Clinical Focus
Updated Medical Necessity Criteria Take Effect Aug. 10
The Magellan Medical Necessity Criteria have been updated and are now available on this website. The updated criteria take effect Monday, Aug. 10, 2009.
Some of the significant changes to the criteria are as follows:
Psychiatric
- Clarified language regarding frequency of individual and family treatment in Eating Disorders criteria
- Added Subacute Psychiatric Geriatric criteria
- Added language to all levels of care for adults to incorporate geriatric-specific issues.
Substance Use
- Eliminated Substance-Induced Disorders criteria set
- Added separate criteria sets for detoxification and rehabilitation
- Added Residential and Ambulatory Detoxification criteria.
Outpatient
- Expanded outpatient criteria to be more specific
- View a detailed description of outpatient changes.
Please note these changes are only for the Magellan Medical Necessity Criteria, which do not apply to all Magellan programs — such as Magellan public sector programs that use alternative criteria.
Due to specific state regulations, the Magellan Medical Necessity Criteria will be effective August 26, 2009 for New Jersey. Effective dates for Molina Healthcare of Florida and Indiana Medicaid programs also will be delayed; Magellan will send separate notifications to affected providers.