Rate Increase for Applied Behavior Analysis (ABA)

PROVIDER ALERT

Effective on or after July 1, 2018, the South Carolina Department of Health and Human Services (SCDHHS) will increase reimbursement for Applied Behavior Analysis (ABA) provided by a Registered Behavior Technician (RBT) to $15.50 per 30 minutes ($31 per hour).

SCDHHS is amending the South Carolina Title XIX State Plan to update the rate-setting methodology for Autism Spectrum Disorder (ASD) services. Updates to the methodology consider the impact of provider cost drivers on the cost of service delivery to support the development of provider rates as well as adapt to market trends as ABA therapy broadens in prevalence locally and nationally.

In September 2017, SCDHHS submitted a budget request for State Fiscal Year (SFY) 2018-19 to substantially increase reimbursement rates for RBT-provided ABA therapy. While the budget is not finalized, forms of SCDHHS' request have been adopted in the SFY 2018-19 Governor's Executive Budget and both the House of Representatives and Senate versions of the SFY 2018-19 General Appropriations Act, expected to be complete next month.

This action was advised at the Medical Care Advisory Committee on February 13, 2018; published by the agency on February 21, 2018; opened to public comment from February 21, 2018 to March 22, 2018; and, published as final on May 23, 2018. Relevant policy and coding changes will be published by June 1, 2018 and noticed through a Provider Bulletin to provide 30 days' notice to providers and the community before the effective date. Any future changes to the reimbursement rates unrelated to state plan amendments or policy manual changes will be communicated through the standard fee schedule update process and may not be communicated via Medicaid Bulletin or Alert.

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

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