ADULT HEALTH SERVICES PROVIDER IN SOUTH CAROLINA

Fatumata Kaba
Oct 13
4 min read

DELIVERING PERSON-CENTERED MEDICAL AND SUPPORTIVE CARE TO PROMOTE HEALTH, DIGNITY, AND INDEPENDENCE FOR ADULTS IN COMMUNITY SETTINGS

Adult Health Services in South Carolina consist of Medicaid-funded in-home and community-based medical and non-medical services provided to adults with disabilities, chronic conditions, or aging-related health needs. These services support functional independence, promote wellness, and prevent unnecessary institutionalization. They are primarily authorized under South Carolina Medicaid’s Home and Community-Based Services (HCBS) Waivers, the Community Long Term Care (CLTC) program, and DDSN-managed waivers.

1. GOVERNING AGENCIES

Agency: South Carolina Department of Health and Human Services (SCDHHS)

Role: Oversees Medicaid enrollment, provider payments, and Adult Health Service standards under HCBS and CLTC programs.

Agency: South Carolina Department of Disabilities and Special Needs (DDSN)

Role: Authorizes medical and personal care services for adults with developmental disabilities.

Agency: South Carolina Department of Health and Environmental Control (DHEC)

Role: Regulates licensure for certain clinical and home-based care providers.

Agency: Centers for Medicare & Medicaid Services (CMS)**

Role: Ensures compliance with federal Medicaid guidelines and waiver requirements.

2. ADULT HEALTH SERVICES OVERVIEW

These services include medical, therapeutic, and supportive care delivered in the participant’s home or adult day health centers to help manage chronic health conditions, perform daily living tasks, and maintain community integration.

Approved providers may deliver:

Skilled Nursing: Medication administration, chronic disease monitoring, wound care
Personal Care: Bathing, dressing, toileting, and mobility support
Adult Day Health Care: Supervision, meals, health screenings, and recreation in a licensed facility
Health Monitoring: Vitals, symptom recognition, and care plan compliance
Therapy Services: PT, OT, or speech therapy (if licensed)
Nutrition Support: Meal planning, feeding assistance, dietary tracking
Care Coordination: ISP development, communication with case managers and physicians
Documentation: Daily logs, clinical notes, billing records

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the South Carolina Secretary of State
Obtain EIN and Type 2 NPI
Apply to SCDHHS and/or DDSN for Medicaid provider enrollment under the appropriate categories (e.g., Personal Care, Home Health, Adult Day Health)
If delivering skilled care, secure DHEC licensure
Carry liability and workers’ compensation insurance
Develop an Adult Health Services Policy & Procedure Manual

4. SOUTH CAROLINA PROVIDER ENROLLMENT PROCESS

Step 1: Form your business entity, obtain EIN and NPI

Step 2: Submit provider application to SCDHHS (and DDSN, if applicable)

Step 3: Apply for DHEC licensure for skilled nursing or adult day health operations

Step 4: Submit required staff credentials, policy manuals, and sample documentation

Step 5: Complete provider readiness review and begin receiving referrals

5. REQUIRED DOCUMENTATION

Articles of Incorporation, EIN, and NPI confirmation
SCDHHS and/or DDSN approval letters
DHEC license (if providing skilled or adult day services)
Insurance coverage (liability, auto, professional)
Adult Health Services Policy & Procedure Manual including:
- Participant intake and care plan templates
- Medication and vital signs protocols
- Personal care documentation and shift notes
- Emergency and critical incident protocols
- HIPAA compliance and participant rights
- Billing logs and service tracking sheets
- Quality assurance and supervision tools

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements: SC licensure, responsible for medication oversight, clinical documentation, and staff supervision

Role: Certified Nursing Assistant (CNA) / Personal Care Aide

Requirements: Background check, CPR/First Aid, and training in ADL assistance

Role: Adult Day Health Program Manager (if applicable)

Requirements: Experience in adult care, compliance, and activity coordination

Role: Licensed Therapists (optional)

Requirements: PT, OT, or SLP licensure for waiver-authorized services

All staff must complete:

HIPAA and participant rights training
Abuse/neglect prevention and emergency response training
Documentation and billing compliance training
Annual in-service competency evaluations

7. MEDICAID WAIVER PROGRAMS

Adult Health Services are reimbursable through:

CLTC (Community Long Term Care) – For elderly and disabled adults needing in-home support
ID/RD Waiver – For individuals with intellectual and developmental disabilities
Community Supports Waiver – For those needing lower-intensity support
HASCI Waiver – For individuals with acquired brain and spinal cord injuries
EPSDT / TEFRA (Under 21) – Pediatric participants transitioning into adult services
State Plan Medicaid Services – For eligible home health or nursing care needs

8. TIMELINE TO LAUNCH

Phase: Business Formation & Policy Manual Development

Timeline: 1–2 months

Phase: Medicaid Enrollment & Facility Licensing (if applicable)

Timeline: 2–3 months

Phase: Staff Hiring, Credentialing & Training

Timeline: 1–2 months

Phase: Readiness Review & Service Activation

Timeline: Begins once authorizations and referrals are received

9. CONTACT INFORMATION

South Carolina Department of Health and Human Services (SCDHHS)

Website: https://www.scdhhs.gov

South Carolina Department of Disabilities and Special Needs (DDSN)

Website: https://ddsn.sc.gov

South Carolina Department of Health and Environmental Control (DHEC)

Website: https://scdhec.gov

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

SOUTH CAROLINA ADULT HEALTH SERVICES PROVIDER

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — SC ADULT HEALTH SERVICES PROVIDER

WCG equips Adult Health Services providers with the tools to deliver high-quality, Medicaid-compliant care to South Carolina’s aging and disabled populations.

Scope of Work: