ANNOUNCEMENTS

GIVE US YOUR FEEDBACK ON CIGNA'S 2011 REVISION OF THE BEHAVIORAL LEVEL OF CARE GUIDELINES

Cigna maintains Level of Care Guidelines for behavioral health utilization management decision-making. The Level of Care Guidelines help ensure 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.

Each year, Cigna reviews its behavioral Level of Care Guidelines to assess appropriateness for continued use. At least every two years, revisions are considered, based upon changes in related literature, research, and evidence-based community practices. 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. Annually, Cigna's behavioral care managers and physician reviewers are assessed to determine if they are applying the Level of Care Guidelines (LOCG) consistently. Training or other improvement actions are conducted as needed.

In 2010, a workgroup of physicians and behavioral health clinicians completed a major two-year cycle review of our Guidelines. The following is a summary of the changes that were made in response to the review:

• Simplified the language of the LOCG to make them more user-friendly for the people we serve
• New language in the Inpatient and Residential LOCG sets basic expectations for inpatient and residential programming
• New language clarifies the expectation that partial hospital programs would provide services while the customer is living in the community, so that the customer has the opportunity to deal with the issues that led to the admission
• New language clarifies that low-intensity Intensive Outpatient Programs (IOP) will be reviewed under the Outpatient guidelines
• New language in the Outpatient LOCG clarifies the need for continuous authorization for customers with chronic mental illness who need ongoing medication management
• Safety to Transfer guidelines were taken out of the 2011 LOCG and transferred to a policy and procedure

Prior to final 2011 adoption for use, Cigna is soliciting feedback from psychiatrists, therapists and facilities on the revised Level of Care Guidelines. To encourage your feedback, we have posted them on our website: Level of Care Guidelines

OTHER CLINICAL SUPPORT TOOLS AND CLINICAL PRACTICE GUIDELINES

Please note that the following changes were made in 2010 to our website:

To support clinical excellence, clinical resources from the Center for Quality Assessment and Improvement in Mental Health have been added, with permission of the copyright holder. The STABLE toolkit provides assistance in the identification and management of Bipolar Disorder and is located for practitioner review within our screening tools: Clinical Screening Tools

And also in the professional resource toolkit at: Treating Behavioral Conditions

Additionally, for use by Primary Care Physicians (PCP), Cigna has adopted the Depression Guidelines and tools from the MacArthur Initiative, and a link to these resources can be found within the Depression practice guidelines for PCP: MacArthur Initiative on Depression & Primary Care

CLINICAL DEVELOPMENT FOR EXCELLENCE

Free continuing education credits are available to physicians and nurses completing this Medscape course accessible via the NIAAA website link below: Video Cases: Helping Patients Who Drink Too Much

REMINDERS

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 ensure 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.

MEDICAL MANAGEMENT PROGRAM GUIDE

Cigna's behavioral Medical Management Program is a comprehensive publication offering information, guidance, and resources for clinical professionals to effectively interface with Cigna in their clinical practice. The Medical Management Program is updated frequently. To ensure you have the most recent information, freely review, print, or download it here: Medical Management Program Guide

If you are interested in joining the Cigna Behavioral Network, please visit the “Providers” section of our website, cignabehavioral.com, for information on how to submit an application for network consideration.

Other Featured Articles:

PREVENTIVE HEALTH PROGRAM RESULTS

POSTTRAUMATIC STRESS DISORDER - PART II

CURRENT TRENDS

WHAT IS TELEPHONIC EAP?

NEW ADDRESSES IN EFFECT FOR CLAIM SUBMISSION

MEDICAL MANAGEMENT PROGRAM

CIGNA SURVEYS

Practitioner Connection Home | Cigna Home | Legal Disclaimer

©2010 Cigna