July 2020 newsletter
Quality Corner
Updates: Clinical Practice Guidelines
Cigna periodically adopts and approves (with subsequent review and re-approval), evidence-based behavioral Clinical Practice Guidelines published by recognized professional practice societies. Formal re-approval of the practice guidelines for updated and continued use is scheduled at least every two years. Cigna Behavioral Health’s Senior Medical Director may initiate more frequent action based on semi-annual review of new scientific evidence or changes in national standards and may recommend the adoption of additional guidelines within the two-year cycle as appropriate.
Prior to adoption, practice guidelines are assessed for consistency with Cigna Behavioral Health’s Medical Necessity Criteria. When used in clinical decision-making, adherence to recognized guidelines assures that care authorized for acute and chronic behavioral health conditions meets national standards for excellence.
As indicated in the Clinical Practice Guidelines at the Cigna for Health Care Professionals website (CignaforHCP.com), guidelines published by the American Psychiatric Association, the American Academy of Pediatrics, the Canadian Psychiatric Association, the National Institute on Alcohol and Alcoholism, the Centers for Disease Control and Prevention, and the American Society of Addiction Medicine, are currently recommended for continued use.
Links to the American Psychiatric Association's Clinical Practice Guidelines were updated in the 2020 Cigna Clinical Practice Guidelines Memo.
To support clinical decision-making, all adopted practice guidelines are provided to Cigna Behavioral Health’s staff and then distributed to all contracted behavioral health care providers by way of:
- Annual email or mail-based communication
- Letter to new providers
- Cigna Behavioral Medical Management Program Guide
- Transformations newsletter
Cigna measures network performance against selected behavioral health practice guidelines annually.
Cigna Behavioral Health Medical Necessity Criteria
Cigna's Behavioral Quality Committee approves behavioral health Medical Necessity Criteria. As mentioned above, these criteria are developed by analyzing evidence-based practice methods consistent with Cigna's Clinical Practice Guidelines for condition-specific management of illness.
Cigna uses the Medical Necessity Criteria in determining responses to behavioral service authorization requests. Service authorization requests are considered on a case-by-case basis and include an assessment of the availability of services in the local delivery system.
We encourage you to access, review, and use Cigna Behavioral Health’s Medical Necessity Criteria as you develop care and treatment plans for your Cigna patients. When Cigna revises its Medical Necessity Criteria, a draft version is posted at CignaforHCP.com. Whether you’re reviewing the draft or current version of the Medical Necessity Criteria, we welcome your review and feedback via the email link option. Your input helps us improve Cigna’s Behavioral Health Medical Necessity Criteria.