Revisions to Rehabilitative Behavioral Health Services Policy and Procedures

 

The South Carolina Department of Health and Human Services (SCDHHS) is revising the Rehabilitative Behavioral Health Services (RBHS) Policy Manual. Changes will be effective on or after Jan. 1, 2016. The intent of this bulletin is to provide notice of general revisions; it is not intended to reflect all revisions in the manual. These changes apply to fee for service RBHS only.

Medical Necessity

The Medical Necessity requirements for Psychosocial Rehabilitative Services (PRS), Behavior Modification (B-MOD) and Family Support (FS) will be modified to more effectively target recipients in need of these specialized behavioral health services. These services are intended for beneficiaries who have experienced sustained and significant impairment of functioning. The intent of these services is to remediate specific functional impairments with individualized and defined therapeutic goals. PRS, B-MOD and FS are to be time-limited; the frequency and duration must be commensurate with the scope of impairment. No RBHS services shall be offered for recreational, social or supervisory purposes.

Parent/Caregiver/Guardian Agreement to Participate in Community Support Services Form

For beneficiaries birth through 15 years of age, a “Parent/Caregiver/Guardian Agreement” will be required as part of the document set for initial and continued service requests sent by private providers to KEPRO. For both private and public providers, this document must be maintained in the beneficiary’s clinical record. Beneficiaries receiving PRS, B-Mod and FS prior to Jan. 1, 2016, must have this form completed and signed by Mar. 15, 2016. Beneficiaries receiving PRS, B-Mod and FS services starting on or after Jan. 1, 2016, must have this form completed, signed and in the beneficiary’s clinical record prior to receiving these services.

Same Day Service Exclusions

SCDHHS will reimburse only one Community Support Service type (i.e., PRS, B-MOD or FS) per service date per beneficiary. Exceptions to this exclusion will be outlined in the RBHS policy manual.

 

 

Frequency  and Reimbursement Change in CALOCUS Assessments (H2000)

Child and Adolescent Level of Care Utilization System (CALOCUS) assessments (H2000) will be available at a frequency of one encounter every six months. H2000 reimbursement rates will be consistent with that of the diagnostic assessment.

CALOCUS Score for Prior Authorization of Community Support Services

The minimum CALOCUS score for PRS, B-MOD and FS will be 17.

Training Changes

Additional training requirements will be added including orientation and service-specific training.

List of Non-billable Activities Added

Language will be added to the manual to reflect activities that are not Medicaid-reimbursable.

Billable Places of Service

SCDHHS will only reimburse for services provided in treatment settings approved in the RBHS policy manual.  

Thank you for your continued support of the Healthy Connections Medicaid program.

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