Another group or vendor provides the info on the next page. If you don’t want to leave our site, choose the “X” in the upper right corner to close this message. Or choose “Go on to next website” to move forward.
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)
Anxiety Disorder
National Institute of Mental Health: Anxiety Disorder
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
Cardiovascular medicine
Journal of the American College of Cardiology: Guidelines and Clinical Documents
Chronic obstructive lung disease (COPD)
Congestive 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
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
High blood pressure in adults
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
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
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
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
- 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
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