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SC Medicaid - SCDHHSMedicaid · Coverage · Medical Policy · SCHigh impact

Updates to ASD Services Provider Manual

Act
by Jun 30, 2026
Effective date
Jul 1, 2026
Identified
Jun 27, 2026

Summary

South Carolina SCDHHS has updated the ASD Services Provider Manual effective July 1, 2026, with changes to telehealth guidance, medical necessity criteria, service descriptors, and documentation requirements. A critical new anti-kickback rule prohibits reimbursement for ABA services provided by clinics or agencies owned by entities that also conducted the member's autism evaluation and diagnosis.

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What to do

by Jun 30, 2026 · 6 steps
01Billing team must review the updated ASD Services Provider Manual (available July 1, 2026 on SCDHHS website) and implement compliance checks in billing system.
02Immediately audit all ABA service authorizations to identify any violations of the new anti-kickback rule prohibiting services from clinics/agencies owned by entities that performed the member's autism evaluation.
03By July 1, 2026: Update all authorization request forms and billing workflows to reflect new medical necessity documentation requirements.
04Providers must ensure all initial and continuing service authorizations submitted on or after July 1, 2026 comply with updated policy guidance.
05Register staff for SCDHHS webinars: July 9, 2026 (1-3 p.m., policy overview) and July 23, 2026 (1-3 p.m., medical necessity documentation).
06Prior authorizations with dates of service before July 1, 2026 remain valid under old policy; only new authorizations require compliance with updated requirements.
If missed: Failure to comply with anti-kickback provisions may result in administrative, civil, or criminal penalties, program termination, and referral to law enforcement.

Original notice

Updates to ASD Services Provider Manual
scdhhs.gov · Always check the source before changing claims.
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Related changes

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Updates to ASD Services Provider ManualHighEffective Jul 1, 2026 · Medical PolicyBrowse every SC Medicaid - SCDHHS change in the policy list

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