Medicaid Rehabilitative Therapy
Overview of Medicaid Rehabilitative Therapy
Rehabilitative Services are medical or remedial services that have been recommended by a Physician or other Licensed Practitioner of the Healing Arts (LPHA) within the scope of their practice under South Carolina State Law and as further determined by the South Carolina Department of Health and Human Services (SCDHHS) for maximum reduction of physical or mental disability and restoration of a beneficiary to their best possible functional level.
LEAs must adhere to the applicable IDEA requirements when Medicaid-reimbursed school-based services are included in the IEP or IFSP.
Medicaid reimbursement is available for school-based rehabilitative therapy services when provided by or under the direction of the qualified rehabilitative therapy provider for which the beneficiary has been referred. Referrals must be made by a physician or other licensed practitioner of the healing arts (LPHA) within the scope of his or her practice under state law.
Reimbursement is available for services that conform to accepted methods of diagnosis and treatment. Reimbursement is not available for services determined to be unproven, experimental or research-oriented, in excess of those deemed medically necessary to treat the beneficiary’s condition, or not directly related to the beneficiary’s diagnosis, symptoms or medical history. Reimbursement is not available for time spent documenting services or traveling to or from services, or for canceled visits and missed appointments.
Current Updates
Click the link above for current information.
Medicaid Therapy Services
Speech-Language Therapy
Occupational Therapy
Physical Therapy
Medicaid Therapy Documentation
All providers shall maintain a clinical record for each Medicaid-eligible beneficiary that fully describes the extent of the treatment services provided.
The clinical record must contain documentation sufficient to justify Medicaid participation and should allow an individual not familiar with the beneficiary to evaluate the course of treatment.
Medicaid File must contain the following documents:
Evaluation and other assessments
Treatment Plan (IEP, or IFSP) (when services are recommended)
Progress Service Notes (summarize therapy services at least every 90 days)
Other documents relevant to the care and treatment of the student (Lab reports, medical reports, additional assessments, and court orders)
Staff Credentials (Staff SCLLR license and Office of Inspector General Report
Other forms and information:
Staff Qualifications
Staff must meet all applicable Medicaid provider qualifications, as well as the applicable state licensure regulations, in addition to any specified requirements by the South Carolina Department of Education for the provision of Medicaid school-based services. The contracted LEA is responsible for ensuring the individuals rendering Medicaid school-based services are approved, credentialed, or licensed.
All subcontracts (e.g., billing contracts, contracted providers, etc.) are subject to the terms of the LEA’s contracts with SCDHHS, and the LEA provider is held solely responsible for the performance of the subcontractor.
All supervisory staff licensed by Labor, Licensing and Regulation (LLR) must adhere to any provisions as required by LLR.
In addition
Medicaid Therapy Training
Technical Assistance
Training and support are provided by the district office. Contact the district office point of contact for additional information.
Resources
SCDE Resources:
•SCDE OMS Webpage: Medicaid - South Carolina Department of Education - 07/25/2023 2:28 PM (sc.gov)
•SCDE – Medicaid Forms: Forms - South Carolina Department of Education - 07/25/2023 2:29 PM (sc.gov)
•SCDE School QA Checklist: Quality Assurance (QA) - South Carolina Department of Education - 07/25/2023 2:31 PM (sc.gov)
•SCDE- Fee/Rate Schedule - Additional Resources - South Carolina Department of Education - 07/25/2023 2:31 PM (sc.gov)
SCDHHS Resources:
•SCDHHS website: SCDHHS - South Carolina Department of Health and Human Services
•SCDHHS LEA Manual and forms website: Local Education Agencies (LEA) Services Provider Manual | SCDHHS
•SCDHHS Medicaid Provider Education webpage: Trainings | SCDHHS
•SCDHHS contact for the Medicaid Provider Services - 1 (888) 289-0709.
Medicaid Contact
Deitrich Drayton
Medicaid and Nursing Administrator
Phone#: 803-212-5482
Email: ddrayton@sccharter.org