Effective April 19, 2025, Evernorth^® Behavioral Health (Evernorth) will adopt the Level of Care Utilization System (LOCUS) for adults and the Child and Adolescent Level of Care/Service Intensity Utilization System (CALOCUS-CASII) criteria in compliance with New York Codes, Rules and Regulation: Part 514 of Title 14 (Clinical Review Criteria for the Treatment of Mental Illness).

LOCUS and CALOCUS–CASII criteria are accepted as evidence-based standards for mental health care.These criteria will be used to conduct mental health level of care medical necessity reviews for commercial health plans in New York, unless federal or state law require the use of other specifically identified clinical criteria.

What this means to you
Adoption of LOCUS and CALOCUS-CASII further supports a consistent application of evidence-based criteria to ensure that treatment includes consideration of practices that have been shown to be most effective for mental health disorders. These guidelines complement our suite of existing evidence-based criteria to support your clinical judgment and decision-making processes.

Please note that we are only changing the source of our criteria for mental health levels of care. Our medical necessity review process is not changing, and we will continue to use the following resources to make determinations when appropriate:

• Standards and Guidelines/Medical Necessity Criteria for Treatment of Mental Health Disorders (Revised April 2020).

We use these criteria for guidance in conducting medical necessity reviews of substance use disorder levels of care in New York.

• Evernorth and Cigna Healthcare^® coverage policies (for autism spectrum disorders, pervasive developmental disorders, and transcranial magnetic stimulation).
• Evernorth Behavioral Health Authorization and Billing Resource.
• State and federal regulations and licensing standards.

Online resources
You can access our evidence-based criteria, clinical support tools, and resources, including the LOCUS and CALOCUS-CASII criteria, in the Supporting Behavioral Websites section of the Coverage Policies page on the Evernorth Provider website (Provider.Evernorth.com).

Additional information

If you have any questions, please call Provider Services at 800.926.2273.