Level of Care Determination/Utilization Tools

​​​​After completion of the CCA, members are then referred – if medically necessary – to either basic or enhanced services, either of which shall apply evidence-based treatment models for addressing the member's diagnosis and associated symptoms or functional problems. Also, if additional diagnostic or functional clarity is needed, members may be referred for psychological testing.​

Our providers use standardized level of care utilization tools to assist in determining the necessary service array:

1. The Level of Care Utilization System (LOCUS) and Child and Adolescent Level of Care Utilization System (CALOCUS) were developed to define the level of care and treatment resources needed for consumers, based on results of the assessment of their clinical needs and functional status. The tools contain a dimensional rating system with scores ranging from 1 (minimal) to 5 (extreme) on each dimension and a composite score, both of which are used to assist in determining the appropriate treatment service. The dimensions on the LOCUS (used for adults) include:

  • Risk of harm,
  • Functional status,
  • Comorbidity,
  • Recovery environment,
  • Treatment and recovery history, and
  • Engagement and recovery status. ​

The dimensions on the CALOCUS (for youth ages six and older) include:

  • Risk of harm,
  • Functional status,
  • Comorbidity,
  • Recovery environment,
  • Resiliency and treatment history, and,
  • Acceptance and engagement.

It is important to note that the tools were developed to be one element of the level of care decision, and that they are not intended to replace clinical judgment and other relevant information. 

2. The American Society of Addiction Medicine (ASAM) criteria are used for consumers engaging in substance use/abuse to determine the appropriate level of service needed, plan treatment, and help make decisions about continued service or discharge. It was developed with six dimensions to guide decisions:

  • Potential for acute intoxication and/or withdrawal;
  • Biomedical conditions and complications;
  • Emotional/behavioral conditions or complications;
  • Treatment acceptance/resistance;
  • Relapse potential; and
  • Recovery environment.

The ASAM criteria are also expected to make improvements in the efficient use of limited resources, treatment retention, and treatment outcomes. A new ASAM tool was implemented in August of 2014.

Members may also be referred to natural supports which are typically non-paid government and/or other community and family-based supports who assist the member in attaining basic needs such as food, shelter, education, legal assistance and employment, as well as contribute to a member's overall wellbeing. Cardinal Innovations' Community Partners staff, located in each of our Community Operations Centers, focus on strengthening such community resources and ensuring our members have access to the services they need.