Language revisions to manual(s) regarding psychological assessment/testing services

PROVIDER ALERT

 

The South Carolina Department of Health and Human Services (SCDHHS) Division of Behavioral Health has made revisions to the language in the Licensed Independent Practitioner (LIP), Rehabilitative Behavioral Health Services (RBHS) and Local Education Agency (LEA) manuals, as they pertain to psychological assessments/testing. These revisions are intended to clarify the scope, range, purpose and utility of psychological assessment/testing as well as aid Managed Care Organizations (MCO) in their decision making for the prior-authorization process for these services. As such, the same language revisions are reflected in the MCO manuals. Revisions include:

  1. Psychological assessment/testing can be used to determine a diagnosis, as per proper utility of psychodiagnostic measures, if initial comprehensive assessment is completed and psychological assessment/testing is deemed clinically necessary as a result.
  2. Units approved for psychological assessment/testing should be commensurate with industry standards, to include consideration of scoring and interpretation as well as potential behavioral health concerns that may complicate the administration of psychological measures and require extra time (e.g. significant developmental disorders).
  3. All Healthy Connections Medicaid members must be covered for psychological assessment/testing, per policy manual, if they have a diagnosis listed in the current version of the Diagnostic Statistical Manual of Mental Disorders (DSM) or if psychological assessment/testing is used to establish a clinically necessary differential diagnosis.
  4. All requests for psychological assessment/testing by the assessor must include a specific referral question(s) that can be reasonably answered by the proposed psychological assessment/testing tools to be administered.
  5. All requests for psychological assessment/testing must clearly establish the benefits of psychological assessment/testing for the member, including, but not limited to, how the psychological assessment/testing will inform treatment.

Please refer to the Core Rehabilitative Behavioral Health Service Standards section in the respective manuals for these revisions. If you have questions regarding the revised policy, you may contact Healthy Connections Office of Behavioral Health line at (803) 898-2565.

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