Behavioral Health Medical Necessity Criteria Milliman Care Guidelines

20th Edition

Behavioral Health Medical Necessity Criteria as of 9/1/16

Pursuant to contractual changes with the Department of Medicaid Services (DMS), Section 21.2 National Standards for Medical Necessity Review, Aetna Better Health of Kentucky has implemented Milliman Care Guidelines, 20th Edition, for Behavioral Health authorization determinations.

Per the contract, The Contractor shall adopt Interqual or Milliman

for Medical Necessity except that the Contractor shall utilize the American Society of Addiction medicine (ASAM) for substance use. If Interqual or Milliman does not cover a behavioral health service, the Contractor shall adopt the following standardized tools for medical necessity determinations for adults: Level of Care Utilization System (LOCUS); for children: Child and Adolescent Service Intensity Instrument (CASII).

Substance Use Disorders

NO CHANGE

ASAM will remain the medical necessity criteria for all authorization requests for treatment of Substance Use Disorders

Example of MCG BHG Admission to Inpatient Level of Care for Child or Adolescent is judged

appropriate as indicated by 1 or more of the following:

Inpatient behavioral care is needed as indicated by ALL of the following:

Treatment is needed because of patient risk due to 1 or more of the following:

Imminent danger to self is present

Imminent danger to others is present

Behavioral health disorder is present with ALL of the following:

Severe psychiatric or behavioral symptoms or conditions are present

Severe dysfunction in daily living is present

Treatment situation and needs are appropriate for inpatient level (instead of lower level of care)

Inpatient treatment is needed due to presence of significant delirium.

Patient has behavioral health disorder and requires somatic treatment for which around-the-clock medical or nursing care must be used because of severe adverse effect risk or medical comorbidity.

Introduction

Methodology Information

Behavioral Health Level of Care Guidelines

Care Guidelines for Behavioral Health

Therapeutic and Testing Procedures

Home Care Behavioral Health

Recovery Facility Behavioral Health

Benchmarks and Data

Abbreviations Care Management Tools MCG Editorial Staff Summary of Changes

Behavioral Health Level of Care Guidelines Level of Care Comparison Information

Behavioral Health Levels of Care Comparison Chart, Adult Behavioral Health Levels of Care Comparison Chart, Child or

Adolescent Eating Disorders Behavioral Health Levels of Care Comparison

Chart Substance-Related Disorders Behavioral Health Levels of Care

Comparison Chart, Adult Substance-Related Disorders Behavioral Health Levels of Care

Comparison Chart, Child or Adolescent Crisis Intervention Behavioral Health Level of Care Observation Behavioral Health Level of Care

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