Level of Care Utilization Review Process Changing July 1 From: Sent: To: Passport Health Plan June 1, 2015 Passport Behavioral Health Providers Background: Effective July 1, 2015 Passport Health Plan will change the Level-of-Care Criteria used for the Behavioral Health utilization review/prior authorization process. Previously, we have utilized a proprietary product designed for a Medicaid population. Beginning July 1, 2015, Passport Health Plan will be using the following tools as part of our Behavioral Health utilization review process: • LOCUS (Level of Care Utilization System); • CASII (Child and Adolescent Service Intensity Instrument); • CANS (Child and Adolescent Needs and Strengths); and • ASAM Criteria (American Society of Addiction Medicine Criteria). These tools are very similar to the existing criteria used for Behavioral Health utilization review determinations. The ASAM Criteria has always been a part of the review process for determining the appropriate level of care for individuals with substance use disorders. Please be aware that through this transition, reviews may take longer initially As a longer term initiative, Passport will be working with the Kentucky Department for Medicaid Services and other Managed Care Organizations to develop a standardized authorization request process by 1/1/16. Provider Action Needed: No action is required at this time, and providers will not be required to complete any trainings or certifications for these new instruments. Only the structure of the reviews will change to accommodate the specific information needed to complete these tools. Thank you for your continued partnership to serve Passport members. Questions: If you have questions about these new tools, please contact your provider relations specialist. ©2015 Passport Health Plan (PROV51416)
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