Behavioral Health Practice Guide: South Carolina EHR, Billing, and Compliance (2026)

New BHDD Agency Structure

South Carolina underwent a major behavioral health system restructuring in 2025. On June 28, 2025, Governor Henry McMaster signed legislation creating the South Carolina Department of Behavioral Health and Developmental Disabilities (BHDD), a new cabinet-level agency that merges three formerly separate departments into a unified structure:

• Office of Mental Health — formerly the South Carolina Department of Mental Health (SCDMH)
• Office of Substance Use Services — formerly the Department of Alcohol and Other Drug Abuse Services (DAODAS)
• Office of Intellectual and Developmental Disabilities — formerly the Department of Disabilities and Special Needs (DDSN)

The reform was catalyzed by a 2023 independent review, commissioned by the Governor, which identified South Carolina's behavioral health system as among the most fragmented nationally. BHDD is led by a governor-appointed director and aims to streamline service delivery, reduce administrative duplication, and improve care coordination across mental health, substance use, and intellectual/developmental disability services.

For behavioral health providers, this restructuring means that licensing, certification, and regulatory oversight functions previously distributed across three separate agencies are consolidating under BHDD. Providers should monitor BHDD communications for updated licensing procedures, reporting requirements, and credentialing processes as the merger operationalizes through 2026. The new BHDD website is bhdd.sc.gov. Individual clinician licenses continue to be issued by the South Carolina Department of Labor, Licensing and Regulation (LLR) through its Board of Examiners in Psychology, Board of Social Work Examiners, and Board of Examiners for Licensure of Professional Counselors, Marriage and Family Therapists, and Psycho-Educational Specialists.

Medicaid and the MCO Landscape

South Carolina's Medicaid program, Healthy Connections, delivers behavioral health benefits through a managed care model administered by the South Carolina Department of Health and Human Services (SCDHHS). SCDHHS partners with five MCOs, each managing its own provider enrollment, reimbursement schedules, and authorization processes:

• Absolute Total Care (rebranded as Wellcare Prime by Absolute Total Care, a Centene subsidiary) — Provider Service: (866) 433-6041
• First Choice by Select Health of SC — Provider Service: (800) 741-6605
• Healthy Blue by BlueChoice of SC — Provider Service: (866) 757-8286
• Molina Healthcare of South Carolina — Provider Service: (855) 237-6178

Effective January 1, 2026, SCDHHS added additional Medicaid members to the managed care delivery model for medical services. Waiver services remain in the fee-for-service delivery model. On January 1, 2026, Healthy Connections Prime MMP plans transitioned to exclusively aligned Dual-Eligible Special Needs Plans (D-SNPs), with Wellcare Absolute Total Care Dual Align (HMO D-SNP) replacing the former MMP structure.

Behavioral health services are covered through the MCOs. SCDHHS approved rate increases for core rehabilitative behavioral health services provided by private, master's-level practitioners and licensed psychologists, effective July 1, 2024. The SCDHHS Provider Service Center is reachable at (888) 289-0709.

Billing and Revenue Cycle Requirements

Behavioral health billing in South Carolina involves MCO-specific processes:

• Timely filing: South Carolina Healthy Connections Medicaid requires claims within 365 days (one year) of the date of service. This applies to both electronic and paper claims, whether original or corrected. Void and replacement adjustments must also occur within one year.
• Prior authorization: Each MCO manages its own authorization processes for behavioral health services. The 2025-2026 legislative session introduced the Patients' Right to Transparency and Timely Access to Healthcare Services Act (Bill 531), which prohibits ongoing prior authorization requirements for chronic conditions after initial approval and exempts providers with 90% PA approval rates from needing prior authorization for 12 months.
• Rate increases: The July 2024 rate increases for master's-level practitioners and licensed psychologists affect reimbursement for rehabilitative behavioral health services (RBHS). Providers should update their fee schedules and billing configurations accordingly.
• Claims submission: Electronic claims are standard. Providers must credential with each MCO individually. The SCDHHS Administrative and Billing Provider Manual (updated November 2025) provides detailed billing instructions.

Your EHR must support five separate MCO payer configurations, track the 365-day filing deadline, and manage MCO-specific authorization workflows. For comprehensive billing code guidance, see our mental health billing codes guide.

SUD Licensing and Services

Substance use disorder treatment in South Carolina is now overseen by the Office of Substance Use Services within the new BHDD, formerly DAODAS. The office coordinates prevention, intervention, and treatment services for substance use disorders statewide. SUD treatment facilities must meet state licensing and certification requirements, which are being consolidated under the BHDD framework.

South Carolina's SAMHSA Block Grant application (FY 2024-2025) outlines the state's behavioral health assessment and planning for substance use prevention, treatment, and recovery services. The state also participates in the federal 42 CFR Part 2 framework for SUD record confidentiality. For detailed EHR configuration requirements related to SUD records, see our 42 CFR Part 2 compliance guide.

Providers should monitor BHDD.sc.gov for updates on SUD licensing procedures as the Office of Substance Use Services completes its transition from the former DAODAS structure.

Telehealth Rules

South Carolina has established permanent telehealth policies for behavioral health:

• Permanent behavioral health flexibilities: South Carolina DHHS made behavioral health telehealth flexibilities permanent following the COVID-19 public health emergency.
• Audio-only coverage: SCDHHS reimburses for audio-only CPT codes when audiovisual telehealth is not available. New audio-only CPT codes 98012-98015 replaced codes 99441-99443 effective January 1, 2025.
• Family therapy restriction: Billing for telephone calls is not allowed for family therapy services. This is a specific exclusion providers must track.
• FQHC/RHC exceptions: Telehealth services rendered through FQHCs or RHCs for certain audio-only CPT codes are reimbursed.
• Therapy services extension: SCDHHS continues to reimburse for physical, speech, and occupational therapy services with audio and visual components through 2026 to allow for further review and clarification.
• AI consent requirements: The 2025-2026 legislative session introduced Bill 788, requiring providers to inform patients in writing when AI is used in therapy services and obtain written consent.

EHR systems must support the updated audio-only CPT codes, enforce the family therapy telephone restriction, and track AI usage disclosure and consent when applicable. See our behavioral health EHR comparison for telehealth module analysis.

EHR and Technology Requirements

South Carolina behavioral health practices face several technology requirements:

• SCRIPTS PDMP integration: South Carolina operates SCRIPTS (South Carolina Reporting and Identification Prescription Tracking System) as its PDMP, now administered by the South Carolina Department of Public Health (following the DHEC restructuring). The system uses the PMP AWARxE platform for provider access and supports EHR integration for in-workflow prescription history viewing. For integration technical support, providers contact scripts@dph.sc.gov.
• Electronic prescribing: South Carolina supports EPCS with standard DEA identity-proofing requirements.
• AI disclosure tracking: If Bill 788 is enacted, EHR systems will need to track written AI usage disclosures and patient consent for AI-assisted therapy services.
• MCO portal management: With five MCOs, practices must manage multiple payer portals for authorization, eligibility verification, and claims status. EHR platforms with integrated clearinghouse connectivity reduce this administrative burden.

South Carolina does not currently mandate connection to a specific statewide HIE, but EHR interoperability is increasingly important for care coordination across the MCO networks and the consolidating BHDD system. Practices should prioritize platforms supporting HL7 FHIR and CDA/C-CDA standards.

Workforce and Interstate Compacts

South Carolina has joined two major interstate behavioral health licensure compacts:

• PSYPACT: South Carolina enacted PSYPACT through H 3204, signed on May 16, 2023, with an effective date of July 17, 2023. Licensed psychologists can practice telepsychology across state lines and conduct up to 30 days of temporary in-person practice per year in other PSYPACT states through the IPC.
• Counseling Compact: South Carolina became an effective member on July 1, 2024. The compact allows LPCs to obtain a privilege to practice in other member states, including via telehealth. The Counseling Compact Commission began granting privileges in fall 2025.

These compacts are particularly relevant for South Carolina practices serving patients in neighboring compact states (North Carolina, Georgia, Tennessee) or recruiting clinicians from those states. The combination of compact participation and permanent telehealth flexibilities positions South Carolina well for multi-state behavioral health service delivery. EHR systems should track compact credentials alongside state licenses and support multi-state documentation.

Parity and Regulatory Compliance

South Carolina requires large employer fully insured plans to cover mental health conditions without financial requirements more expensive than those for other medical conditions, with deductibles and out-of-pocket maximums integrated with medical services. Plans must ensure that financial requirements and treatment limitations for all behavioral health conditions are no more restrictive than those for medical/surgical services.

The 2025-2026 legislative session has introduced significant healthcare access legislation. Bill 531 (Patients' Right to Transparency and Timely Access to Healthcare Services Act) targets prior authorization reform, prohibiting ongoing PA for chronic conditions after initial approval and exempting high-approval-rate providers. Bill 788 addresses AI in therapy services, requiring written disclosure and consent.

At the federal level, enforcement of portions of the 2024 MHPAEA final rule was paused in May 2025. South Carolina providers should monitor both state legislative developments and federal parity enforcement guidance. South Carolina's mental health patient rights are codified in Title 44, Chapter 22 of the South Carolina Code of Laws, covering consent, disclosure, and patient protections. See our behavioral health revenue cycle guide for denial management strategies.

Top EHR Picks for South Carolina Behavioral Health Practices

• Ease: strongest for AI-native documentation and automated revenue cycle management. Particularly suited for South Carolina practices managing five MCO payer configurations, navigating the BHDD transition, and optimizing reimbursement following the July 2024 rate increases for master's-level practitioners and licensed psychologists.
• AZZLY Rize: practical fit for organizations delivering both mental health and SUD services, especially as the Office of Substance Use Services transitions into BHDD. Strong for 42 CFR Part 2 compliance, integrated BH/SUD documentation workflows, and ASAM-level treatment planning.
• PIMSY: solid option for mid-size South Carolina practices wanting balanced BH workflow support with clinical documentation, scheduling, and billing that handles multiple MCO configurations and the updated audio-only CPT code requirements.

For a broader comparison of behavioral health EHR systems, see our best EHR for mental health recommendations.

Frequently Asked Questions