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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

Physical health

 

A and B recommendations

 

Asthma

 

Chronic kidney disease (PDF)

 

Chronic obstructive lung disease (COPD) (PDF)

 

Congestive heart failure (CHF)

 

Contraceptive use recommendations (PDF)  

 

Coronary artery disease (CAD)

 

Domestic violence screening

 

Hepatitis C clinical decision support tool (PDF)  

 

Hepatitis C screening

 

HIV/AIDS care

 

High blood pressure 

 

Immunizations for adults and children

 

Low back pain

 

Opioids for chronic pain

 

Pediatric health care recommendations (PDF)

 

Prenatal care

 

Prenatal and postpartum care 

 

Screening recommendations

 

Vaccine recommendations

 

Preterm birth

 

17-alpha hydroxprogesterone caproate (17P) and Makena® (PDF)

 

Preterm birth toolkit

 

Progesterone and preterm birth prevention (PDF)

 

Universal cervical length screening and vaginal progesterone for short cervix (PDF)

 

Sickle cell disease

 

Sickle cell disease expert panel report 

 

Sickle cell disease management (PDF)

 

Vaccine recommendations for pregnant women

 

General guidelines

 

Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine

 

Behavioral and mental health

 

Alcohol abuse

 

Attention-deficit/hyperactivity disorder (ADHD)

 

Bipolar disorder (PDF)

 

Screening, brief intervention and referral to treatment (SBIRT) (PDF)

 

Children and families in the aftermath of disasters and crises (PDF)

 

Generalized anxiety disorder (PDF)

 

Major depressive disorder

 

Panic disorder

 

Disruptive behavior disorders in children and adolescents 

 

Acute stress disorder and posttraumatic stress disorder

 

Guideline watch (PDF)

 

Practice guideline (PDF)

 

Quick reference guide (PDF)

 

Eating disorders

 

Practice guideline (PDF)

 

Guideline watch (PDF)

 

Quick reference guide (PDF)

 

Nicotine use

 

Health equity in tobacco prevention and control (PDF)

 

Personalized quit plan form (PDF)

 

Tobacco cessation

 

Tobacco-free toolkit (PDF)

 

Tobacco-related disparities (PDF)

 

Treating tobacco use and dependence

 

Obsessive-compulsive disorder

 

Practice guideline (PDF)

 

Guideline watch (PDF)

 

Quick reference guide (PDF)

 

Opioid addiction

 

American Society of Addiction Medicine (ASAM) national practice guideline (PDF)

 

ASAM national practice guideline synopsis (PDF)

 

Schizophrenia

 

Practice guideline (PDF)

 

Guideline watch (PDF)

 

Quick reference guide (PDF)

 

Substance use disorder 

 

Practice guideline (PDF)

 

Guideline watch (PDF)

 

Quick reference guide (PDF)

 

Suicidal behaviors

 

Practice guideline (PDF)

 

Quick reference guide (PDF)

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

Hospice care

 

We work with providers to approve hospice care for members when they need end of life services and supports. 

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