Beginning in early 2023, PacificSource will use different criteria for level-of-care decisions (inpatient, residential, partial hospitalization, and intensive outpatient) for mental health treatment. This change was originally intended to start January 1, 2023, but has been delayed. The start date has yet to be determined.
When this change occurs, medical necessity reviews for a primary mental health diagnosis will use the following criteria:
These criteria sets will replace Milliman Care Guidelines (MCG). All substance use disorder reviews will continue to use the American Society of Addiction Medicine (ASAM).
We will notify our provider partners of the start date when confirmed, and provide resources to learn about the use of the new criteria.