Clinical Care Criteria

The Behavioral HealthCare Program utilizes the following clinical criteria for medical necessity:

Mental Health and Substance Abuse

BHCP uses the Milliman Care Guidelines Behavioral Health Care24th Edition, evidence based behavioral health guidelines provided by MCG Health.

Medicare

BHCP also uses the National Coverage Determinations and Local Determinations set forth by Medicare Coverage Guidelines for the Anthem MaineHealth Joint Venture Medicare Advantage plan and for Martins Point Generations Advantage members https://www.cms.gov/medicare-coverage-database/indexes/ncd-alphabetical-index.aspx?NCDId=26&ncdver=1&bc=AgAAgAAAAAAA&

Behavioral HealthCare Program Criteria:

Admission and Continued Stay Criteria for Crisis Beds

Psychological and Neuropsychological Testing Criteria