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 currently uses InterQual® criteria and anticipates transitioning to MCG™ care guidelines on or after August 1, 2026.

InterQual® Transparency

Medical Policies

• Medical Drug Site of Care Policy
  Date posted: 4/9/2026Effective Date: 01/01/2026
• Powered Upper Extremity Range of Motion Assist Devices - CM-001
  Date posted: 8/1/2026Effective Date: 10/01/2026