June 2026 Top of Mind

Updated Clinical Criteria Guidelines for Transcranial Magnetic Stimulation and Applied Behavior Analysis

Optum Health Behavioral Solutions of California (Optum) adopted the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines (2016, 2023 editions) and the American Psychiatric Association (APA) Position Statement on Transcranial Magnetic Stimulation (TMS) for the management of TMS services. This became effective July 1, 2025.

Optum Health Behavioral Solutions of California (Optum) also adopted The Council of Autism Service Providers (CASP) Applied Behavior Analysis (ABA) Practice Guidelines for the Treatment of Autism Spectrum Disorder for the management of ABA services. This became effective Nov. 1, 2025.

These guidelines apply specifically to California Commercial insured members. This legislative update strengthens several of California’s Code of Regulation Rules to improve access to Mental Health and Substance Use Disorder (MH/SUD) services, requiring the use of clinical guidelines developed by non-profit professional associations. These guidelines may be accessed on Provider Express under the State/Contract Specific Clinical Criteria California section on the Clinical Criteria and Guidelines page.

All other California applicable clinical criteria in place are aligned with non-profit association developed criteria and remain unchanged. These include ASAM, LOCUS, CALOCUS-CASII, ECSII and American Psychological Association Psychological and Neuropsychological Testing Billing and Coding Guide.