Modification to Rehabilitative Therapy Checkpoint


Effective immediately, the South Carolina Department of Health and Human Services (SCDHHS) will be modifying the rehabilitative therapy checkpoint.  The checkpoint consists of combined hours of service to include speech-language pathology, occupational, and physical therapy for all individuals under age 21.

The number of hours allowed without prior approval is increased from 75 (300 units) to 105 (420 units) per fiscal year.  With this modification, dates of service on or after July 1, 2012 will be included as part of the new checkpoint.  The SCDHHS now requires prior approval for services exceeding the combined total of 105 (420 units) hours.  KePRO will be prior approving these services.  The state fiscal year begins July 1st and ends June 30th of each year.  The checkpoint applies to both private rehabilitative providers as well as to those performed in the outpatient hospital clinic.  Additional information regarding policy changes as well as reimbursement rates will be provided at a later date.

All rehabilitative therapy claims are subject to retrospective review by the Division of Program Integrity. Program Integrity (PI) reviews will be conducted on an on-going basis and may be either random or targeted reviews. The purpose of the PI reviews will be to identify any overpayments, fraud, or abuse and to ensure compliance with policy.  This checkpoint does not apply to School-Based Rehabilitative Therapy Services provided under the Individuals with Disabilities Education Act (IDEA) which are exempt from the yearly frequency checkpoint.

This bulletin affects the policy for Fee-For-Service (FFS) beneficiaries and beneficiaries in the Medical Home Networks (MHNs).  For beneficiaries enrolled in a Managed Care Organization (MCO), please refer to the individual MCO plan regarding their services.  The MCO plans, at a minimum, are required to provide the same level of services covered by the FFS model and will be notified of this change.


Please refer any questions regarding this bulletin to the SCDHHS Provider Service Center at 1-888-289-0709. Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.                  


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