Aligning Coverage Criteria and Utilization Review Criteria with Clinical Practice

Generally Accepted Standards of Care (GASC) provide guidelines for what care patients should receive and when, based on the available evidence. Clinicians use GASC to determine the appropriate care and placement for their patients. Insurers claim to make decisions to reimburse or authorize covered services based on whether they are “medically necessary,” purportedly based on GASC. When insurers deviate from GASC in mental health and substance use disorder (MH/SUD) care, people get hurt. States have the opportunity to protect them.

Learn more by reading the full Gold Standard on GACS.