RBHS - Mental Health Services- in Schools

The Medicaid program, as established by Title XIX of the Social Security Act, provides quality health care to low-income, and disabled individuals by utilizing state and federal funds, to reimburse providers for approved medical services.

 The South Carolina Department of Health and Human Services (SCDHHS) provides Medicaid reimbursement for medically necessary services provided to Medicaid-eligible individuals in the Local Education Agency (LEA).

The South Carolina (South Carolina or State) State Medicaid Plan allows an array of behavioral health services under the Rehabilitative Services Option, 42 CFR 440.130(d). 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.

 Effective July 1, 2022, the moratorium on RBHS provider enrollment will be partially lifted. Service must be rendered in a school-based setting by a provider that is employed or contracted by the school (SCPCSD).

 Local Education Agencies (LEA)

 SCPCSD is recognized as an LEA by the South Carolina Department of Education (SCDE) and has contracted with SCDHHS to provide Medicaid-reimbursable school-based services to Medicaid-eligible children with special needs. Individual Charter Schools must sign an annual contract with the South Carolina Public Charter School District each year. 

Individual service providers employed or contracted by an LEA must meet the specified Medicaid provider qualifications. 

Medicaid Student Eligibility - Rehabilitative Behavioral Health Services (RBHS)

RBHS are available to all Medicaid beneficiaries diagnosed with mental health and/or a substance use disorder (SUD), as defined by the current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD) who meet medical necessity criteria. Services are provided to, or directed exclusively toward, the treatment of the Medicaid-eligible beneficiary for ameliorating disabilities, improving the beneficiary’s ability to function independently, and restoring maximum functioning through the use of diagnostic and restorative services.

All Providers of RBHS must fulfill the requirements for South Carolina licensure/certification and appropriate standards of conduct by means of evaluation, education, examination, and disciplinary action regarding the laws and standards of their profession, as promulgated by the South Carolina Code of Laws and established and enforced by the South Carolina Department of Labor Licensing and Regulation. Professionals who have received appropriate education, experience, and have passed prerequisite examinations as required by the applicable State laws and licensing/certification Board and additional requirements as may be further established by SCDHHS, may qualify to provide RBHS. Licensed professionals must maintain a current license and/or certification from the appropriate authority to practice in South Carolina, or the state in which licensed clinical professionals render services and must be operating within their scope of practice.

 Private Providers Rendering Services in Schools 

Subcontractors 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.

The SCPCSD must contract with any qualified provider for school-based services and the private provider must also contract with the individual school.