Here providers can access program descriptions and medical necessity criteria (MNC) for CBH-funded services. The MNC for each service are based on HealthChoices Appendices T and S, American Society of Addiction Medicine (ASAM), or OMHSAS-approved criteria as indicated.
For MNC for substance use levels of care, please reference the PA Department of Drug and Alcohol Programs (DDAP) Guidance for Appropriate Application of ASAM in Pennsylvania’s Substance Use Disorder (SUD) System of Care. For more information please refer to The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, Third Edition.
It is important to note that CBH authorization decisions are made based on eligibility criteria and MNC as approved by the Commonwealth of Pennsylvania. CBH does not reward or provide any form of incentive to physician advisors for issuing denial of services. CBH does not reward or provide any form of incentive to clinical management staff to make decisions that result in the underutilization of benefits.
For MNC for mental health levels of care, please reference the links below: