Level of Care Utilization Review Process Changing July 1

Level of Care Utilization Review Process Changing July 1
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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)