CommercialPrior AuthMedium impact
LOCUS and CALOCUS-CASII criteria adoption in Illinois, Maryland, and Oregon
Cigna·IL, MD, OR · Psychiatry, Pediatrics·Medical Policy
Effective date
Aug 29, 2026
We identified it
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.
Action Required
By August 29, 2026: Billing 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. Providers 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. Continue using ASAM Criteria for substance use disorder reviews and existing Evernorth/Cigna policies for autism spectrum disorders and other specified conditions. Update internal reference materials and staff training to reflect this change. No changes to the authorization or billing workflow are required—only the source of clinical criteria is changing.