2018 - 2019 Magellan Care GuidelinesSummary of revisions

EFFECTIVE JULY 1, 2018

2018 – 2019 MAGELLAN CARE GUIDELINES

Overview

• Annual review cycle

Magellan Care Guidelines will be effective July 1 of every year

Naming Convention: 2018 – 2019 Magellan Care Guidelines

Magellan Care Guidelines are comprised of MCG Guidelines and Magellan Healthcare Guidelines

• Changes include:

Upgrade to the 22nd Edition MCG Behavioral Health Care Guidelines content

Updates to Magellan Healthcare Guidelines

Retirement of selected Magellan Healthcare Guidelines

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2018 – 2019 MAGELLAN CARE GUIDELINES

Exclusions

• Magellan will continue to use ASAM criteria for management of substance use services where required by state or customer contract.

• Magellan will continue to use other State-mandated criteria where required.

• Visit MagellanProvider.com for the latest information:1. From the Providing Care tab, select “Clinical Guidelines.”

2. Choose “Medical Necessity Criteria.”

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Summary of changes to the Magellan Healthcare Guidelines

MAGELLAN HEALTHCARE GUIDELINES

Summary

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• The 2018 – 2019 Magellan Care Guidelines includes 10 Magellan Healthcare Guidelines:

3 Magellan Healthcare Guidelines were retired.

• Of the 10 Magellan Healthcare Guidelines: 1 guideline was substantively modified 7 guidelines were updated with new language 2 guidelines had no changes.

2018 – 2019 Magellan Healthcare Guidelines

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Magellan Healthcare Guidelines ORG/OTG

MHC-01-2018 Transcranial Magnetic Stimulation Treatment SUBSTANTIVE CHANGES

MHC-40-2018 Outpatient Applied Behavior Analysis CHANGE: add “>40 hours if medically necessary”

MHC-14-2018 Subacute Hospitalization, Psychiatric, Adult and Geriatric CHANGE: add to UDS "other biological screening"

MHC-16-2018 Subacute Hospitalization, Psychiatric, Child and Adolescent CHANGE: add to UDS "other biological screening"

MHC-03-2018 Psychological Testing NO CHANGES

MHC-31-2018 Neuropsychological Testing NO CHANGES

MHC-21-2018 Supervised Living, Psychiatric, Adult and Geriatric CHANGE: add to UDS "other biological screening"

MHC-06-2018 Supervised Living, Psychiatric, Child and Adolescent CHANGE: add to UDS "other biological screening"

MHC-08-2018 Supervised Living, Substance Use Disorders, Rehabilitation, Adult and Geriatric CHANGE: add to UDS "other biological screening"

MHC-28-2018Supervised Living, Substance Use Disorders, Rehabilitation, Child and Adolescent

CHANGE: add to UDS "other biological screening"

Retired Magellan Healthcare Guidelines

1. Ambulatory, Substance Use Disorders, Buprenorphine Maintenance (MHC-02-2017)

Replaced by MCG “Medication-Assisted Opioid Withdrawal” (MCG B-909-OPD)

2. Ambulatory, Substance Use Disorders, Methadone Maintenance (MHC-MM)

Replaced by MCG “Medication-Assisted Opioid Withdrawal” (MCG B-909-OPD)

3. Residential Treatment, Sexual Offender, Child and Adolescent (MHC-17-2017)

− Magellan no longer manages the service and population for which the guideline was developed.

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Updates to Magellan Healthcare Guidelines

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1. Transcranial Magnetic Stimulation (TMS): Commercial and Medicare non-Novitas regions

Updates to Magellan Healthcare Guidelines

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2. Outpatient Applied Behavior Analysis

− Supplemental language added to service hours per week in “Comprehensive Interventions” sections: “More than 40 hours will be approved where medically necessary for the member.”

3. Inclusion of language regarding Other Biological Screening

− “A urine drug screen (UDS) or other biological screening (blood, exhaled breath, oral fluid/saliva, sweat and hair) is considered at the time of admission, when progress is not occurring, when substance misuse is suspected, or when substance use and medications may have a potential adverse interaction.”

− The new language affects the following criteria:

Subacute Hospitalization, Psychiatric, Adult and Geriatric

Subacute Hospitalization, Psychiatric, Child and Adolescent

Supervised Living, Psychiatric, Adult and Geriatric

Supervised Living, Psychiatric, Child and Adolescent

Supervised Living, Substance Use Disorders, Rehabilitation, Adult and Geriatric

Supervised Living, Substance Use Disorders, Rehabilitation, Child and Adolescent

Summary of changes to the MCG Guidelines

Updates to 22nd Edition MCG Care Guidelines

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• Title change: “Residential Acute” replaced with “Residential”

• Eating disorders levels of care:− Separated into “Adult” and “Child or Adolescent”

− Now aligns with other level of care guidelines.

MCG Care Guidelines (will vary by health plan)

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MCG Care GuidelinesInpatient Behavioral Health Level of Care, Adult

Inpatient Behavioral Health Level of Care, Child or Adolescent

Acute Outpatient Behavioral Health Level of Care, Adult

Acute Outpatient Behavioral Health Level of Care, Child or Adolescent

Residential Behavioral Health Level of Care, Adult

Residential Behavioral Health Level of Care, Child or Adolescent

Partial Hospital Behavioral Health Level of Care, Adult

Partial Hospital Behavioral Health Level of Care, Child or Adolescent

Intensive Outpatient Program Behavioral Health Level of Care, Adult

Intensive Outpatient Program Behavioral Health Level of Care, Child or Adolescent

Substance-Related Disorders, Acute Outpatient Behavioral Health Level of Care, Adult

Substance-Related Disorders, Acute Outpatient Behavioral Health Level of Care, Child or Adolescent

Substance-Related Disorders, Inpatient Behavioral Health Level of Care, Adult

Substance-Related Disorders, Inpatient Behavioral Health Level of Care, Child or Adolescent

Substance-Related Disorders, Residential Behavioral Health Level of Care, Adult

Substance-Related Disorders, Residential Behavioral Health Level of Care, Child or Adolescent

Substance-Related Disorders, Partial Hospital Behavioral Health Level of Care, Adult

Substance-Related Disorders, Partial Hospital Behavioral Health Level of Care, Child or Adolescent

Substance-Related Disorders, Intensive Outpatient Program Behavioral Health Level of Care, Adult

Substance-Related Disorders, Intensive Outpatient Program Behavioral Health Level of Care, Child or Adolescent

Eating Disorders, Inpatient Behavioral Health Level of Care, Adult

Eating Disorders, Inpatient Behavioral Health Level of Care, Child or Adolescent

Eating Disorders, Residential Behavioral Health Level of Care, Adult

Eating Disorders, Residential Behavioral Health Level of Care, Child or Adolescent

Eating Disorders, Partial Hospital Behavioral Health Level of Care, Adult

Eating Disorders, Partial Hospital Behavioral Health Level of Care, Child or Adolescent

Eating Disorders, Intensive Outpatient Program Behavioral Health Level of Care, Adult

Eating Disorders, Intensive Outpatient Program Behavioral Health Level of Care, Child or Adolescent

Observation Behavioral Health Level of Care, Adult

Electroconvulsive Therapy (ECT)

Day Treatment Behavioral Health Level of Care

Medication-Assisted Opioid Withdrawal Behavioral Health Level of Care

Note: All partial hospital guidelines are customized.

Customized Partial Hospital MCG Care Guidelines

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New language added:

“There is clinical evidence that the patient’s condition requires a

structured program with frequent nursing and/or physician supervision, active treatment each program day

and assessment no less than 3 times weekly by a professional nurse or

physician or Advanced Practice Registered Nurse (APRN), one of

which must be a physician or APRN.”

Confidentiality statement

The information presented in this presentation is confidential and expected to be used solely in support of the delivery of services to Magellan members. By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.

The information contained in this presentation is intended for educational purposes only and should not be considered legal advice. Recipients are encouraged to obtain legal guidance from their own legal advisors.