SPECIALIZED THERAPIES SERVICES PROVIDER IN SOUTH CAROLINA

Fatumata Kaba
Oct 13
4 min read

DELIVERING CUSTOMIZED THERAPEUTIC INTERVENTIONS TO PROMOTE FUNCTION, COMMUNICATION, AND QUALITY OF LIFE FOR INDIVIDUALS ACROSS THE LIFESPAN

Specialized Therapies Services in South Carolina include physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) delivered under Medicaid State Plan benefits and Home and Community-Based Services (HCBS) Waiver programs. These services are intended for individuals with physical disabilities, developmental delays, traumatic injuries, or chronic conditions requiring skilled therapeutic support to achieve or maintain optimal functioning.

1. GOVERNING AGENCIES

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

Role: Manages Medicaid reimbursement and service authorizations for therapy services.

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

Role: Regulates licensed therapy practices and oversees facility licensure if services are delivered in outpatient settings.

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

Role: Oversees therapy supports authorized under the ID/RD, HASCI, and CS Waivers.

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

Role: Defines federal guidelines for reimbursable therapy services under Medicaid programs.

2. SPECIALIZED THERAPIES SERVICES OVERVIEW

Specialized therapies help individuals achieve developmental milestones, improve communication, strengthen motor skills, and increase independence in daily activities.

Approved providers may deliver:

Physical Therapy (PT): Strengthening, mobility training, gait support, and balance work.
Occupational Therapy (OT): Fine motor skills, ADL retraining, sensory integration, and adaptive strategies.
Speech-Language Therapy (SLP): Speech production, language comprehension, feeding and swallowing interventions, and AAC device use.
Therapy Evaluations: Functional assessments to determine goals and service needs.
Direct 1:1 Interventions: In-home or clinic-based, depending on service model.
Care Plan Development & Progress Monitoring: ISP or treatment plans aligned with individual goals.
Documentation: Session notes, treatment goals, outcome tracking, and Medicaid billing forms.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the South Carolina Secretary of State.
Obtain EIN and Type 2 NPI.
Ensure all therapists are licensed in SC by the appropriate state board (PT, OT, or SLP).
Secure a DHEC facility license if operating a brick-and-mortar therapy clinic.
Enroll as a Medicaid provider through SCDHHS under each therapy discipline.
Develop a Specialized Therapy Services Policy & Procedure Manual including treatment models, compliance protocols, and documentation standards.

4. SOUTH CAROLINA PROVIDER ENROLLMENT PROCESS

Step 1: Register business, secure EIN, NPI, and liability insurance.

Step 2: Obtain therapist licensure and any applicable facility licenses (if not mobile/in-home).

Step 3: Enroll in Medicaid via the SCDHHS Provider Enrollment Portal, selecting each therapy type (PT/OT/SLP).

Step 4: Submit credentialing documents, policies, and sample treatment plans.

Step 5: Begin providing services upon authorization through waiver case managers or physician referrals.

5. REQUIRED DOCUMENTATION

Business license, EIN, and NPI verification
SC licensure for each therapist and clinical supervisor
Medicaid provider approval letter
Facility license (if applicable via DHEC)
Liability and malpractice insurance
Specialized Therapy Services Policy & Procedure Manual including:
- Evaluation and treatment planning protocols
- Medicaid billing and session note templates
- Participant rights, HIPAA compliance, and confidentiality policies
- Incident reporting and safety procedures
- Progress documentation and goal tracking forms
- Quality assurance and peer review systems

6. STAFFING REQUIREMENTS

Role: Licensed Therapist (PT, OT, SLP)

Requirements: Active South Carolina license, Medicaid credentialing, and background check.

Role: Therapy Assistant (PTA, COTA, SLPA – if applicable)

Requirements: Must work under direct supervision of a licensed therapist.

Role: Clinical Supervisor / Program Director

Requirements: Oversight of documentation, compliance, and service quality.

All staff must complete:

HIPAA and confidentiality training
Abuse prevention and incident reporting
Emergency protocols and safety procedures
Medicaid billing standards and note-writing training
Continuing education as required by state boards

7. MEDICAID WAIVER PROGRAMS

Therapy services are reimbursable under:

ID/RD Waiver – PT/OT/SLP services for individuals with intellectual and developmental disabilities
HASCI Waiver – For individuals with head or spinal cord injuries
Community Supports (CS) Waiver – For individuals needing non-residential habilitative therapies
Medicaid State Plan – Standard therapy benefits with physician referral
Katie Beckett/TEFRA Program – Pediatric therapy services for children with complex needs
EPSDT Services (Early and Periodic Screening, Diagnosis, and Treatment) – Comprehensive therapy access for children under 21

8. TIMELINE TO LAUNCH

Phase: Business Formation & Policy Manual Development

Timeline: 1–2 months

Phase: Therapist Credentialing & Medicaid Enrollment

Timeline: 2–3 months

Phase: Facility Setup (if applicable) & Staff Orientation

Timeline: 30–60 days

Phase: Begin Service Delivery upon Authorization

Timeline: Immediately following approval and plan of care acceptance

9. CONTACT INFORMATION

South Carolina Department of Health and Human Services (SCDHHS)

Website: https://www.scdhhs.gov

SCDHHS Medicaid Provider Enrollment Portal

Website: https://providers.scdhhs.gov

South Carolina Department of Health and Environmental Control (DHEC)

Website: https://scdhec.gov

SC Board of Physical Therapy, Occupational Therapy, and Speech-Language Pathology

Licensure Portal: https://llr.sc.gov

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

SOUTH CAROLINA SPECIALIZED THERAPY PROVIDER

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — SOUTH CAROLINA THERAPY PROVIDER

WCG assists therapy providers with launching compliant, person-centered services that support Medicaid-eligible individuals with developmental, physical, or communication challenges.

Scope of Work: