Psychiatric Residential Treatment Facility (PRTF) Carve-In Frequently Asked Questions (FAQs)

Effective July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will include Psychiatric Residential Treatment Facility (PRTF) services as part of the Medicaid managed care benefit.

Providers will be required to file claims for PRTF services to the Managed Care Organizations (MCOs) for enrolled members. Providers must verify eligibility and contact the applicable MCO for prior authorization, when required, before rendering services. Both Medicaid and managed care eligibility can be verified at the SC Medicaid Web Portal https://portal.scmedicaid.com/login .

Below is a list of frequently asked questions (FAQs) for both Medicaid members and Medicaid providers.

MEMBER FAQS

If you have questions please contact your MCO at the Member Service phone number below:

  1. I am hearing and reading about changes to PRTF services. How does this impact me?
    While there is no change in member benefits, there will be changes for providers.

    Beginning July 1, 2017 PRTF services will be covered by the SCDHHS's contracted Managed Care Organizations (MCOs). PRTF providers will need to verify eligibility (Medicaid and managed care eligibility) and receive prior authorization from the member's MCO. Providers will file claims with the member's MCO.
     

  2. My child needs PRTF placement after July 1, 2017. What will I need to do differently?
    If your child is enrolled with a MCO, contact the plan directly.

    If your child is enrolled with regular Medicaid, the process remains the same. The following documents must be submitted to the PRTF:

    • Certification of Need (CON)
    • Child and Adolescent Level of Care Utilization System(CALOCUS)
    • Clinical Information

    The PRTF then submits this information for authorization
     

  3. Will I be able to select which PRTF my child is placed?
    SCDHHS and its contracted MCOs will work with the family to find the best placement option.
     
  4. Who do I call if I have questions regarding my managed care (MC) benefits?
    If you have questions please contact your MCO at the Member Service phone number below:
    • Absolute Total Care: (866) 433-6041
    • BlueChoice HealthPlan Medicaid: (866) 781-5094
    • First Choice by Select Health: (888) 276-2020
    • Molina Healthcare of South Carolina: (855) 882-3901
    • WellCare of South Carolina: (888) 588-9842
       
  5. How do I know if I am in managed care or fee-for-service?
    This information is located on your Medicaid Healthy Connections card(s). If you still have questions, please contact the Member Service Center at 1 (888) 549-0820.
     
  6. Will I have to signup annually with an MCO?
    You will remain in the same managed care plan unless you choose otherwise. Upon completion of the MCO's annual review process, you will have a 90-day window to change health plans. You will receive an annual anniversary letter to inform you that you may make a change in your health plan enrollment.
     
  7. Will my child be discharged if his/her current PRTF isn't covered under the MCO?
    The MCO has a responsibility to ensure that medically appropriate care is provided.

    If you have questions please contact your MCO at the Member Service phone number below:

    • Absolute Total Care: (866) 433-6041
    • BlueChoice HealthPlan Medicaid: (866) 781-5094
    • First Choice by Select Health: (888) 276-2020
    • Molina Healthcare of South Carolina: (855) 882-3901
    • WellCare of South Carolina: (888) 588-9842
       
  8. Will I still be able to go to the doctor of my choice to have the Certificate of Need (CON) completed or will the MCO assign a provider to assess my child and complete the CON?
    Each Managed Care Organization (MCO) contracts with providers, this is called the MCO's provider network. Members must visit providers that are in the MCO provider network or get prior approval from the members MCO to visit providers that are not in the MCO's provider network. Members may check whether or not a provider is in a MCO's network by accessing https://www.scchoices.com/Member/ProviderSearch.aspx?frommenu=true or by contacting the member's MCO. To contact Member Services for each MCO:
    • Absolute Total Care: (866) 433-6041
    • BlueChoice HealthPlan Medicaid: (866) 781-5094
    • First Choice by Select Health: (888) 276-2020
    • Molina Healthcare of South Carolina: (855) 882-3901
    • WellCare of South Carolina: (888) 588-9842

PROVIDER FAQS

  1. Why do SCDHHS-approved providers have to go through credentialing with each individual MCO?
    All health plans are required to credential each provider as outlined in 42 CFR 438.214, and the MCO contract and policies & procedures manual.
     
  2. Will providers no longer have to be enrolled with Medicaid if their patients are enrolled within an MCO?
    Providers will have to enroll and remain enrolled as a Medicaid provider regardless of the member's health plan.
     
  3. Will all beneficiaries be enrolled within an MCO?
    Some beneficiaries will remain enrolled in fee-for-service, or traditional Medicaid.
     
  4. What do providers need to do if they have beneficiaries scheduled for reauthorization that are covered by an MCO?
    If the child is enrolled with a MCO, contact the plan directly.
     
  5. Who do I call if I have questions regarding a beneficiary's managed care benefits?
    If you have general questions regarding the member's managed care benefits, please contact the member's MCO at the phone number below:
    • Absolute Total Care: (803) 933-3638
    • BlueChoice Health plan Medicaid SC: (800) 574-886
    • First Choice by Select Health: (888) 559-1010
    • Molina Healthcare of South Carolina: (855) 882-3901
    • WellCare of South Carolina: (888) 588-9842
       

    If you have questions regarding prior authorization, please contact the appropriate MCO at the phone number below:

    • Absolute Total Care: (866) 433-6041
    • BlueChoice Health plan: (866) 902-1689
    • First Choice by Select Health: (888) 559-1010, opt 4
    • Molina Healthcare of South Carolina: (855) 237-6178
    • WellCare of South Carolina: (888) 588-9842
       
  6. Am I notified by SCDHHS if the client is no longer enrolled with the MCO?
    Providers are strongly encouraged to check eligibility monthly, prior to submitting documents for prior authorization. All eligibility and enrollment can be verified using the following:

    Upon checking eligibility, providers will be able to determine managed care participation. The Provider Web Tool will list the name and phone number of the MCO.
     

  7. What is Therapeutic Home Time (THT)?
    Therapeutic Home Time is considered a reimbursable component of the service under the all-inclusive rate. THT allows youth to spend time in their home and community for short periods of time in order to facilitate smooth transitions to lower levels of care.
     
  8. How often can THT be used?
    The maximum allowed days for THT are 14 per fiscal year per beneficiary.
     
  9. What is the rate for THT?
    THT is reimbursed at the per diem rate for each PRTF.
     
  10. What if the youth needs more days of THT?
    THT in excess of 14 days will not be covered.
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