Clinical guidelines and policy bulletins

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

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

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

• American Academy of Pediatrics (AAP): ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents, October 2019

Behavioral health treatments and services

Cancer screenings

Cardiovascular disease and comorbid conditions

Cardiovascular medicine

Chronic obstructive lung disease (COPD)

• Centers for Disease Control and Prevention: Chronic Obstructive Pulmonary Disease (COPD)

Congestive Heart Failure

Cognitive impairment

Community reintegration

Coronary Artery Disease

Dental services

Depression in primary care

Diabetes care

Diabetes standards of medical care

Eating Disorder

Elder abuse

Elderly and disabled

Hepatis C

High blood pressure in adults

HIP

HIV/AIDS

Home and community-based services

Hypertension

• Guidelines Made Simple|2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults

Immunizations

• Immunizations for adults and children
• Immunizations for children and adolescents

Lead (PDF)

Long-term care

Low Back Pain

• Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians (2020)

Major depressive disorder

• Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts February 2019

Medication management (PDF)

Obesity

• Obesity Algorithm | Obesity Medicine Association

Obstructive Sleep Apnea

• American Academy of Sleep Medicine Clinical Practice Guideline (2017)
• American Academy of Pediatrics (Sept. 2012) 

Opioids for chronic pain

• 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

Preventive care for Medicaid members

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

Postnatal care for mothers and newborns (PDF)

Postpartum care (may require ACOG membership to access)

Schizophrenia

Sickle Cell Anemia

Seizure Disorder/Epilepsy

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 

• US Department of Veterans Affairs Assessment and Management of Patients at Risk for Suicide (2019)

Tobacco cessation

• Tobacco and Nicotine Cessation During Pregnancy ACOG. Number 807 (May 2020)

Trauma Informed Care

Vaccine recommendations

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