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Developmental Evaluation Centers Preserve Access and Funding
Background
Developmental evaluation centers, "DECs," are multidisciplinary centers providing diagnostic and treatment services to children, age 0-21 years, who have or are suspected to have a developmental disability, learning disability, significant developmental delay, or other learning/behavioral disorder. South Carolina code section 44-21-80 designates the following institutions as "regional tertiary level developmental evaluation centers"; MUSC Department of Pediatrics (MUSC Children's Hospital), USC Department of Pediatrics (Palmetto Health Children's Hospital), and Greenville Children's Hospital.
The vast majority of children served by the DECs are Medicaid-eligible children, and each DEC is contracted with SC DHHS (South Carolina Department of Health and Human Services) to provide comprehensive, multidisciplinary services. Recently, the Center for Medicare and Medicaid Services, "CMS," indicated to SC DHHS that it will no longer allow billing of bundled codes. This change in policy will force the DECs to utilize CPT-based coding for services - a significant problem as CPT coding doesn't adequately describe the bundle of services provided to these children. Potential losses from the expected change in reimbursement methodology are in the millions of dollars, and seriously jeopardize the continuation of the centers themselves.
The South Carolina Children's Hospital Collaborative is currently working with SC DHHS to explore options and reimbursement methodologies to save the DECs.
Links
South Carolina Code Section 44-21-80
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