Private Rehab Manual - Quick Summary of Changes for February 1, 2024: 


Page 1: Clarifies to whom the policy manual applies, which includes the Managed care organizations (MCOs), and refers to LLR regarding supervision of practice that is allowed by the licensing board.

Page 5-6: Defines covered services and medical necessity, which will help providers avoid denials on technicalities. Please note that the private rehab manual *does apply* to ambulatory rehab centers (CARF, CORF). It is also noted that Medicaid does not cover maintenance therapy.  Check the description of maintenance therapy on page 6 to ensure your services have the potential to be a covered benefit for your patient(s).

Page 7: Aligns SLP, Aud, PT, and OT scopes of practice with 42 CFR 440.110 - SLP is listed in section (c)(1)

Pages 8-9: Definition for Telehealth eligibility, requirements, and limitations

Page 9: EPSDT services are defined as covered services with a link to information on the EPSDT portion of the SC DHHS website. You can review the Periodicity schedule by the AAP to review medical, hearing, and vision screenings that qualify under EPSDT.

Page 10: Improved clarity on biofeedback being a modality of treatment but not separately reimbursable

Page 11: Timely filing refers directly to the SC DHHS Administrative and Billing manual rather than containing guidelines about 48 hours, 7 days, 10 days, etc.

Page 12: “The presence or absence of school-based services must not reduce beneficiaries’ access to rehabilitative therapy and audiological services delivered in private practice or clinical settings.”

Page 14-15: Clarity on referrals and requirements in referrals, limitation on provider self-referral

Page 15-17: Improvement in the language regarding documentation requirements

Page 18: Definitions for modifiers (GT, GO, GP, 52, 59) - if unclear when to use the 52 or 59 modifier, refer to the definition and/or ASHA billing guidance (multiple procedure billing guidelines such as the NCCI edit table)

Notable positive changes specific to SLP services:

Page 20: “The Provider uses a variety of assessments or tests to determine the presence and severity of a disorder. Reporting of a standard test score is not required to indicate the presence of a disorder.”

Page 21: Added Pediatric Feeding Disorder to the list of categories of Speech-Language Disorders (i.e. disorders that SLPs diagnose)

Page 21-23: The code list with service limitations used to exist in a separately linked portion of the private rehab manual called “section 4.”  It is now contained within the text of the manual and shows limitations associated with each code.  The intent is for the SC DHHS Fee Schedule to align with THIS code list now within the manual.  This positive change helps ensure medicaid beneficiaries have access to medically necessary services across the spectrum of SLP domains and our full scope of practice. There may still be some additional CPT codes that we expect to see added later in 2024 which are not yet contained in this version of the manual, because - whether or not the codes are added- this will be dependent on the passage of the budget for fiscal year 2024-2025.

We worked with our PT and OT colleagues to help ensure their CPT code list was updated, so if your practice has multiple therapy types, please review the changes in the PT and OT sections of the manual.

GO-LIVE date was announced as February 1, 2024.  It may take some time for the MCO’s to implement these policy changes.  We will continue to work with members to understand what kinds of issues they are experiencing regarding Medicaid policies in 2024!


Accomplishments in 2023:

  • Advocated for BabyNet program and private rehabilitative service coverage improvement
  • Met with SC DHHS regarding the medicaid managed care organizations and third party liability
  • Advocated with private commercial carriers for improvements in speech therapy policies, provider credentialing, and reimbursement
  • Created additional resources on the SCSHA website to address member questions
  • Represented the association for the license board meetings
  • Worked with ASHA to address concerns about school-based Medicaid billing
  • Held multiple SC therapy coalition town hall meetings (SCSHA, SCOTA, APTA-SC)
  • Surveyed private therapy practice owners about Select Health and shared most pressing results with Select Health leaders
  • Started using internet-based technology to track SCSHA advocacy
  • Worked with ASHA to offer feedback on the medical review policy from EviCore
  • Assisted members working through dilemmas in their practice setting related to Medicaid policy
  • Held a webinar from ASHA presenters on the Workload model in the schools
  • Continued to address issue related to the SC Department of Education certification for SLPs
  • Joined a coalition called COVER SC which will be formulating a plan to advocate for closing the Medicaid coverage gap
  • Reviewed legislation and worked with the lobbyist to create a strategy to address LEAD-K, Read to Succeed
  • School SLP survey was conducted by the SCSHA school SLP Committee
  • Met with Rep. Pace regarding HB 3515 which would repeal the practice act for SLP and Audiology (bill is stalled)
  • Members gathered for SCSHA Legislative Day in April and presented the 2023 award for legislator of the year to Senator Loftis, and were introduced in the SC House and SC Senate

The advocacy efforts for SCSHA take many volunteers and led by Kelly Caldwell, the Vice President of Government Affairs, and guided by our lobbyist, Wanda Crotwell. The SCSHA legislative affairs committee is actively involved each year in reviewing and updating advocacy missions as well as the legislative agenda. To find out more about our advocacy leadership, we are including biographies here. Read more about advocacy with SCSHA in the menu. 

 Kelly Caldwell is a Speech-Language Pathologist for AnMed Health Voice Clinic where she has been since 2017.  Prior to that, Kelly worked at Spartanburg Regional Healthcare System in acute care.  She also works PRN for Prisma Health Baptist Easley Hospital.  In addition to those duties, Kelly is a mentor for The Medical SLP Collective.  Her primary clinical interests are in voice, swallowing, and upper airway disorders. She has a three-year-old son named Cameron, husband Charlie, and a cat and dog, Claire, and Copland. In terms of advocacy, Kelly was successful in leading advocacy efforts to change ASHA’s guidance on endoscopy during the COVID-19 pandemic during August 2020 to match ever-changing evidence.  Her goals as Vice President of Government Affairs include advocacy for solving state-level problems, building relationships with SLPs across SC to help ensure that our advocacy is in response to their problems, and continuing the streamlined approach of identifying problems in policy or legislation that affect our profession.  Before becoming an SLP, Kelly worked as a music educator in North Carolina, went back to school for Speech Pathology, and relocated to upstate South Carolina.  She lives in Easley, SC and works in Anderson, SC.  She has a Bachelor of Music in Flute Performance, Master of Arts in Teaching from UNC Chapel Hill, and Master of Science in Communication Sciences and Disorders from East Carolina University.

Wanda Crotwell is a government relations professional with more than 30 years of experience in the fields of government, communications, and public relations. Prior to joining The Southern Group, she was a lobbyist and strategic advisor at Mike Daniel and Associates for seven years.  Before joining MD&A in 2012, she was assistant to the Commissioner for External Affairs at the South Carolina Department of Health and Environmental Control, where she served under four separate commissioners and managed governmental affairs, legislative services, constituent services, annual budget requests, accountability reports, internal communications, and media relations.  In this capacity, she also served as policy advisor and strategic counsel to the Commissioner.

Her areas of expertise include legislative relations, lobbying, inter-governmental relations, strategic communication planning and implementation, regulatory development and consultation, environmental and health facilities permitting facilitation, speech writing, management, business communications, public speaking, and a first-hand understanding of state government.  She also possesses a keen understanding of the legislative process and the skills necessary to navigate that process for multiple issues at once.  She is well-known in the legislative arena for her ability to take complex issues and communicate those issues in understandable terms to achieve desired results.