Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
SC Medicaid - SCDHHSMedicaid · Coverage · Medical Policy · SC · Family Medicine, Pediatrics, PsychiatryMedium impact

Autism Spectrum Disorder Services Provider Manual Update

Act
by Sep 1, 2025
Effective date
Sep 1, 2025
Identified
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.

Get alerts when payers change rules like this one

We check SC Medicaid - SCDHHS and other payers every day and email you when a change matches your specialty and state.

Get SC Medicaid - SCDHHS alertsPolicy Monitoring is free. No card required.

What to do

by Sep 1, 2025 · 3 steps
01Billing 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).
02Primary care physicians should implement the new Medical Care Home Autism Assessment option.
03Attend virtual training sessions on Sept 4 or Sept 12, 2025, and review the updated ASD Services Provider Manual when available.

Original notice

Autism Spectrum Disorder Services Provider Manual Update
scdhhs.gov · Always check the source before changing claims.
View original ↗

Related policy hubs

SC Medicaid - SCDHHS policiesSC policy changesFamily MedicinePediatricsPsychiatry

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account