Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
CignaCommercial · Prior Auth · Medical Policy · IL, MD, OR · Psychiatry, PediatricsMedium impact

LOCUS and CALOCUS-CASII criteria adoption in Illinois, Maryland, and Oregon

Act
by Aug 29, 2026
Effective date
Aug 29, 2026
Identified
Aug 25, 2026

Summary

Effective August 29, 2026, Evernorth Behavioral Health will adopt LOCUS (Level of Care Utilization System) for adults aged 19+ and CALOCUS-CASII for youth aged 6-18 in Illinois, Maryland, and Oregon to determine mental health level-of-care medical necessity. This replaces previous criteria sources for these three states only. The medical necessity review process itself remains unchanged.

Get alerts when payers change rules like this one

We check Cigna and other payers every day and email you when a change matches your specialty and state.

Get Cigna alertsPolicy Monitoring is free. No card required.

What to do

by Aug 29, 2026 · 5 steps
01Billing and prior authorization teams in Illinois, Maryland, and Oregon must update their clinical criteria references for mental health level-of-care determinations to use LOCUS (ages 19+) and CALOCUS-CASII (ages 6-18) instead of previous criteria sources.
02Providers should familiarize themselves with these new evidence-based criteria available on the Evernorth Provider website (Provider.Evernorth.com) in the Supporting Behavioral Websites section of the Coverage Policies page.
03Continue using ASAM Criteria for substance use disorder reviews and existing Evernorth/Cigna policies for autism spectrum disorders and other specified conditions.
04Update internal reference materials and staff training to reflect this change.
05No changes to the authorization or billing workflow are required—only the source of clinical criteria is changing.

Original notice

LOCUS and CALOCUS-CASII criteria adoption in Illinois, Maryland, and Oregon
providernewsroom.com · Always check the source before changing claims.
View original ↗

Related changes

See all Cigna changes →
Summary of Provider Newsroom behavioral health articlesMediumEffective Aug 29, 2026 · Medical PolicyAdoption of LOCUS and CALOCUS-CASII criteria in ColoradoMediumEffective Apr 11, 2026 · GeneralBrowse every Cigna change in the policy list

Related policy hubs

Cigna policiesIL policy changesMD policy changesOR policy changesPsychiatryPediatrics

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account