On July 1, 2016, Medicaid funded Rehabilitative Behavioral Health Services (RBHS) became part of the service array that are covered by the Medicaid Contracted Managed Care Organizations in South Carolina. In South Carolina about 70% of children are enrolled in a Managed Care Plan; the remainder of these youth are enrolled in fee for service Medicaid.
As of July 1, 2016 there are 5 Managed Care Organizations who are contracted with the South Carolina Department of Health and Human Services:
- Select Health: (888) 559-1010; http://www.selecthealthofsc.com/index.aspx
- Molina: (855) 237-6178; http://www.molinahealthcare.com/en-us/Pages/home.aspx?CookieCheck=true
- WellCare: (888) 588-9842; https://www.wellcare.com/south%20carolina
- BlueChoice: (866) 757-8286; http://printadirectory.thesolutionsgroup.com/?source=BHM
- Absolute and total care: (866) 433-6041; http://apps.absolutetotalcare.com/findadoc
For youth who are enrolled in a Managed Care Plan, Medicaid has given a 90 day grace period for current approved Community Support services (BMOD, PRS, FS) to ensure continuity of care during the transition. This means that existing services will be allowed to continue without having to undergo the continuation of services request process during this time. Each MCO has its own provider network; after the 90 day grace period the MCOs may choose not to approve services for providers outside of their network.
Starting 7/1/16, new service referrals for Medicaid eligible youth enrolled in an MCO require COC to send the RBHS provider the current Plan of Care, Family Story, and CAFAS. The RBHS provider is required to complete the appropriate Authorization Request form and submit the documentation (POC, FS, and CAFAS) to the MCO for authorization.
For youth who are Medicaid Eligible and NOT enrolled in an MCO, also called fee for service (FFS) Medicaid, COC will complete the Medicaid RBHS referral form as usual. Continuation of services requests for youth enrolled in fee for service Medicaid is the same process as it has been.
For questions concerning RBHS referrals made by COC please contact Amanda Newell by email at Amanda.Newell@admin.sc.gov, or by phone at 803-734-4524.
Please see the Rehabilitative Behavioral Health Services Provider Manual and the RBHS FAQ on the South Carolina Department of Health and Human Services website for more information.
Providers can also contact the provider service center with questions at: 1-800-575-0418
The Qualified Provider List (QPL)
The Continuum of Care (COC) is required to ensure that when it sends a referral for services to a provider that the provider receiving the referral is qualified to provide those services. In order to ensure that providers are qualified, the COC partnered with several other state agencies to develop a Fixed Price Bid for Medicaid Rehabilitative Behavioral Services. The Continuum has several Fixed Price Bids for other types of services such as Residential, and Transportation services. Providers must have gone through the certification process for each bid to be put on a Qualified Provider List (QPL) for the services they wish to provide. Providers must be enrolled in Medicaid and have completed the solicitation process with the Materials Management Office (MMO) to be included on the list.
As per South Carolina procurement law, all Medicaid enrolled providers who wish to be on the QPL will need to submit a bid and be awarded a contract by the South Carolina State Fiscal Authority.
The Medicaid Rehabilitative Behavioral Services fixed price bid will be open for bid on March 8, 2016, June 8, 2016, and September 8, 2016. After that time the bid will be open on the third Wednesday of December, March, June, and September until June 17, 2020. If you have questions about this bid please contact the Materials Management Office or visit the following direct link to the Medicaid Rehabilitative Behavioral Services fixed price bid: http://webprod.cio.sc.gov/SCSolicitationWeb/contractSearch.do?solicitnumber=5400010212
In the coming months there will be changes in SCDHHS RBHS policy which include a Managed Care carve in of Rehabilitative Behavioral Health services. For more information about the changes please see SCDHHS’s web site as well as the Outpatient and Rehabilitative Behavioral Health Services Managed Care Training provider alert: https://www.scdhhs.gov/pro-alert/outpatient-and-rehabilitative-behavioral-health-services-managed-care-training
Please see below for more information:
Medicaid Provider Manual List:https://www.scdhhs.gov/provider-manual-list
Current RBHS providers:https://www.scdhhs.gov/site-page/private-rbhs-provider-directory
State Fiscal Authority Procurement Services:http://www.mmo.sc.gov/PS/PS-index.phtm