Policy Updates Medical Policy & Clinical GuidelinesMedicaidMay 29, 2024

MCG Care Guidelines 28th edition

Effective September 1, 2024, Anthem will upgrade to the 28th edition of MCG Care Guidelines for the following modules. Below is high level summary of the updates and is not intended to be all inclusive:

  • Behavioral Health Care (BHG):
    • The goal length of stay (GLOS) has been changed in two guidelines in the 28th edition of Behavioral Health Care.
  • Inpatient & Surgical Care (ISC):
    • The goal length of stay (GLOS) has been changed in a total of 72 Optimal Recovery Guidelines in the 28th edition of Inpatient & Surgical Care. In medical Optimal Recovery Guidelines, the GLOS has been changed in 37 guidelines and the GLOS has been changed in 35 surgical Optimal Recovery Guidelines, in the 28th edition of Inpatient & Surgical Care.
  • General Recovery Care (GRG):
    • The benchmark length of stay (BLOS) has been refined in the 28th edition of General Recovery Care.
  • Recovery Facility Care (RFC):
    • A total of one guideline has been removed from the 28th edition of Recovery Facility Care.
  • Chronic Care (CCG):
    • A total of 10 guidelines have been moved in the 28th edition of Chronic Care.

If you have any questions, please contact the Provider Services number on the back of the member's ID card.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: July 2024 Provider Newsletter