Medical Policies

Clinical criteria are used to support consistent, evidence-based decisions regarding the diagnosis, management, and treatment of health care conditions.

CommunityCare uses its plan Medical Policies when an applicable policy is available. When a CommunityCare Medical Policy is not available, CommunityCare uses nationally recognized clinical criteria based on current medical evidence, widely accepted clinical practice guidelines, and relevant clinical literature.

CommunityCare used InterQual® criteria for requests received before October 3, 2026, and uses MCG™ Care Guidelines for requests received on or after October 3, 2026.

• InterQual® Transparency
• MCG Care Guidelines Transparency

Medical Policies

• Implantable VNS Devices for Stroke Rehabilitation - CM-002
  Date posted: 9/1/2026Effective Date: 11/01/2026
• Medical Drug Site of Care PolicyEffective Date: 01/01/2026
• Powered Upper Extremity Range of Motion Assist Devices - CM-001
  Date posted: 8/1/2026Effective Date: 10/01/2026
• Site of Care for Advanced Imaging - CM-006
  Date posted: 12/9/2025Effective Date: 03/01/2026

Medical Drug List

• Medical Drug Formulary List

Medical Drug Policies