Clinical guidelines and policy bulletins

We’ve chosen certain clinical guidelines to help our providers get members high-quality, consistent care that uses services and resources effectively. These include treatment protocols for specific conditions, as well as preventive health measures.

These guidelines are intended to clarify standards and expectations. They should not: 

• Take precedence over your responsibility to provide treatment based on the member’s individual needs
• Substitute as orders for treatment of a member
• Guarantee coverage or payment for the type or level of care proposed or provided

Aetna clinical policy bulletins

Aetna medical clinical policy bulletins

Alcohol abuse

• American Society of Addiction Medicine Alcohol Withdrawal Management
• Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions

Anxiety Disorder

Asthma

Attention deficit hyperactivity disorder

Congestive heart failure (CHF)

Chronic kidney disease

Chronic obstructive pulmonary disease

Coronary artery disease

Depression management toolkit

Diabetes

Eating Disorders

Hepatitis C screening

HIV/ AIDS

Hypertension guidelines

Hypertension screening in adults

Low back pain

Major depressive disorder

Obesity

Opioids for chronic pain

Schizophrenia

Sickle Cell Anemia

Substance use disorder

• American Society of Addiction Medicine Treatment of Opioid Use Disorder
• American Society of Addiction Medicine Consensus Statement — Appropriate Use of Drug Testing in Clinical Addiction Medicine (Reviewed December 2019)

Tobacco cessation materials

Tobacco cessation during pregnancy

Trauma informed care

• Fostering resilience and recovery: a change package for advancing trauma-informed primary care
• SAMHSA substance abuse and mental health services administration

Ambulatory adult Prenatal Care Guideline

Centers for Disease Control and Prevention (CDC) immunization schedules for adult and pediatric patients

Maryland Healthy Kids/EPSDT Program

Pediatric preventive health care

Suicide Prevention

U.S. Preventive Services Task Force A and B recommendations

Breastfeeding

CDC vaccine recommendations for pregnant women

Domestic violence

Domestic violence hotline

Teen pregnancy

Women, Infants and Children (WIC)

WIC prescreening tool

We use the following medical review criteria to make medically necessary decisions:

• Criteria required by applicable state or federal regulatory agency
• Medicaid pharmacy guidelines
• MCG
• American Society of Addiction Medicine (ASAM)
• Level of Care Utilization System (LOCUS)
• Children and Adolescent Service Intensity Instrument (CASII)
• Child and Adolescent Needs Strengths Scale (CANS)[MJ1] [UC2] [UC3] 
• Clinical policy bulletins (CPB)
• Early Childhood Service Intensity Instrument (ECSII)