Adoption of LOCUS/CASII/ECSII for Guidance on Clinical Criteria Decisions in the Treatment of Mental Health Conditions
We are pleased to announce that Optum is adopting the Level of Care Utilization System (LOCUS), the Child and Adolescent Service Intensity Instrument (CASII) and the Early Childhood Service Intensity Instrument (ECSII) for guidance on clinical criteria decisions for the treatment of behavioral health conditions across most Commercial and Medicaid membership.
- Level of Care Utilization System (LOCUS) – a standardized level of care assessment tool developed by the American Association of Community Psychiatrists used to make medical necessity determinations and placement decisions for adults.
- Child and Adolescent Service Intensity Instrument (CASII) – a standardized assessment tool developed by the American Academy of Child and Adolescent Psychiatry (AACAP) used to make medical necessity determinations and to provide level of service intensity for children and adolescents ages 6-18.
- Early Childhood Service Intensity Instrument (ECSII) – a standardized assessment tool developed by the AACAP used to make medical necessity determinations and to provide level of service intensity for children ages 0-5.
While our existing behavioral health level of care criteria were developed with consideration of evidence-based literature and clinical criteria established by professional organizations, we are moving toward these externally developed guidelines for a number of reasons:
- Externally validated: L/C/E criteria were created and updated based on the changing landscape of evidence informed care, market and regulatory considerations, and feedback from stakeholders across the care system.
- Common language drives improved care: The use of these guidelines creates a common language for providers with payers, regulators, and other stakeholders of the care system, which results in a clearer understanding of patient needs. The six dimensions provide a more holistic view of acuity and chronicity of behavioral condition, thereby promoting more appropriate care for patients and a better overall experience.
- Effective management of behavioral health services: Three main concepts need to be considered and balanced in effectively managing behavioral health services: (1) Use of wrap-around services; (2) tailored to specific age of the member; and, (3) adopts a system of care approach. The L/C/E criteria best meet all three of these concepts.
Please note, we will continue to use The ASAM Criteria, developed by the American Society of Addiction Medicine, as the clinician criteria for substance use disorder services.
What will be different for you
While there may be some variations in some of the questions that are asked during the utilization review process, we do not anticipate any significant difference in the information-taking process. Members should have no gaps in care. Levels of care are not changing (inpatient, PHP, IOP, etc.).
LOCUS and CASII scoring matches our levels of care and would be applied similarly to our current Level of Care Guidelines. Now, ECSII will offer criteria addressing ages 1-5.
Effective Dates for LOCUS/CASII/ECSII — UPDATED
The adoption of LOCUS only will begin December 14, 2019, rather than December 13, 2019, as originally announced in the following Western Region states:
LOCUS will be implemented in all other states and CASII/ECSII will be implemented nationally on January 31, 2020. These changes will be effective as indicated unless superseding state, federal, contractual or customer requirements apply. Note that some markets and programs are already using these guidelines.
As the effective date approaches, please visit this page for updates and additional information.
If you have questions about this change, please contact Provider Relations at 1-877-614-0484.
Frequently Asked Questions (rev. 1/2020)
To assist you in preparing for this transition, we are including links to current training resources provided by Deerfield Solutions and the American Academy of Child and Adolescent Psychiatry. For more information, visit these websites: