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Guidelines
Respected professional and public health organizations create clinical practice guidelines that document best practices and recommendations for care. We’ve chosen certain clinical guidelines to help our providers give members high-quality, consistent care with effective use of services and resources. These include treatment protocols for specific conditions, as well as preventive health measures.
The intention of these guidelines is to clarify standards and expectations. They should not:
- Take precedence over your responsibility to provide treatment based on the member’s needs
- Substitute as orders for treatment of a member
- Guarantee coverage or payment for the type or level of care proposed or provided
Clinical practice guidelines
Alcohol Use Disorder
- American Society of Addiction Medicine Alcohol Withdrawal Management- January 2020
- Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions (November 2018)
Asthma
- National Heart, Lung and Blood Institute (NHLBI)-2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group
- National Heart, Lung and Blood Institute (NHLBI)- Asthma Management Guidelines: Focused Updates 2020
Attention-deficit/hyperactivity disorder
Behavioral health treatments and services
- Centers for Disease Control and Prevention: Screening for Breast Cancer
- Centers for Disease Control and Prevention: Screening for Prostate Cancer
Cardiovascular disease and comorbid conditions
Chronic obstructive lung disease (COPD)
Diabetes standards of medical care
HIP
Home and community-based services
Hypertension
Immunizations
Low Back Pain
Obesity
Obstructive Sleep Apnea
- American Academy of Sleep Medicine Clinical Practice Guideline (2017)
- American Academy of Pediatrics (Sept. 2012)
- Use of Opioids in the Management of Chronic Pain (2022) VA/DoD Clinical Practice Guidelines
- CDC’s Clinical Practice Guideline for Prescribing Opioids for Pain|Guidelines|Healthcare Professionals | Opioids CDC
Preventive care for Medicaid members
Postnatal care for mothers and newborns (PDF)
Postpartum care (may require ACOG membership to access)
Substance Use Disorder
- American Society of Addiction Medicine Consensus Statement — Appropriate Use of Drug Testing in Clinical Addiction Medicine (Reviewed December 2019)
- American Society of Addiction Medicine Treatment of Opioid Use Disorder (2020)
Suicide Prevention
Clinical policy bulletins
These bulletins state our policy about the medical necessity or investigational status of medical technologies and other services to help with coverage decisions. A national review team creates the bulletins and bases them on:
- Published medical literature
- Formal technology assessments
- Structured evidence reviews
- Evidence-based consensus statements
- Expert opinions
- Evidence-based guidelines from professional and public health entities
Aetna® clinical policy bulletins