2022 Clinical Practice Guidelines

 

The guidelines below were reviewed and adopted by the Molina Healthcare National Quality Improvement Committee. Committee approval dates are shown for 2015 and beyond. All guidelines are reviewed monthly by the National Quality Improvement Committee and are approved annually unless otherwise noted.

Clinical guidelines are not used by Molina to decide benefit coverage. The guidelines are an educational tool to aid clinical decision-making. They are not a standard of care. The physician should adapt the guideline when clinical judgment so indicates.


Acute Stress and Post-Traumatic Stress Disorder (PTSD)

Molina Healthcare has adopted the guideline for Acute Stress and Post-Traumatic Stress Disorder from the Department of Veterans Affairs & Department of Defense.

The Clinical Practice Guideline may be accessed here.

Published: June 2017

Revised: N/A

Molina adopted/reviewed: March 2020, March 2021, April 2022


Anxiety/Panic Disorder

Molina Healthcare has adopted the guideline for Anxiety/Panic Disorder from the American Psychiatric Association.

The Clinical Practice Guideline may be accessed here.

Published: January 2009

Revised: N/A

Molina adopted/reviewed: March 2020, March 2021, April 2022


Asthma

Molina Healthcare has adopted the guideline for Diagnosis and Management of Asthma (EPR-3) from the National Institute of Health (NIH): National Heart, Lung, and Blood Institute (NHLBI).

The Clinical Practice Guideline may be accessed here.

Published: July 2007

Revised: December 2020

Molina adopted/reviewed: March 2015, March 2016, February 2017, March 2018, April 2019, March 2020, March 2021, April 2022


Attention Deficit Hyperactivity Disorder (ADHD)

Molina Healthcare has adopted the guideline for Diagnosis, Evaluation, and Treatment of Attention-Deficit Hyperactivity Disorder in Children and Adolescents from the Journal of the American Academy of Pediatrics (AAP).

The Clinical Practice Guideline may be accessed here.

Published: November 2011

Revised: October 2019

Molina adopted/reviewed: March 2015, March 2016, February 2017, March 2018, April 2019, March 2020, March 2021, April 2022

 

Autism

Molina Healthcare has adopted the guideline for Identification, Evaluation, and Management of Children With Autism Spectrum Disorder from the The American Academy of Pediatrics.

The Clinical Practice Guideline may be accessed here.

Published: January 2020

Revised: N/A

Molina adopted/reviewed: September 2021, April 2022


Bipolar Disorder

Molina Healthcare has adopted the guideline for Bipolar Disorder from the American Psychiatric Association.

The Clinical Practice Guideline may be accessed here.

Published: April 2002

Revised: N/A

Molina adopted/reviewed: March 2020, March 2021, April 2022


Children with Special Health Care Needs
 

Molina Healthcare has adopted the guideline for Promoting Health for Children and Youth with Special Health Care Needs from Bright Futures.

The Clinical Practice Guideline may be accessed here.

Published: 2017

Revised: N/A

Molina adopted/reviewed: August 2021, April 2022

 

Chronic Kidney Disease

Molina Healthcare has adopted the guideline for Evaluation and Management of Chronic Kidney Disease Guideline from the National Kidney Foundation, Kidney Disease Outcome Quality Initiative (NKF KDOQI).

The Clinical Practice Guideline may be accessed here.

Published: March 2014

Revised: N/A

Molina adopted/reviewed: July 2017, March 2018, April 2019, March 2020, March 2021, April 2022

 

Chronic Obstructive Pulmonary Disease

Molina Healthcare has adopted the guideline for Global Strategy for Diagnosis, Management, and Prevention of COPD from the Global Initiative for Chronic Obstructive Lung Disease (GOLD).

The Clinical Practice Guideline may be accessed here.

Published: 2011

Revised: November 2021

Molina adopted/reviewed: March 2015, March 2016, February 2017, March 2018, February 2019, April 2019, March 2020, March 2021, January 2022, April 2022


Depression

Molina Healthcare has adopted the guideline for Treatment of Patients with Major Depressive Disorder from the American Psychiatric Association (APA).

The Clinical Practice Guideline may be accessed here.

Published: October 2010

Revised: N/A

Molina adopted/reviewed: March 2015, March 2016, August 2017, March 2018, April 2019, March 2020, March 2021, April 2022


Diabetes

Molina Healthcare has adopted the guideline for Diabetes from the American Diabetes Association (ADA).

The Clinical Practice Guideline may be accessed here.

Published: January 2015

Revised: December 2021

Molina adopted/reviewed: March 2015, March 2016, February 2017, March 2018, February 2019, April 2019, March 2020, March 2021, February 2022, April 2022  

 

Heart Failure in Adults

Molina Healthcare has adopted the guideline for Management of Heart Failure from the American College of Cardiology (ACA).

The Clinical Practice Guideline may be accessed here.

You may also visit the web site below for more information. 

American College of Cardiology: here.

Published: 2013

Revised: May 2022

Molina adopted/reviewed: March 2015, March 2016, August 2017, March 2018, April 2019, March 2020, March 2021, April 2022, July 2022

 

Homelessness - Special Health Care Needs

Molina Healthcare has adopted the guideline for Adapting Your General Recommendations for the Care of Homeless Patients from the National Health Care for the Homeless Council. 

The Clinical Practice Guideline may be accessed here.

Published: 2010

Revised: N/A

Molina adopted/reviewed: September 2021, April 2022

 

Hypertension

Molina Healthcare has adopted the guideline for Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults from the American College of Cardiology.

The Clinical Practice Guideline may be accessed here.

Published: February 2014

Revised: August 2018

Molina adopted/reviewed: March 2015, March 2016, February 2017, March 2018, February 2019, April 2019, March 2020, March 2021, April 2022


Obesity

Molina Healthcare has adopted the guideline for Comprehensive Medical Care of Patients with Obesity from the American Association of Clinical Endocrinologists (AACE).

The Clinical Practice Guideline may be accessed here.

Published: July 2016

Revised: N/A

Molina adopted/reviewed: March 2015, March 2016, February 2017, March 2018, April 2019, March 2020, March 2021, April 2022


Opioid Management

Molina Healthcare has adopted the guideline for Use of Medications in the Treatment of Addiction Involving Opioids from the American Society of Addiction Medicine (ASAM).

The Clinical Practice Guideline may be accessed here.

Published: June 2015

Revised: January 2020

Molina adopted/reviewed: July 2017, March 2018, April 2019, March 2020, March 2021, April 2022

Molina Healthcare has adopted the guideline CDC Guideline for Prescribing Opioids for Chronic Pain.

The Clinical Practice Guideline may be accessed here.

Published: March 2016

Revised: N/A

Molina adopted/reviewed: April 2019, March 2020, March 2021, April 2022


Perinatal Care

Molina Healthcare has adopted the guideline for Perinatal Care from the American College of Obstetricians and Gynecologists.

The Clinical Practice Guideline may be accessed here - Guidelines can be reviewed by ACOG members only using a secure password.

Published: July 2012

Revised: September 2017

Molina adopted/reviewed: March 2015, March 2016, February 2017, November 2017, March 2018, February 2019, April 2019, March 2020, March 2021,  April 2022                                               


Pregnancy Management

Molina Healthcare has adopted the guideline for Routine Prenatal and Postnatal Care from Michigan Quality Improvement Consortium.

The Clinical Practice Guideline may be accessed here.

Published: 2018

Revised: June 2020

Molina adopted/reviewed: April 2019, March 2020, March 2021, April 2022


Schizophrenia

Molina Healthcare has adopted the guideline for Schizophrenia from the American Psychiatric Association,

The Clinical Practice Guideline may be accessed here.

Published: 2021

Revised: N/A

Molina adopted/reviewed: April 2021, April 2022


Sickle Cell Disease

Molina Healthcare has adopted the guideline for Management of Sickle Cell Disease from the National Heart, Lung, and Blood Institute (NHLBI).

The Clinical Practice Guideline may be accessed here.

Published: December 2014

Revised: N/A

Molina adopted/reviewed: July 2017, March 2018, April 2019, March 2020, March 2021, April 2022


Substance Abuse Treatment

Molina Healthcare has adopted the guideline for Detoxification and Substance Abuse Treatment from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The Clinical Practice Guideline may be accessed here.

Published: October 2015

Revised: N/A

Molina adopted/reviewed: July 2017, March 2018, April 2019, March 2020, March 2021, April 2022

 

Suicide Risk

Molina Healthcare has adopted the guideline for Assessment and Management of Patients at Risk for Suicide from the Department of Veterans Affairs & Department of Defense.

The Clinical Practice Guideline may be accessed here.

Published: May 2019

Revised: N/A

Molina adopted/reviewed: August 2021, April 2022

 

Trauma-Informed Primary Care
 

Molina Healthcare has adopted the guideline for Fostering Resilience and Recovery: A Change Package for Advancing Trauma-Informed Primary Care from The National Council for Mental Wellbeing.

The Clinical Practice Guideline may be accessed here.

Published: November 2019

Revised: N/A

Molina adopted/reviewed: August 2021, April 2022

 

 

2022 Preventive Health Guidelines

 

The guidelines below were reviewed and adopted by the Molina Healthcare National Quality Improvement Committee. Committee approval dates are shown for 2015 and beyond. All guidelines are reviewed monthly by the National Quality Improvement Committee and are approved annually unless otherwise noted. 

Clinical guidelines are not used by Molina to decide benefit coverage. The guidelines are an educational tool to aid clinical decision-making. They are not a standard of care. The physician should adapt the guideline when clinical judgment so indicates.

 

Adult Preventive Services Recommendations

Molina Healthcare has adopted the guideline for Adult Preventive Services Recommendations from U.S. Preventive Services Task Force.

The Clinical Practice Guideline may be accessed here.

Published: 2013

Revised: December 2021

Molina adopted/reviewed: March 2015, March 2016, October 2017, March 2018, April 2019, March 2020, March 2021, July 2021, August 2021, April 2022 

Recent updates recommended include the following:

  • Screening for Hepatitis B (Revised December 2020)
  • Tobacco Smoking Cessation in Adults, interventions including pregnant/nonpregnant adults (Revised January 2021)
  • Lung Cancer: Screening: aged 50-80 years with a 20 pack-year smoking history and currently smoke or have quit within the past 15 years (Revised March 2021)
  • Screening for Hypertension: 18 years or older without known hypertension (Revised April 2021)
  • Colorectal Cancer Screening: adults aged 45-49 & 50-75 years (Revised May 2021)
  • Healthy Weight and Weight Gain in Pregnancy: Behavioral Counseling Interventions: pregnant persons (Revised May 2021)
  • Gestational Diabetes Screening: asymptomatic pregnant persons at 24 weeks of gestation or after (Revised August 2021)
  • Screening for Prediabetes and Type 2 Diabetes: asymptomatic adults aged 35-70 years who have overweight or obesity (Revised August 2021)
  • Aspirin Use for Preventive Medication to prevent Preeclampsia and related Morbidity and Mortality (Revised September 2021)
  • Chlamydia Screening: sexually active women, including pregnant persons (Revised September 2021)
  • Gonorrhea Screening: sexually active women, including pregnant persons (Revised September 2021)
  • Prevention of Dental Caries: Children younger than five: Screening and Interventions: Fluoride Varnish & Fluoride Supplementation (Revised December 2021)

 

Recommendations for Preventive Pediatric Health Care

Molina Healthcare has adopted the guideline for Preventive Pediatric Health Care from Bright Futures/American Academy of Pediatrics.

The Clinical Practice Guideline may be accessed here.

Published: 2013

Revised: July 2022

Molina adopted/reviewed: March 2015, March 2016, October 2017, March 2018, April 2019, March 2020, March 2021, April 2022, July 2022

 

Recommended Adult Immunization Schedule for ages 19 Years or Older, United States, 2022


Molina Healthcare has adopted the guideline for Adult Immunization Schedule, 19 Years and Older, 2021 from Centers for Disease Control and Prevention.

The Clinical Practice Guideline may be accessed here.

Published: 2014

Revised: February 2022

Molina adopted/reviewed: March 2015, March 2016, March 2017, March 2018, April 2019, March 2020, March 2021, April 2022

 

Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2022

Molina Healthcare has adopted the guideline for Recommended Child and Adolescent Immunization Schedule for ages 18 years and younger, 2022 from Centers for Disease Control and Prevention.

The Clinical Practice Guideline may be accessed here.

Published: 2014

Revised: February 2022

Molina adopted/reviewed: March 2015, March 2016, March 2017, March 2018, April 2019, March 2020, March 2021, April 2022