Effective January 26, 2026, Evernorth^® Behavioral Health (Evernorth) will update the age requirements for the Level of Care Utilization System (LOCUS) and the Child and Adolescent Level of Care/Service Intensity Utilization System (CALOCUS-CASII) criteria in compliance with California Senate Bill 855, Rule 1300.74.721(h)(2), and as discussed in the filing review with the state of California.

What this means to you

Currently, Evernorth uses the LOCUS criteria for customers aged 18 and older and the CALOCUS-CASII criteria for customers aged 6 through 17.

Effective January 26, 2026, Evernorth will use the LOCUS criteria for customers aged 19 and older and the CALOCUS-CASII criteria for customers aged 6 through 18 when conducting mental health level of care medical necessity reviews for commercial health plans in California, unless federal or state law requires the use of other specifically identified clinical criteria.

Please note that Evernorth is only changing which criteria are applied when conducting medical necessity reviews of mental health levels of care for customers who are aged 18. The medical necessity review process and medical necessity criteria are not changing.

Additional resources

Evernorth will continue to use the following resources to make determinations when appropriate:

• The American Society of Addiction Medicine (ASAM) Criteria^® for guidance in conducting medical necessity reviews of substance use disorder levels of care).
• 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.

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).

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