For Providers

Medical Necessity Criteria

Magellan Behavioral Health of Pennsylvania is committed to the philosophy of promoting treatment at the most appropriate, least-restrictive level of care needed to effectively meet an individual's biopsychosocial needs. We see the continuum of care as a fluid treatment pathway where individuals may enter treatment at any level and be moved to more or less-intensive settings or levels of care as their changing clinical needs dictate. At any level of care, such treatment is individualized, active and takes into consideration the individual's stage of readiness to change and readiness to participate in treatment.

• The Pennsylvania Department of Public Welfare (DPW) publishes and maintains behavioral health "Medical Necessity Criteria" for the Pennsylvania HealthChoices program:

 - HEALTHCHOICES BEHAVIORAL HEALTH SERVICES GUIDELINES for MENTAL HEALTH MEDICAL NECESSITY CRITERIA

• For levels of care not included in the DPW criteria, Magellan has created supplemental Medical Necessity Criteria.

• For children and adolescents with substance abuse issues, we follow the American Society of Addiction Medicine (ASAM) criteria.