Education CDC | T2025 | $20.00 | $20.77 | |
| Mental Health Services | H0046 | $32.26 | $33.49 | |
| Peer Guidance CDC | T2025 | $20.00 | $20.77 | |
| Psy/Rx/Alcohol Counseling | T1007 | $38.80 | $40.29 | |
| In Home Support | T2025 | $16.20 | $16.82 |
*Billed through Therap
The new rates are already reflected on the CLTC Fee Schedule. Updated rates for services billed through Therap, DDSN’s case management, authorization and billing system, will be reflected in Therap beginning Dec. 1, 2022. When the Therap system is updated, authorizations for services billed through Therap will show the new rates. All claims billed through Therap and submitted for dates of service prior to Dec. 1, 2022, should be submitted using the rates reflected on the authorization (the rates that were listed prior to this update). All claims paid for dates of service prior to Dec. 1, 2022, will receive retroactive rate adjustments for services incurred back to July 1, 2022, to account for the difference in the rates announced in this bulletin.
For services not billed through Therap, all claims paid for dates of service prior to implementation of the new rates will be identified and providers will receive adjustments to address the retroactive payment period.
Rate Increases for Early Intervention Services
Effective July 1, 2022, reimbursement will be increased for early intervention providers to reflect a cost-of-living increase for the codes listed below.
| Service Description | Code | Modifier | Previous Rate per Unit | NewRate per Unit |
|---|---|---|---|---|
| Early Intervention: birth to age 3 | T1016 T1018 T1027 | TL | $23.74 | $24.65 |
| Early Intervention: ages 3 to 6 | T1027 | $25.54 | $26.52 | |
| Early Intervention: School for the Deaf and the Blind: ages 3-6 | T1027 | $27.95 | $29.01 |
Retroactive rate adjustment settlements for early intervention providers will be implemented for services incurred on and after July 1, 2022.
Providers should direct any questions related to the waiver services addressed in this bulletin to the Medicaid Waiver mailbox: MedicaidWaiver@scdhhs.gov. Early intervention related questions can be sent to the BabyNet mailbox at BabyNet@scdhhs.gov.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.