2010 Medical Necessity Criteria Revised; 23-Hour Observation Level of Care Added
Magellan has revised its 2010 Medical Necessity Criteria (MNC) to include a new level of care for 23-hour observation.
We review our MNC in its entirety annually, and update as needed to incorporate research findings and expert opinion in the behavioral health field. The MNC Task Force, a multi-disciplinary team of senior clinical leaders with broad experience from across our company, conducts an ongoing review of the criteria as well, and we release updates as needed.
Subsequent to the release of the annual update to the MNC in August 2009, this task force determined additional modifications should be incorporated prior to the next annual review.
23-Hour Observation Criteria Added
One of the most significant modifications is the addition of criteria for treatment at a 23-hour observation level of care for adults and children/adolescents. Based on review of literature and expert consensus, MNC Task Force members agreed that this level of care has become widely available and, therefore, is in need of codification. The 23-hour observation level of care allows a facility to monitor a patient closely until a clear picture of his or her condition emerges. At that point, an appropriate level or care for treatment can be recommended.
Accessing Magellan’s Medical Necessity Criteria
The 2010 MNC updates became effective on August 10, 2009. Subsequently, the 23-hour observation criteria became effective on December 2, 2009. You can obtain the 2010 Medical Necessity Criteria on this website (under the “Providing Care” top-menu item, then “Clinical Guidelines,” then “Medical Necessity Criteria”).
Provider Feedback Welcomed
We welcome ongoing feedback from clinician reviewers and network providers on the MNC and consider every substantive comment during the annual review process. You may send comments to Marvin Guynes, MS, LPC, CPHQ, Magellan Health Services, MCGuynes@MagellanHealth.com or 1301 E. Collins Blvd., #100, Richardson, TX 75081, using the comment form posted on this website.