Public Notice of Final Action for Prior Authorization Requirements for Services Rendered Out-of-state
The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding prior authorization requirements for services rendered outside of the South Carolina Medicaid Service Area (SCMSA) under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Effective on or after April 1, 2025, SCDHHS will amend the South Carolina Title XIX State Plan to clarify prior authorization requirements for services rendered to Healthy Connections Medicaid members who are referred to receive services out-of-state. This action will remove requirements for prior authorization for services rendered by an out-of-state provider when the service delivery occurs within the SCMSA. Requirements for prior approval for referrals to receive services that are rendered outside of SCMSA will remain unchanged.
Based on the actions above, SCDHHS does not anticipate a budget impact.
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 the SCDHHS, Bureau of Policy, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9 a.m. and 5 p.m.