Medical Necessity Criteria

Aetna Better Health of Kentucky uses the following medical review criteria for physical health and behavioral health medical necessity decisions, as applicable:

  • Criteria required by applicable state or federal regulatory agency
  • Aetna Medicaid Pharmacy Guidelines
  • InterQual guidelines
  • American Society of Addiction Medicine (ASAM)
  • LOCUS (Level of Care Utilization System (LOCUS)
  • Children and Adolescent Service Intensity Instrument (CASII)
  • Child and Adolescent Needs Strengths Scale (CANS)
  • Early Childhood Service Intensity Instrument (ECSII)

You can get a free copy of the criteria by calling 1-855-300-5528 (TTY: 711 or TDD: 1-800-627-4702) Monday – Friday from 7 a.m. – 7 p.m. ET.