Public Notice of Final Action for Prior Authorization Requirements for Services Rendered Outside the South Carolina Medicaid Service Area

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following action regarding prior authorization requirements for services rendered outside the South Carolina Medicaid Service Area (SCMSA) under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective on or after Oct. 1, 2025, SCDHHS will amend the South Carolina Title XIX State Plan to clarify prior authorization requirements for Healthy Connections Medicaid members receiving services outside of the SCMSA. This action will clarify that services rendered within the SCMSA by an out-of-state provider do not require additional prior authorization unless the service or procedure code requires it. Prior authorization is required for services rendered outside of the SCMSA.

Based on the actions above, SCDHHS does not anticipate a budget impact.

Print Version

Copies of this notice are available at each South Carolina Healthy Connections Medicaid county office and at www.scdhhs.gov for public review. Additional information regarding this action is available upon request at the address cited below.

Any written comments submitted may be reviewed by the public at the SCDHHS, Office of Health Programs, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9 a.m. and 5 p.m.