Effective for dates of service on or after July 1, 2026, the South Carolina Department of Health and Human Services (SCDHHS) will update the Autism Spectrum Disorder (ASD) Services Provider Manual. These updates will streamline service definitions, clarify medically necessary autism services and support current trends and best practices. Policy updates will include the following:

• Updated telehealth guidance;
• Clarified and strengthened medical necessity criteria;
• Expanded and clarified list of non-covered services;
• Updated provider qualifications and enrollment guidelines;
• Strengthened plan of care and documentation requirements, including additional context to service delivery locations; and
• Clarified policy to include more descriptive service guidelines and procedure code standards.

Telehealth Flexibilities
As described in Medicaid bulletin #24-070, evaluation of utilization data, clinical evidence and feedback from providers and other stakeholders have been used to update guidance regarding telehealth flexibilities. The Delivery of Family Adaptive Behavior Treatment Guidance (97156) via telehealth will be permanently incorporated in the ASD Services Provider Manual. Direct Adaptive Behavior Treatment with Protocol Modification (97155) will also be permanently incorporated in the ASD Services Provider Manual with prior authorization requirements. Lastly, the delivery of Behavior Identification Assessment (97151) via telehealth will no longer be allowable.

Provider Qualifications and Enrollment
As described in Medicaid bulletin #23-059, the Centers for Medicare and Medicaid Services strengthened requirements for Medicaid provider screening to prevent fraud, waste and abuse. Additional guidance has been added to the ASD Services Provider Manual to clarify and align requirements for "high risk" provider enrollment categorization.

A draft of the updated ASD Services Provider Manual is available for review here:

The ASD Services Provider Fee Schedule will be updated to reflect the above.

Providers are encouraged to submit feedback about the draft manual by emailing [email protected] by June 1, 2026.

The updated manual draft will go into effect and be posted on the provider manual page of the SCDHHS website by July 1, 2026.

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.

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

Print Version