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Behavioral health criteria changing November 13, 2023

Beginning November 13, 2023, PacificSource will use different criteria for level-of-care decisions for mental health treatment (including inpatient, residential, partial hospitalization, and intensive outpatient).

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 younger: 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).

For more information, see the following documents: