Provider's Info_Summary.docx
DOCX document 55 KB Posted
- Attached to
- MEDICAID REHABILITATIVE BEHAVIORAL SERVI
- Solicitation number
- 5400029987
- Issued by
- Richland County, South Carolina
About this file
This Provider Information Summary form is for the South Carolina State Fiscal Accountability Authority Division of Procurement Services solicitation for Medicaid Rehabilitative Behavioral Health Services (RBHS), administered in conjunction with the South Carolina Department of Social Services and the Department of Behavioral Health and Development Disabilities. The solicitation seeks qualified providers to deliver assessment services, service plan development, psychotherapy services, and community support services for children under age 21. Assessment services include psychiatric diagnostic evaluations, psychological testing and evaluation, behavioral health screening, and child and adolescent level of care utilization assessments. Psychotherapy services encompass individual, family, group, and multiple family group therapy sessions at varying durations. Community support services include peer support, crisis management, behavior modification, psychosocial rehabilitation, and family support services. Responses are due September 8, 2026 at 11:00 AM ET, with a non-mandatory pre-bid conference scheduled for August 20, 2026 at 10:00 AM via Teams and questions due August 7, 2026. Award notification is scheduled for September 22, 2026. The contract term begins October 2, 2026 and expires October 1, 2031, with automatic annual renewal for one-year periods unless the state provides thirty days' notice not to renew.
Pricing is fixed as established by the South Carolina Department of Health and Human Services with sole rate-setting authority. Service rates vary by procedure code, unit type, and provider credential level, ranging from $7.99 for Licensed Practical Nurse services to $252.43 for Child and Adolescent Level of Care Utilization System assessments by Licensed Psychologists. Eligibility is restricted to providers already enrolled or intending to enroll as Medicaid RBHS providers, with proof of enrollment required. Termination of Medicaid enrollment during the contract term results in automatic contract termination. Contractors must maintain Commercial General Liability insurance with limits of at least $1,000,000 per occurrence, Abuse or Molestation Insurance with limits of at least $1,000,000 per occurrence, and Information Security and Privacy insurance with limits of at least $1,000,000 per claim and $2,000,000 aggregate. Offerors must be registered South Carolina vendors and demonstrate responsibility and capability to perform the work, with monthly documentation of services required throughout the contract period.
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|---|---|---|
| Amendment 2.docx | DOCX document | |
| Amendment 1.docx | DOCX document | |
| Solicitation.docx | DOCX document |
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Text version
Solicitation #
PROVIDER INFORMATION SUMMARY
Offeror must complete this form and indicate on the following pages which Medicaid Rehabilitation Health Services Offeror has been enrolled to provide or intends to be enrolled:
**The offeror must submit proof of enrollment with SCDHHS and MCOs. Termination of enrollment will result in termination of this contract.
Offeror/ Program Name:
Complete Address City / State / Zip
Primary Contact Person:
| Name |
| Phone # |
| E Mail |
Required Program Information:
| FID # |
| NPI |
| Vendor # |
Medicaid Enrollment Information:
| Effective Enrollment Date |
| Medicaid ID |
| Name of HHS Program Manager |
If different from above contact person, please provide the name and telephone number for a central (South Carolina) staff responsible for the following:
Service Authorizations Supervision Clinical Oversight State Agency Liaison StaffPrimary Contact Person:
Name Phone # E Mail
Primary Contact Person:
Primary Contact Person:
| SERVICE NAME / BRIEF DESCRIPTION |
| PROC CODE |
| UNIT FREQ |
| FREQUENCY LIMITS |
| MODIFIER / DESCRIPTION |
| RATE |
INDICATE BELOW COUNTIES TO BE SERVED OR STATEWIDE
ASSESSMENT SERVICES
Psychiatric Diagnostic Evaluation without Medical –
90791
Encounter = 1 unit
1 Encounter per 6 months
| AH |
| Licensed Psychologist |
| $236.92 |
Initial
| HO |
| Master’s Level |
| $162.27 |
Psychological Testing and Evaluation Assessment Face to Face (1 Hour) 96130
| 1 unit = 60 minutes |
| 1 Encounter per day |
| AH |
| Licensed Psychologist |
| $90.43 |
| 96131 |
| 1 unit = 60 minutes (after the initial hour) |
| Up to 5 total hourly units per day |
| AH |
| Licensed Psychologist |
| $90.43 |
Psychological Testing and Evaluation Assessment Face to Face (30 Minutes)
96136
1 unit = 30 minutes
1 Encounter per day
| AH |
| Licensed Psychologist |
| $45.21 |
96137 1 unit = 30 minutes (after the initial 30 minutes)
Up to 6 total 30-minute sessions per day
| AH |
| Licensed Psychologist |
| $45.21 |
Behavioral Health Screening
H0002
15 minutes = 1 unit
2 units per day
| AH |
| Licensed Psychologist |
| $42.07 |
| HO |
| Master’s Level |
| $28.81 |
| HN |
| Bachelor’s Level |
| $25.24 |
Mental Health Comprehensive Assessment – Follow–up
H0031
Encounter = 1 unit
12 Encounters per year
| AH |
| Licensed Psychologist |
| $118.46 |
| HO |
| Master’s Level |
| $81.14 |
Child and Adolescent Level of Care Utilization System (CALOCUS) Assessment
H2000
Encounter = 1 unit
1 Encounter per 6 months
| AH |
| Licensed Psychologist |
| $252.43 |
| HO |
| Master’s Level |
| $172.99 |
| SERVICE NAME / BRIEF DESCRIPTION |
| PROC CODE |
| UNIT FREQ |
| FREQUENCY LIMITS |
| MODIFIER / DESCRIPTION |
| RATE |
IINDICATE BELOW COUNTIES TO BE SERVED OR STATEWIDE
Service Plan Development
Service Plan Development – Interdisciplinary Team w/Client
99366
Encounter = 1 unit 6 Encounters per rolling 12 months
$44.43
Service Plan Development – Interdisciplinary Team w/o Client
99367
Encounter = 1 unit 6 Encounters per rolling 12 months
$44.43
Service Plan Development by Non–Physician
H0032
15 minutes = 1 unit
10 – units per week
| AH |
| Licensed Psychologist |
| $52.06 |
| HO |
| Master’s Level |
| $35.66 |
| HN |
| Bachelor’s Level |
| $31.38 |
| SERVICE NAME / BRIEF DESCRIPTION |
| PROC CODE |
| UNIT FREQ |
| FREQUENCY LIMITS |
| MODIFIER / DESCRIPTION |
| RATE |
INDICATE BELOW COUNTIES TO BE SERVED OR STATEWIDE
Psychotherapy Services
Individual Psychotherapy – Face to Face – 25-30 minutes
90832
Encounter= 1 unit Unit= 1 session 1 per date of Service IP can be rendered in a variety of combinations, 6 sessions per month.
| AH |
| Licensed Psychologist |
| $78.08 |
| HO |
| Master’s Level |
| $53.48 |
Individual Psychotherapy – Face to Face 45-50minutes
90834
Encounter =1 unit Unit = 1 session 1 per date of Service IP can be rendered in a variety of combinations, 6 sessions per month.
| AH |
| Licensed Psychologist |
| $156.18 |
| HO |
| Master’s Level |
| $106.97 |
Individual Psychotherapy – Face to Face – 60-75 minutes
90837
Encounter=1 unit Unit= 1 session 1 per date of Service IP can be rendered in a variety of combinations, 6 sessions per month.
| AH |
| Licensed Psychologist |
| $208.24 |
| HO |
| Master’s Level |
| $142.63 |
Family Psychotherapy – w/o Client – Hour session
90846
Encounter=1 unit Unit = 1 session
1 per date of service, 4 sessions per month
| AH |
| Licensed Psychologist |
| $224.09 |
| HO |
| Master’s Level |
| $153.49 |
Family Psychotherapy – w/Client – Hour Session
90847
Encounter=1 unit Unit = 1 session
1 per date of service, 4 sessions per month
| AH |
| Licensed Psychologist |
| $224.09 |
| HO |
| Master’s Level |
| $153.49 |
Multiple Family Group Psychotherapy – Hour session
90849
Encounter= 1 unit Unit =1 session
8 sessions per month
| AH |
| Licensed Psychologist |
| $79.54 |
| HO |
| Master’s Level |
| $54.48 |
| Group Psychotherapy – Hour session |
| 90853 |
| Encounter= 1 unit |
Unit =1 session
| 8 sessions per month |
| AH |
| Licensed Psychologist |
| $34.71 |
| HO |
| Master’s Level |
| $23.78 |
| SERVICE NAME / BRIEF DESCRIPTION |
| PROC CODE |
| UNIT FREQ |
| FREQUENCY LIMITS |
| MODIFIER / DESCRIPTION |
| RATE |
INDICATE BELOW COUNTIES TO BE SERVED OR STATEWIDE
Community Support Services
Peer Support Service – Provided by DMH and DAODAS only
H0038
15 minutes = 1 unit
16 units per day
| CPSS |
| $14.88 |
Crisis Management
H2011
15 minutes = 1 unit
16 units per day
| AH |
| Licensed psychologist |
| $55.53 |
| HO |
| Master’s level |
| $38.03 |
| HN |
| Bachelor’s level |
| $33.47 |
Behavior Modification
H2014
32 units per day
| AF |
| Specialty physician (psychiatrist) |
| $29.02 |
| HP |
| Doctoral level (MD) |
| $28.21 |
| AM |
| Physician team member (PA) |
| $14.44 |
| SA |
| Nurse practitioner (APRN) |
| $13.51 |
| AH |
| Licensed psychologist |
| $14.63 |
| HO |
| Master’s level |
| $10.02 |
| TD |
| Registered nurse (RN) |
| $12.19 |
| HN |
| Bachelor’s level |
| $8.78 |
| TE |
| Licensed Practical Nurse (LPN) |
| $7.99 |
Psychosocial Rehabilitation Service Individual
H2017
24 units per day
| U1 |
| Licensed psychologist |
| $14.63 |
| U2 |
| Master’s level |
| $11.16 |
| U3 |
| Bachelor’s Level |
| $10.11 |
| U4 |
| Registered nurse (RN) |
| $12.19 |
| U5 |
| < Bachelor’s Degree (TFC only) |
| $6.72 |
| U6 |
| Licensed psychologist Group |
| $7.33 |
| U7 |
| Master’s level Group |
| $5.57 |
| U9 |
| Registered nurse (RN) Group |
| $6.09 |
| U8 |
| Bachelor’s level Group |
| $5.06 |
| UA |
| < Bachelor’s Degree (TFC only) Group |
| $3.37 |
Family Support
S9482
32 units per day
| AF |
| Specialty physician (psychiatrist) |
| $29.07 |
| HP |
| Doctoral level (MD) (Pharm) |
| $28.27 |
| AM |
| Physician team member svc(PA) |
| $14.43 |
| SA |
| Nurse practitioner (APRN) |
| $13.53 |
| AH |
| Licensed psychologist |
| $14.63 |
| HO |
| Master’s level |
| $10.02 |
| TD |
| Registered nurse (RN) |
| $12.23 |
| HN |
| Bachelor’s level |
| $8.82 |
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