Medical Necessity Guidelines for Pennsylvania Behavioral Health HealthChoices

Community Care uses the state of Pennsylvania "Appendix T" criteria for most levels of mental health care and for substance use disorder services for adults. View the Appendix T criteria or ASAM criteria. If you cannot access these criteria via the website, please contact us for a paper copy.

Community Care also uses the State of Pennsylvania "Appendix S" Medical Necessity Guidelines in reviewing BHRS relating to Applied Behavior Analysis using BSC and TSS services for children and youth with diagnoses of autism spectrum disorders. If you cannot access these guidelines via the website, please contact us for a paper copy.

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