As announced in the Medicaid bulletin (MB# 26-015) issued May 15, 2026, the South Carolina Department of Health and Human Services (SCDHHS) has updated the ASD Services Provider Manual. The program information and requirements described in the manual are effective for dates of service on or after July 1, 2026. The manual will be available July 1, 2026, on the provider manual page of SCDHHS' website.

All ASD services authorized prior to July 1, 2026, can continue as authorized per policy guidance in place at time-of-service authorization. Any initial or continuing service authorization submitted on or after July 1, 2026, must reflect compliance with updated policy.

Based on feedback submitted on the draft manual, SCDHHS has incorporated additional clarification related to telehealth guidance, medical necessity criteria, descriptive service guidelines and documentation requirements. SCDHHS appreciates providers taking time to submit feedback on the draft of the manual distributed May 15, 2026. 

SCDHHS will conduct two live webinars to review the updates to the ASD Services Provider Manual. 

ASD Services Provider Manual Policy Updates
July 9, 2026, from 1-3 p.m. 
Register here.  

ASD Services Provider Manual Documenting Medical Necessity
July 23, 2026, from 1-3 p.m. 
Register here.  

The initial webinar will review the policy manual updates, and the second will provide more detailed guidance related to medical necessity criteria and documentation. Both webinars will be recorded and made available for viewing on the SCDHHS website.

Anti-kickback Policy  
SCDHHS is reminding providers of its anti-kickback policy published in the Provider Administrative and Billing Manual to ensure compliance with state and federal laws. Language has been added to the ASD Services Provider Manual, stating “ABA services provided by a clinic or agency owned by any private entity related to the same private entity that conducted the member’s Autism evaluation and diagnosis” are not reimbursable.

The South Carolina Healthy Connections Medicaid program strictly prohibits all forms of provider kickbacks and self-referrals as outlined in S.C. Code § 44-113-60 and 42 USC § 1320a-7b(b). Violations of either statute may result in administrative, civil and/or criminal penalties, up to and including program termination and referral to law enforcement authorities. 

South Carolina’s Medicaid managed care organizations (MCOs) are responsible for the authorizations, coverage and reimbursement related to the services described in this bulletin for members enrolled in an MCO. 

Please refer any questions or concerns regarding this bulletin to the Provider Service Center (PSC) at (888) 289-0709 or submit an inquiry online. The PSC’s regular hours of operation are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday. Questions can also be emailed to MedicaidStatePlan@scdhhs.gov.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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