Addition of Intensive Outpatient and Partial Hospitalization Programs

SCDHHS is making these changes to support access to a comprehensive continuum of behavioral health services, enhance the state's provider network and ensure services are delivered effectively for Healthy Connections Medicaid members.

Outpatient Hospital Providers

Scope of Services

IOP and PHP provide clinical diagnostic and treatment services at a level of intensity similar to an inpatient or residential program but on a less than 24-hour basis. IOP and PHP may be appropriate when a patient does not require a restrictive 24-hour inpatient setting but does need a higher intensity of treatment services than standard outpatient care can provide. They can be used as a "step down" from inpatient care or a "step up" from standard outpatient treatment, operating as a stand-alone level of care to stabilize a deteriorating condition and prevent hospitalization.

Prior Authorization

Prior authorization is required for both IOP and PHP services regardless of whether the service is a "step down" or "step up" from previous levels of care. Stays beyond 30 calendar days will require a review of medical necessity for authorization of continued services. Further information on how to submit prior authorization is available from SCDHHS's quality improvement organization, Acentra Health at scdhhs.acentra.com .

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