Evernorth^® Behavioral Health’s (Evernorth’s) adoption of 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 New York has been postponed. The adoption of this criteria was originally expected to take place on April 19, 2025.

We will provide you with advanced notice when a new effective date is established.

What this means to you
Until further notice, Evernorth will continue using MCG Behavioral Health Guidelines to conduct mental health level of care medical necessity reviews for commercial health plans in New York, unless federal or state law requires the use of other specifically identified clinical criteria.

In addition, 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 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.