MedicaidCoverageMedium impact
Autism Spectrum Disorder Services Provider Manual Update
SC Medicaid - SCDHHS·SC · Family Medicine, Pediatrics, Psychiatry·Medical Policy
Effective date
Sep 1, 2025
We identified it
Jun 18, 2026
Summary
South Carolina Medicaid is updating medical necessity requirements for autism spectrum disorder (ASD) treatment services for members 0-21 years old. Key changes include replacing 'Comprehensive Psychological Evaluation' with 'Comprehensive Diagnostic Assessment' and adding new qualified providers and assessment tools. A new Medical Care Home Autism Assessment option is being added for primary care physicians.
Action Required
By September 1, 2025: Billing team and providers must update ASD service authorization processes to use new 'Comprehensive Diagnostic Assessment' terminology and ensure assessments are conducted by qualified providers (MD, DO, PhD, PsyD, or LPES) using approved tools (ADI-R, ADOS, or CARS). Primary care physicians should implement the new Medical Care Home Autism Assessment option. Attend virtual training sessions on Sept 4 or Sept 12, 2025, and review the updated ASD Services Provider Manual when available.