How to make a To Youth Advocate Programs, Inc.’s Rehabilitative Behavioral Health Services (BHRS) How to Make a Referral To Youth Advocate Programs, Inc. Rehabilitative Behavioral Health Services (RBHS) I. Who Can Make Referrals Representatives from the following South Carolina State agencies may make referrals/authorize Rehabilitative Behavioral Health Services (RBHS) for beneficiaries who meet medical necessity requirements: • • • • • • Department of Social Services Department of Mental Health Continuum of Care Department of Disabilities & Special Needs Department of Juvenile Justice Department of Education and Local Education Agencies II. How to Make a Referral There are two ways to make a referral: 1) Fax/Email a copy of a completed DHHS Form 254 along with a completed Medical Necessity Statement (MNS); or 2) Fax/Email a copy of a completed DHHS Form 254 along with the completed Individual Plan of Care (IPOC). DHHS Form 254 and the Medical Necessity Statement (MNS) are available at all authorized state agencies. If you need any of these forms, or are not familiar with these forms, contact your supervisor or director for more information on how to obtain the forms. Greenville William Cameron, Director 1427 Laurens Road, Suite E Greenville, SC 29607 Phone 1-864-232-7532 Fax 1-864-232-7537 [email protected] Charleston Conway Tom Lindenmuth, Director 3422 Rivers Avenue, 2nd Floor North Charleston, SC 29405 Phone 1-843-554-2555 Fax 1-843-554-5066 [email protected] Pam Bohannon, Director 1717 Fourth Avenue, Unit 1 Conway, SC 29526 Phone 1-843-381-6268 Fax 1-843-381-6638 [email protected]