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LOCAT, ABA & ASAM Guidelines

Helping patients get the right care

You want to recommend the best treatment option for your patients. There are several tools that can help.

LOCUS and CALOCUS/CASII

Starting Q2 2021 for patients with commercial plans, Aetna® will use the Level of Care Utilization System (LOCUS) and the Child and Adolescent Level of Care Utilization System/Child and Adolescent Service Intensity Instrument (CALOCUS/CASII) for its medical necessity reviews. This replaces the use of the Level of Care Assessment Tool (LOCAT) for behavioral health reviews.*

This person-centered approach aims to find the best fit between individual needs and behavioral health services.

Patients with Medicare Advantage plans: continue to use CMS criteria for all Organizational Determinations. LOCUS will be used in all other cases.

These materials may not be duplicated without expressed written permission from the American Association for Community Psychiatry.

LOCUS© Evaluation Parameters (PDF)

LOCUS© Levels of Care Descriptions (PDF)

LOCUS© Guide for Patients and Families (PDF)

CALOCUS/CASII® Levels of Care Descriptions (PDF)

CALOCUS/CASII® Anchor Points (PDF)

LOCUS CALOCUS PROVIDER FAQ (PDF)

*Currently, these guidelines are effective for commercial patients in California.

For more information about LOCUS, visit the American Association of Community Psychiatrists website. For more information about the CALOCUS/CASII, visit the Academy of Child and Adolescent Psychiatry website.

Level of Care Assessment Tool

Aetna’s Level of Care Assessment Tool (LOCAT℠) helps behavioral health professionals determine the levels and types of care that are medically necessary for patients with mental health conditions.
LOCAT (PDF)

Applied Behavior Analysis Medical Necessity Guide

The Applied Behavior Analysis (ABA) Medical Necessity Guide is a nationally recognized guide. It helps clinicians decide appropriate levels and types of services that are medically necessary for a patient. The ABA Medical Necessity Guide can help you with the coverage determination process.
ABA medical necessity guide (PDF)

American Society of Addiction Medicine Criteria

The American Society of Addiction Medicine (ASAM) has a new edition of its criteria. Addiction specialists use these criteria to help them choose treatment options. The criteria also help patients and their families better understand treatment options.

Copyright 2015 by the American Society of Addiction Medicine.  Reprinted with permission.  No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM.

Introduction to the ASAM criteria for members (PDF)

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Applied Behavior Analysis Medical Necessity Guide

By clicking on “I Accept”, I acknowledge and accept that:

The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.

Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.

The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.

Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.

Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law.

 

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Level of Care Assessment Tool

By clicking on “I Accept”, I acknowledge and accept that:

Aetna's Level of Care Assessment Tool ("LOCAT") serves as a guideline to help determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. LOCAT does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.

Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.

The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.

Please note also that LOCAT may be updated and is, therefore, subject to change.

Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal and state law.

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