McKesson Health Solutions has made significant changes to the InterQual Level of Care Criteria for 2016.

Beginning in August 2016, the Clinical Services – Utilization Management department at AmeriHealth (formerly known by some providers as Care Management and Coordination) will use the 2016 InterQual Level of Care criteria for review of acute inpatient, acute rehabilitation, skilled nursing facility, and long-term acute care admissions. In addition, we will transition to the 2016 home care guidelines. Changes include:

• InterQual Acute Adult Level of Care criteria:
  
  • - General Medical. Updates were made to inpatient chemotherapy administration.
  • - Sepsis and Septic Shock. Criteria were updated based on the current evidence, including the recently published Third    International Consensus Definitions for Sepsis and Septic Shock.
  • - Sickle Cell Crisis. Criteria were updated based on the new National Heart, Lung, and Blood Institute guidelines.
  
  
• InterQual Acute Pediatric criteria:
  • - General Medical. Updates were made to inpatient chemotherapy administration.
  • - Hyperbilirubinemia. Criteria were revised to align more closely with American Academy of Pediatrics guidelines.
  
  
• InterQual Post-Acute Care criteria: Updates were made to the Subacute/Skilled Nursing Facility, Long Term Acute Care, and Acute Rehabilitation products.