Guidelines for Determining Coverage | Clinical Policy Bulletins | Medicare | Payment Policy

The Aetna Level of Care Assessment Tool, or "LOCAT" helps participating behavioral health providers determine the appropriate levels and types of care for patients in need of evaluation and treatment for behavioral health conditions and diagnoses, and for patients in need of placement in specialized behavioral health care facilities or units.

Behavioral health providers use LOCAT to help evaluate a patient’s symptoms by identifying and scoring various behavioral health dimensions, and by narrowing down some of those dimensions into sub-dimensions to further assist the provider in providing a more complete clinical picture of the patient.

Dimension 1, Dangerousness, assists providers in determining whether a patient is exhibiting dangerous symptoms. The four sub-dimensions are Suicidal Intent, Self-Injuriousness, Homicidal Intent and Irritability/Aggression.

Dimension 2, Functional Impairment, helps providers determine the severity of impairment in functioning by assessing the following sub-dimensions: Social Isolation, Nutritional Impairment, Sleep Disturbance and School or Work Impairment.

Dimension 3, the Mental Status/Cognitive Factor, helps providers assess a patient's appearance, mood, etc. The sub-dimensions of this Factor are Appearance, Speech, Affect, Delusions, Hallucinations, Thought Content, Behavioral/Neurovegetative and Orientation.

Dimension 4, Substance Use/Abuse/Dependence, helps providers assess whether or not substance abuse is contributing to the patient's curent symptoms. The sub-dimensions are Scope of Use/Abuse, Patterns of Use/Abuse and Withdrawal Potential.

Dimension 5, Medical Illness, helps providers determine whether or not medical illnesses are contributing to the patient's behavioral health symptoms.

Dimension 6, the Environment Stress Factor, helps providers examine what additional outside influences may be affecting the patient. Sub-dimensions include Family Stress, Stress from Non-Family Members, Housing, School or Job.

Dimension 7, the Support System Factor, helps providers measure the amount of support a patient has available to help cope with an illness.

The LOCAT instrument does not replace medical judgment, where a provider believes that a different level of care or course of treatment is necessary. Treating providers are solely responsible for medical advice and treatment of members.

To find more information related to LOCAT, please click here.