Providing care

Medical Necessity Criteria

Magellan 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.

• Magellan uses MCG Care Guidelines for most medical necessity criteria. Due to MCG licensure restrictions, we are unable to post the full criteria here. You can find a list of the services covered by the MCG Care Guidelines here [link to pdf listing the guidelines].
• The Idaho Department of Health and Welfare requires all substance use disorder placement, continued stay, and discharge be conducted in accordance with the most recent version of the American Society of Addiction Medicine (ASAM) criteria. Due to ASAM licensure restrictions, Magellan is unable to post The ASAM Criteria® on its website You can find a list of the services covered by The ASAM Criteria® here [link to pdf listing the guidelines].
• For levels of care not included in the MCG Care Guidelines or The ASAM Criteria®, Magellan has created supplemental guidelines. These guidelines cover the following services:
  • Early and Serious Mental Illness
  • Homes for Adults
  • List the rest

Click here for the Magellan Care Guidelines for these services [link to Magellan guidelines].

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