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Clinical guidelines and policy bulletins

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

 

Anxiety Disorder

 

National Institute of Mental Health: Anxiety Disorder

 

 

Asthma

 

 

Attention-deficit/hyperactivity disorder

 

 

Behavioral health treatments and services

 

Substance Abuse and Mental Health Services Administration: Health Care and Support For Mental Health, Drug or Alcohol

 

Cancer screenings

 

Cardiovascular disease and comorbid conditions

 

Journal of the American College of Cardiology: AHA/ACC/HHS Strategies to Enhance Application of Clinical Practice Guidelines in Patients With Cardiovascular Disease and Comorbid Conditions

 

Cardiovascular medicine

 

Journal of the American College of Cardiology: Guidelines and Clinical Documents

 

Chronic obstructive lung disease (COPD)

 

Congestive Heart Failure

 

Journal of the American College of Cardiology: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure

 

Cognitive impairment

 

National Institute on Aging: Assessing Cognitive Impairment in Older Patients

 

Community reintegration

 

JAMA Internal Medicine: The Effect of Guided Care Teams on the Use of Health Services

 

Coronary Artery Disease

 

Journal of the American College of Cardiology: Primary Prevention of CVD Guideline Hub

 

Dental services

 

American Academy of Pediatrics: Oral Health

 

Depression in primary care

 

Institute for Clinical Systems Improvement: Health Care Guideline – Depression in Primary Care

 

Diabetes care

 

American Diabetes Association: Diabetes Care

 

Diabetes standards of medical care

 

American Diabetes Association:  Practice Guidelines Resources

 

Eating Disorder

 

American Academy of Pediatrics: Identification and Management of Eating Disorders in Children and Adolescents

 

Elder abuse

 

Centers for Disease Control and Prevention: Abuse of Older Persons

 

Elderly and disabled

 

National Institute on Aging: Healthy Aging, Alzheimer’s, and More!

 

Hepatis C

 

U.S. Preventive Services Task Force: Hepatitis C Virus Infection in Adolescents and Adults: Screening

 

High blood pressure in adults

 

JAMA Network: Hypertension

 

HIP

 

American Academy of Orthopaedic Surgeons: Management of Osteoarthritis of the Hip

 

HIV/AIDS

 

Health Resources & Services Administration: Ryan White HIV/AIDS Program

 

Home and community-based services

 

HCBS.org Clearinghouse: New and Notable Publications

 

Hypertension

 

Immunizations

 

Lead

 

Bright Futures: Recommendations for Preventative Pediatric Health Care

 

Long-term care

 

Centers for Disease Control and Prevention: Long-term Care Facilities (LTCFs)

 

Low Back Pain

 

Major depressive disorder

 

Obesity

 

Obstructive Sleep Apnea

 

Opioids for chronic pain

 

Pediatric Preventative Health

 

Bright Futures: Recommendations for Preventative Pediatric Health Care

 

Preventive care for Medicaid members

 

Medicaid.gov: Early and Periodic Screening, Diagnostic, and Treatment

 

Preventive Screenings, Counseling and Preventive Medication ― USPSTF Guidelines (Pediatric, Adult, Senior)

 

U.S. Preventative Services Task Force: Recommendations

 

Postnatal care for mothers and newborns (PDF)

 

World Health Organization: WHO recommendations on Postnatal care of the mother and newborn

 

Postpartum care (may require ACOG membership to access)

 

The American College of Obstetricians and Gynecologist: Optimizing Postpartum Care

 

Schizophrenia

 

Psychiatry Online: The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia, Third Edition

 

Sickle Cell Anemia

 

American Society of Hematology: ASH Clinical Practice Guidelines on Sickle Cell Disease (SCD)

 

Seizure Disorder/Epilepsy

 

American Epilepsy Society: Guidelines

 

Stroke

 

AHA|ASA Journals: Guidelines for the Primary Prevention of Stroke

 

Substance Use Disorder

 

Suicide Prevention 

 

Tobacco cessation

 

Trauma Informed Care

 

National Council for Mental Wellbeing: Healthy Minds – Strong Communities

 

Vaccine recommendations

 

Center for Disease Control and Prevention: ACIP Vaccine Recommendation and Guidelines

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

 

Aetna medical clinical policy bulletins

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