Evernorth Adopts LOCUS in Three States, and States That the Review Process Is Not Changing
- Effective 29 August 2026, Evernorth Behavioral Health adopts the Level of Care Utilization System (LOCUS) for members aged 19 and older and the Child and Adolescent Level of Care and Service Intensity Utilization System (CALOCUS-CASII) for members aged 6 through 18, for mental health level-of-care medical necessity reviews.
- The change applies to commercial and individual health plans in Illinois, Maryland and Oregon, and Evernorth cites three statutes as the basis: Illinois Compiled Statutes 2025 Chapter 215 134/87, Maryland 2024 House Bill 932, and Oregon 2021 House Bill 3046.
- Evernorth states that only the source of its criteria is changing, and that its medical necessity review process is not changing. LOCUS and CALOCUS-CASII are described as accepted evidence-based standards for mental health care.
- The carve-outs are extensive. Substance use disorder levels of care continue to be reviewed against the ASAM Criteria across all health plan business. Autism spectrum disorder assessment and treatment, intensive behavioural interventions, transcranial magnetic stimulation and complementary and alternative medicine remain governed by Evernorth and Cigna Healthcare coverage policies.
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Presented as a payer adopting evidence-based standards, the notice cites three statutes as the reason. This is compliance rather than choice, and the most consequential sentence in it is the one saying nothing else changes.
- Three statutes enacted across five years, discharged on a single date. Oregon legislated in 2021, Maryland in 2024, Illinois in 2025, and all three take effect in Evernorth’s operations on 29 August 2026. Treat state enactment and payer implementation as separate events with a long gap between them.
- The criteria changed and the process did not, by Evernorth’s own account. The legislative purpose of these statutes was to move outcomes, not sources. Watch denial and appeal rates in the three states from Q4, because that is precisely where the payer’s reading and the legislature’s reading come apart.
- The carve-outs cover more ground than the change does. Substance use disorder stays on ASAM, and autism services, intensive behavioural interventions and transcranial magnetic stimulation stay on the insurer’s own coverage policies in all 3 states. The mandate reaches mental health level-of-care review and stops there.