Applied Behavioral Analysis (ABA): An autism treatment method based on behaviorist theories. By breaking complex skills into small steps, this technique teaches youth to respond and behave in socially appropriate ways.
Appeal: An appeal is asking for a hearing because you do not agree with a decision the South Carolina Department of Health and Human Services (SCDHHS), a Managed Care Organization (MCO) or another party acting on behalf of the agency has made. The hearings that are held are often referred to as "fair hearings."
Learn More about the Appeals Process
Autism: Autism, or autism spectrum disorder (ASD), is a lifelong developmental condition that can cause significant social, communication and behavioral challenges
Centers for Medicare & Medicaid Services (CMS): The United States Department of Health and Humans Services (USDHHS) agency is responsible for providing oversight and coordination in working with states to administer the Medicaid program, including EPSDT.
EPSDT: The federally mandated Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program is a preventive health care program designed to improve the overall health of Healthy Connections Medicaid members from birth through the month of the member’s 21st birthday. Special emphasis is given to early detection and treatment of health issues. Learn more about EPSDT.
Fair Hearing: A fair hearing is an in-person proceeding conducted by a hearing officer of the SCDHHS Division of Appeals and Hearings. The hearing officer listens to your explanation as to why you do not agree with the action taken by SCDHHS, the MCO or another party acting on the agency's behalf. The hearing officer will also listen to the representative for the other party explain the action taken on your case. After the hearing, the hearing officer will issue a written decision in the case.
Managed Care Organization: A managed care organization (MCO) is a health plan with a group of doctors and other providers working together to give health services to its members. Healthy Connections Medicaid has five health plans, Absolute Total Care, BlueChoice HealthPlan Medicaid, First Choice by Select Health of South Carolina, Molina Healthcare of SC and WellCare.
Learn More About the Health Plans
Medicaid: A joint federal-state program, administered by the Centers for Medicare & Medicaid Services, that helps states in supporting medical costs for eligible persons with low incomes and limited resources. South Carolina's Medicaid program is called Healthy Connections.
Medically Necessary: Medically necessary services are health care services or supplies needed to identify or treat an illness, injury, condition, disease or its symptoms. The services or supplies must meet acceptable standards of medicine.
Primary Care Providers (PCPs): A primary care physician (PCP), or primary care provider, is considered to be your main doctor and will be responsible for dealing with the vast majority of your health care issues. PCPs are your first stop for medical care.
Referral: A referral is consent from your primary care physician to see a specialist for an illness or injury. You may also need a referral to have special treatments, such as x-rays or surgery. Your primary care physician will decide if you need to see a specialist.
Spectrum: Spectrum describes the range of difficulties that individuals on the autism spectrum may experience and the degree to which they may be affected.