Effective August 29, 2026, Evernorth^® Behavioral Health (Evernorth) will adopt the Level of Care Utilization System (LOCUS) for customers aged 19 and older and the Child and Adolescent Level of Care/Service Intensity Utilization System (CALOCUS-CASII) criteria for customers aged 6 through 18 in compliance with Illinois (Illinois Compiled Statutes 2025 Chapter 215 134/87), Maryland (Maryland 2024 House Bill 932), and Oregon (Oregon 2021 House Bill 3046) rules and regulations.

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 and individual health plans in these states unless federal or state law requires 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 reviewing mental health levels of care. Our medical necessity review process is not changing.

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

• The ASAM Criteria^® – Evernorth uses these criteria, developed by the American Society of Addiction Medicine, for guidance in conducting medical necessity reviews of substance use disorder levels of care for all health plan business, unless contractual requirements, or federal or state law requires use of other clinical criteria.
• Evernorth and Cigna Healthcare^® coverage policies – for autism spectrum disorders/pervasive developmental disorders: Assessment and treatment, intensive behavioral interventions, transcranial magnetic stimulation, and complementary and alternative medicine.
• 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.