2024 Provider Updates

HEDIS® Toolkit

The Lucet™ Healthcare Effectiveness Data and Information Set (HEDIS®) Provider Toolkit is available here. HEDIS was developed by the National Committee for Quality Assurance (NCQA®). 

HEDIS, a set of performance measures used in the healthcare industry, is part of NCQA accreditation, and is an essential activity for Lucet to ensure members receive the highest quality care from providers. The purpose of this toolkit is to offer better understanding of the 2024 Measurement Year HEDIS behavioral health performance measures and to provide guidance to healthcare providers on how they can help improve the quality of care and performance on the HEDIS measures. 

Added for 2024:

• Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E)
• Depression Remission or Response for Adolescents and Adults (DRR-E)
• Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)

Improving health through positive change: that is our company mission and what each of our employees live by every day. Members receive care that is coordinated, focused on whole-person health, and customized to fit the unique needs of the individual.  

Our goal is to help you help others. Providers are at the heart of health care delivery, serving members when they are most vulnerable, suffering from mental illness, or impacted by trauma. A better quality of life for our members starts with you. 

Help us help your patients and contribute to healthcare data quality by using the information in the toolkit to apply best practices! 

Summaries can be viewed and downloaded both collectively in one document and individually. Please visit here for a copy.

2024 Medical Necessity Criteria

In 2023 Lucet, in keeping with industry trends, began using placement criteria produced by professional provider organizations. Lucet continues to utilize internally produced medical policies. These are listed below with changes noted.

Lucet Health’s Externally Sourced Placement Criteria for 2024

• Level of Care Utilization System (LOCUS)
• For adult mental health
• Child/Adolescent Level of Care Utilization System (CALOCUS)
• For mental health age 6-18
• Early Childhood Service Intensity Instrument (ECSII)
• For mental health age 0-5
• American Society of Addiction Medicine Criteria (The ASAM Criteria)
• For substance use disorders
• ASAM is expected to publish revised criteria in the second half of 2024. Lucet may not implement any changes until 2025.

Lucet Health’s Internally produced Medical Policies for 2024

• 23-hour observation
• Psychological and Neuropsychological Testing
• Electroconvulsive Therapy
• Applied Behavior Analysis
• Applied Behavior Analysis for the Treatment of Autism Spectrum Disorder
• Applied Behavior Analysis for the Treatment of Autism Spectrum Disorder for Federal Employees
• Applied Behavior Analysis for the Treatment of Down Syndrome
• Transcranial Magnetic Stimulation
• Lucet is dropping the requirement that members have two trials of two augmentation medications for rTMS authorization. This change is consistent with modern literature, trends with other insurance companies, CMS/Medicare, and provider organization recommendations.

The policy still requires:

• Trials of two different antidepressants
• A trial of evidence-based psychotherapy
• Evidence of Major Depressive Disorder, severe

Lucet is required to utilize some medical policies produced by our health plan clients.

Health Plan produced Medical Policies for 2024

• BCBS Arkansas #2011053 – Autism Spectrum Disorder in Children, Applied Behavioral Analysis
• BCBS Arkansas #2003055 – Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric Disorders
• BCBS Arkansas #2023005 – Autism Spectrum Disorder in Adults, Applied Behavioral Analysi• BCBS Arkansas / Walmart #1028 – Autism Spectrum Disorder, Applied Behavior Analysi• BCBS Arkansas / Walmart #542 – Transcranial Magnetic Stimulation (TMS) as a Treatment of Depression and Other Psychiatric/Neurologic Disorders
• BCBS Louisiana #00121 – Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders

Lucet is required to utilize some Medicare National Coverage Determinations (NCD) & Local Coverage Determinations (LCD) policies. NCD and LCD information is available at MCD Search (cms.gov).

Form Changes

Transcranial Magnetic Stimulation (TMS) Form has been simplified to reduce the amount of information that is required and to make it simpler to fill out the document. A cover page has been added with instructions.

Psychological and Neuropsychological Testing (PNT) Form cover page has been updated to reduce the number of fax numbers.

Please replace any copies of these forms with the current versions.
The placement criteria, medical policies, and forms are available here.