Home | Provider Resources | About Us | Contact Us | Search

En Español

Community Care Medical Necessity Criteria For Pennsylvania Behavioral Health HealthChoices

Community Care uses the state of Pennsylvania “Appendix T” criteria for most levels of mental health care and for addictions services for adults.  These criteria can be viewed by clicking here. If you cannot access these criteria via the website, please contact us for a paper copy. 

In addition, we use the American Society of Addiction Medicine patient placement criteria for adolescent addiction services.  These criteria are not available on the internet.  If you would like a copy, please contact us and we will send you a paper copy.

Some supplemental levels of care are not addressed in Appendix T.  Community Care has developed supplemental medical necessity criteria for these levels of care.  They include: Psychiatric Rehabilitation Services, Community Treatment Team, Acute Stabilization and Diversion, and Individual Residential Treatment/Community Residential Rehabilitation (CRR) Host Home.  Not all of these supplemental levels of care are available in each county.  Please find these medical necessity criteria below.

If the member's clinical condition necessitates a level of care that is covered in the member's benefit plan but that level of care is not available, the next highest covered benefit level of care will be authorized.

< Back to All Articles