Magellan Healthcare
Provider Focus Newsletter
News & information for Magellan network providers

region/plan-specific news : California

What you need to know about Senate Bill 855

This new law applies to all California regulated health plans, including California regulated Employee Assistance Programs.

Watch for more information by mail about Magellan’s operational changes related to SB 855 that could affect how you contact, request services or otherwise interact with Magellan.

  1. Plans must provide coverage for medically necessary treatment of mental health and substance use disorders (MH/SUD) listed in the mental and behavioral disorders chapter of the most recent edition of the International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM).
  2. All healthcare services plans (e.g., Magellan) must apply specific clinical criteria and guidelines when conducting utilization review.
  3. Magellan will utilize guidelines set forth in the most recent version of treatment criteria developed by the nonprofit professional association for the relevant clinical specialty. (Refer to the grid below.)
  4. Requests for services will be evaluated for medical necessity based on the prescribed guidelines. 
Clinical Specialty Nonprofit Professional Association Criteria or Guidelines + Version Link to education / training program
Substance Use Disorders, Any Age American Society of Addiction Medicine (ASAM) ASAM, 3rd Edition, 2013 https://www.asam.org/education/live-online-cme/the-asam-criteria-course
Mental Health Disorders, Patients Age 18 and Older American Association of Community Psychiatrists Level of Care Utilization System (LOCUS) 20, 2020

https://www.communitypsychiatry.org/resources/locus

 

https://www.communitypsychiatry.org/resources/locus/schedule-your-locuscalocus-training

Mental Health Disorders, Patients Age 6 to 17

American Association of Community Psychiatrists or

American Academy of Child & Adolescent Psychiatry

Child and Adolescent Level of Care Utilization System (CALOCUS) 20

 

Or Child and Adolescent Service Intensity Instrument (CASII), 2019

https://www.communitypsychiatry.org/resources/locus

 

https://www.communitypsychiatry.org/resources/locus/schedule-your-locuscalocus-training

 

Mental Health Disorders, Patients Age 0 to 5 American Academy of Child & Adolescent Psychiatry

Early Childhood Service Intensity Instrument (ESCII)

 https://www.aacap.org/AACAP/Member_Resources/Practice_Information/ECSII

*In California, Magellan does business as Human Affairs International of California and Magellan Health Services of California, Inc. - Employer Services.

2020 MarCom Gold Award Winner 2019 MarCom Gold Award Winner
2018 MarCom Gold Award Winner 2017 MarCom Gold Award Winner

About Provider Focus

Welcome to Provider Focus, our award-winning e-newsletter for network providers! Here you’ll find articles and information to keep you up-to-date on news and topics relevant to serving Magellan members, including a section for regional- and plan-specific news. Check back as a new issue is released each quarter.

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