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Behavioral health criteria changes delayed


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:

  • For adults ages 19 and older: LOCUS—the Level of Care Utilization System.
  • For children ages 6 through 18: CALOCUS-CASII—the Child and Adolescent Level of Care Utilization System/Child and Adolescent Service Intensity Instrument.
  • For children ages 5 and under: ECSII—the Early Child Service Intensity Instrument.

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.