Clinical practice guidelines

Use these resources to find information about specific treatment types and guidelines.

Our team of leading providers is dedicated to the delivery of quality, cost-effective health care for our Members. The following clinical practice guidelines are intended to support our health care team and serve as resources to ensure our providers have the most up to date, evidence based information recommended by nationally recognized organizations.

Asthma

Coronary Artery Disease (CAD)

Congestive Heart Failure (CHF)

Chronic Obstructive Pulmonary (Lung) Disease (COPD)

Diabetes Mellitus (DM)

HIV/AIDS

Hypertension (HTN)

Adult Immunizations CDC Guidelines

Adult Preventive Screenings

American College of Obstetricians and Gynecologists Clinical Guidelines

Prenatal Care, American Family Physician

Alcohol Abuse

Major Depressive Disorder

Opioid Use Disorder

Schizophrenia

Tobacco Cessation

Psychotropic Medication Management

Clinical Pharmacy Medication Review Revised 2007, 2010, 2012

Coordination of Community Support for Enrollees in HCBS Waivers

Community Re-Integration and Support

Long-Term Care (LTC) Residential Condition of Services

  • Criteria required by applicable state or federal regulatory agency
  • Milliman Care Guidelines as the primary decision support for most medical diagnoses and conditions
  • Aetna Clinical Policy Bulletins (CPBs)
  • LOCUS/CALOCUS Guidelines
  • American Society of Addiction Medicine (ASAM) Criteria

Approved by Quality Management and Utilization Management Committee: April 20, 2023