News
Effective March 29, 2024: Clinical Policies
Date:
01/17/24
Superior HealthPlan has updated certain clinical policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on March 29, 2024, at 12:00AM.
POLICY
| APPLICABLE PRODUCTS | NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS |
| Applied Behavior Analysis (CP.BH.104) | Ambetter | Policy updates include:- Replaced all instances of “DSM-5” with “DSM-5 TR”
- Added requirement for a comprehensive diagnostic evaluation to have been conducted within the past five years in I.A.1
- Added Social Skills Improvement System (SSIS) as an additional skill assessment option in I.E.1.b.ii.e
- In I.E.,2.b. deleted “comprehensive”
- Deleted I.E.,2.b.ii.e). and replaced it as a “note” under I.2.b.ii.d)
- In I.E.2.c.vi. deleted “in the home or community activities”
- Added I.E.2.f.i. “Behavioral health outpatient services” to the list
- Added statement to I.E.3.b. “Assessments are performed consistent with criteria in I.E.1. b”
- Rearranged criteria point in I.E.3 for clarity
- In II.A. added statement “… and generally involve a gradual step-down in services”
- In II.C. Removed the statements “Services may be appropriate for discontinuation and/or transfer to alternative or less intrusive levels of care”
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To review all policies, please visit Superior’s Clinical, Payment & Pharmacy Policies webpage.
Prior to updates, Medical Clinical policies are reviewed and approved by the Utilization Management Committee.
For questions or additional information, contact Superior HealthPlan Prior Authorization department at 1-800-218-7508.
