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Provider Training

Fee Schedule and Provider Manual

Fee Schedule

ASD Fee Schedule

Provider Manual

The SCDHHS Medicaid Autism Spectrum Disorder (ASD) Provider Manual is to be used for program information and requirements, billing procedures and provider services guidelines. Providers should carefully review this manual in order to be compliant with policy guidelines.

ASD Provider Manual

Provider FAQs

Is a Registered Behavior Technician (RBT) credential necessary for a line therapist? 
Yes. A behavior technician will have 90 days from the time of hire to acquire the RBT credential. 

Can a Board Certified Assistant Behavior Analyst (BCaBA) act as the supervisor on a case? 

Yes, provided they are receiving supervision from a Board Certified Behavior Analyst (BCBA). Under no circumstance should a BCaBA be the supervisor to another BCaBA in the supervisor role.

Who can rendor codes 0360T and 0361T?

A BCBA and a BCaBA can render these services. An RBT with a bachelor’s degree and 500 hours of experience can also render these services; however, supervision must be provided by a BCBA or BCaBA.

Can providers use either the two or three tier model? 

Yes. SCDHHS is not prescriptive in the number of tiers provided; however, no one individual can simultaneously bill multiple services. Each role they serve must be discrete and billed accordingly within the approved hours allotted.

Can an ASD provider deliver services to a beneficiary who is enrolled in a managed care organization (MCO)? 

Yes. Providers must be credentialed and contracted with the MCO before providing services to MCO members. All contracts for services to an MCO-enrolled beneficiary are negotiated directly with the MCO.

Will the caseload restrictions be weighted based on severity of caseload/number of line hours approved? 
Yes. The caseload restrictions are as follows: 

  • Board Certified Behavior Analysts (BCBAs) must maintain the following caseload ratio throughout treatment: 
    Without support of a BCaBA: 6-12 cases 
    With support of a BCaBA: 13-16 cases 
  • Caseload counts are dependent on amount of line therapy provided 
    30-40 hours per week = one case 
    10-25 hours per week = ½ case 
    < 10 hours per week = ¼ case

How does a provider have to enroll to treat ASD cases?

A provider must be enrolled and credentialed with Medicaid. Enrollment and credentialing can be completed simultaneously. The enrollment requirements can be found in the ASD Provider Manual.

Will background checks be required for providers? 

Yes, an annual criminal background check is required for all providers. This does not need to include fingerprinting. Proof of a SLED background check will suffice. Additionally, annual updates from the South Carolina Department of Social Services Central Registry of Child Abuse and Neglect must indicate no findings of abuse or neglect against the individual. 

Will ASD services be allowable in a group?

At this time, group ASD services are not allowed and will not be included in the South Carolina State Medicaid Plan. SCDHHS will explore adding group services in the future.

Can ASD providers deliver services within a school?

Yes. Please refer to the ASD provider manual for further information.

Are non-ABA therapies covered within the ASD service plan?

Yes. A list of evidence-based practices can be found within the ASD Provider Manual.

Will previous ASD diagnoses, such as those established via the previous Diagnostic and Statistical Manual of Mental Disorders (DSM), continue to be valid?

Yes. All diagnoses that were medically established will continue to be valid and cross-walked with the current DSM or International Classification of Diseases (ICD) diagnosis.

What constitutes medical necessity for ASD?

A confirmed ASD diagnosis per manual guidelines and documentation that ASD services are medically necessary to ameliorate symptoms.

Will children age 0-3 be eligible for ASD services?

Yes. Any Medicaid beneficiary age 0-21 that meets medical necessity criteria for ASD is eligible for services. Beneficiaries age 0-3 may be considered presumptively diagnosed and will continue to have access to services based on medical necessity.