The Practitioner Connection
Volume XXVIII, 4th Quarter

REMINDERS

CIGNA'S 2008 LEVEL OF CARE GUIDELINES FOR BEHAVIORAL HEALTH

Cigna maintains Level of Care Guidelines for behavioral health utilization management decision-making. The Level of Care Guidelines help to assure that care provided is based on appropriate medical evidence or evidence-based practice and that it is consistent with current and validated Clinical Practice Guidelines for condition-specific management of illness. Even so, consideration is always given to the local availability of services and to individual needs, on a case by case basis, when applying the criteria. Annually, Cigna's care managers and physician reviewers are assessed to determine if they are applying the Level of Care Guidelines consistently, and training or other improvement actions are conducted as needed.

Cigna's Level of Care Guidelines for behavioral health are reviewed for continued use at least annually. At least every two years, based upon changes in the literature, research, and evidence-based community practices, revisions are considered. Cigna monitors new developments in technology and application continuously, and may revise the Level of Care Guidelines at any time that an update is indicated. When updates are made, they are posted on Cigna's behavioral health Web site along with a feedback mechanism located near the guideline so that input and feedback can be solicited from psychiatrists, therapists and facilities.

In addition to articles in our email communications (E-Brief), and in this newsletter, our contracted network professionals and facilities that provide care to the people we serve are notified in writing that the guidelines are available on the Web and where they can be accessed. New professionals and facilities joining the network receive notification of the Level of Care Guideline's availability as a part of the contracting process. We encourage you to access, use, and give us feedback on them.

Cigna's 2008 revision of the Level of Care Guidelines for behavioral health was recently finalized. The major changes include:
• Separate Outpatient Mental Health and Substance Abuse treatment guidelines for adults and for children/adolescents
• Substance Abuse Halfway House guidelines
• New Eating Disorders guidelines, including 5 separate Level of Care alternatives with consideration of consistency with mental health care needs
• Expansion of the Psychological Testing guideline to include a Neuropsychological Testing guideline
• Early Intensive Behavior Intervention guidelines for Autism Spectrum Disorders
• Elimination of Custodial Care, Psychiatric Disability, and Pain Management Guidelines.

Web site posting of Cigna's revised Level of Care Guidelines for behavioral health is scheduled for January 2009. Once posted, you may freely download and access the full text at:

http://apps.cignabehavioral.com/web/basicsite/provider/newsAndLearning/guidelines.jsp

OPEN DIALOGUE

Cigna encourages the open discussion of care and treatment options between professionals and facilities and the individuals we serve.

ENCOURAGING MEDICALLY APPROPRIATE CARE

In our philosophy and in the decisions of management and staff, Cigna's goal is to assure the authorization of medically appropriate care. Staff and network professionals are compensated in a manner that is intended to promote, rather than deny, quality care and services for the individuals we serve. Cigna considers the quality and the appropriateness of care and service prior to awarding any bonuses or incentives.

Other Featured Articles:

ACCESS TO OUTPATIENT CARE

IDENTIFYING BORDERLINE PERSONALITY DISORDER

CIGNA MEDICARE ACCESS

EAP ASSISTANCE WITH WORKFORCE REDUCTIONS

TWO NEW INITIATIVES

INSURANCE IDENTIFICATION CARDS

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