Updates to the Autism Spectrum Disorder (ASD) Transition Plan

The South Carolina Department of Health and Human Services (SCDHHS) updated the autism spectrum disorder (ASD) services transition plan for delivery of ASD services. This plan supersedes the bulletin entitled “Transition Guidelines for Autism Services,” published May 4, 2017. The following outlines the instructions for providers of ASD services for services delivered on or after July 1, 2017.

1. State Plan Beneficiaries with an Existing ASD Prior Authorization (PA)
   1. Enroll individual board certified behavior analysts (BCBAs) and/or board certified assistant behavior analysts(BCaBAs) as applied behavior analysis (ABA) providers with Medicaid.
   2. Enroll any ABA group/organization Provider with Medicaid.
   3. Contract with managed care organizations (MCOs) with whom your beneficiaries are enrolled.
   4. Provide services currently authorized on the PA to beneficiary. An updated PA letter will be sent to beneficiaries with new Current Procedural Terminology (CPT) codes and service frequencies.
   5. Bill fee-for-service (FFS) or MCO as appropriate for authorized services using new ASD CPT codes.
2. State Plan Beneficiaries with NO existing ASD PA
   1. Enroll individual BCBAs and/or BCaBAs as ABA providers with Medicaid.
   2. Enroll any ABA group/organization provider with Medicaid.
   3. Contract with MCOs with whom your beneficiaries are enrolled.
   4. Verify submission of completed ASD Document List as required in the ASD provider policy manual to obtain a PA for ABA services.
   5. FFS documentation should be submitted securely to: autism@scdhhs.govor by mail to SCDHHS, P.O. Box 8206, Columbia, SC 29202, Attn: Pete Liggett, Ph.D. MCO documentation should be sent to the MCO-designated address.
   6. Bill FFS or MCO as appropriate for authorized services using new ASD CPT codes.
3. State Plan Beneficiaries who have not yet requested an ASD PA
   1. Enroll individual BCBAs and/or BCaBAs as ABA providers with Medicaid.
   2. Enroll any ABA group/organization provider with Medicaid.
   3. Contract with MCOs with whom your beneficiaries are enrolled.
   4. Submit documentation to FFS or MCO as required in the ASD provider policy manual to obtain a PA for ABA services.
   5. FFS documentation should be submitted securely to: autism@scdhhs.govor by mail at SCDHHS, P.O. Box 8206, Columbia, SC 29202, Attn: Pete Liggett, Ph.D. MCO documentation should be sent to the MCO designated address.
   6. Bill FFS or managed care organization (MCO) as appropriate for authorized services using new ASD CPT codes.
4. PDD Waiver Beneficiaries
   1. Provide services currently authorized on the Pervasive Developmental Disorder (PDD) Waiver PA to beneficiary.
   2. Bill FFS claims through SCDHHS’ approved process.
   3. Transition beneficiary to State Plan ASD services before Jan. 1, 2018.

Should you have any questions regarding this bulletin, 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.