Practice requirements for ABA providers in South Carolina

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As of 2026-10-21, per the July 2026 SCDHHS ASD provider training update and the July 1, 2026 provider manual: newly enrolling individual ASD providers must complete level one and level two fingerprint-based criminal background checks (SLED and FBI) during enrollment. ASD provider groups are in the 'high' risk screening category, with a pre-enrollment site visit and disclosure of ownership. The training update lists exceptions for state-agency providers, school-district mental-health counselors, and entities acting for state agencies. The manual indicates group files must carry annual SLED checks plus child-abuse registry and sex-offender registry checks for staff; this is drawn from a manual that has not been verified against the final version.

No complete staff-training standard was confirmed. The cited draft manual describes recordkeeping, not training: groups must keep files for seven years from the date of service, including for former providers, with licenses/certifications, employment application, degrees and verification of the outcome of the 90-day grace period for any uncredentialed BT. These file-content requirements are present in the draft but final-manual verification remains outstanding.

Providers must be physically located in the SC Medicaid Service Area, subject to the geographic exception under 42 CFR 431.52. Fee-for-service prior authorization runs through the state QIO; MCO authorization is a separate process, and the 97151 exemption applies separately and should be confirmed against the manual. Providers must separately complete contracting, credentialing and enrolling with each MCO to serve MCO members (SCDHHS ASD provider enrollment page and ASD provider page).

Case supervision must follow BACB guidelines and be provided by a BCBA-D, BCBA, or BCaBA. The July 1, 2026 manual requires BACB professional supervision of the RBT but does not restate a numeric percentage, contact count, or observation minimum. A BCaBA must be supervised by a BCBA-D or BCBA and must disclose that supervisor’s name and contact on a member consent form. BCaBAs may supervise RBTs and others who implement interventions. Indirect BT/RBT case supervision is not reimbursable as 97155. 97155 is direct, in-person protocol modification by the enrolled BCBA-D, BCBA, or BCaBA, billable only for time that provider is in session with the member, at up to 10% of rendered 97153 hours, capped at 64 units per month and 16 units per week. 97155 may be concurrent with 97153 only when two different providers each meet that code’s threshold and document distinct roles; it may not be billed concurrently with 97153 merely to teach an RBT the initial protocol. Up to 25% of QIO-approved 97155 units may be telehealth (GT) only with prior authorization, for home-based treatment of maladaptive behaviors when severe access problems are documented, and the enrolled provider must be in the SC Medicaid Service Area and able to deliver most 97155 in person. Staff-to-member ratio is at least 1:1 except group adaptive behavior treatment, where the RBT/BCBA/BCaBA must be directly engaged. Caseload maximums (collective, any location or company; weighted 30–40 hours/week = 1 case, 10–25 = 1/2 case, under 10 = 1/4 case): BCBA-D/BCBA maximum 12 cases without a BCaBA and 16 with a BCaBA; BCaBA maximum 12. These caps assume the enrolled analyst both provides BACB RBT supervision and delivers separate in-person direct services. At least one hour of 97156 is required each month of authorized and rendered direct treatment and protocol modification. The IPOC must include at least two measurable caregiver goals and a schedule of at least six caregiver-training sessions per six-month authorization, unless a written justification is submitted.