Preventive Health Guidelines

Preventive Health Guidelines can be beneficial to the provider and his/her patients. All practice guidelines are based on scientific evidence, review of the medical literature, or appropriately established authority, as cited. All recommendations are based on published consensus guidelines and do not favor any particular treatment based solely on cost considerations.

These guidelines are meant to recommend a standard level of care and do not preclude the delivery of additional preventative services depending on the individual needs of the patient.

Molina Healthcare reviews and revises guidelines at least every two years and more frequently as clinical evidence is updated. Once the guidelines have been reviewed and modified as needed by a dedicated Quality Improvement Committee, Molina Healthcare providers will be notified of any changes and updates by fax and/or mail.

To request a copy of any guideline, please call Molina’s Provider Services. 

Use link below to reach our clinical practice guidelines:

Clinical Practice Guidelines

The files below are in PDF format ()

Preventative Health Guidelines:

 

EPSDT Services to Members Under Twenty-One (21) Years

Molina Healthcare maintains systematic and robust monitoring mechanisms to ensure all required Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services to Enrollees under twenty-one (21) years are timely according to required preventive guidelines. All Enrollees under twenty-one (21) years of age should receive preventive, diagnostic and treatment services at intervals as set forth in Section 1905® of the Social Security Act. Molina’s Improvement Department is also available to perform Provider training to ensure that best practice guidelines are followed in relation to well child services and care for acute and chronic health care needs.

Participating providers are responsible for contacting new Members who are not compliant with EPSDT periodicity and immunization schedules for children as identified in the quarterly encounter list provided by Molina. Providers should document reasons for noncompliance, where possible, and document efforts to bring the Member’s care into compliance with the standards.

Well child / adolescent visits
Visits consist of age appropriate components including but not limited to:

  • comprehensive health and developmental history;
  • nutritional assessment;
  • height and weight and growth charting;
  • comprehensive unclothed physical examination;
  • appropriate immunizations;
  • laboratory procedures, including lead blood level assessment appropriate for age and risk factors;
  • periodic developmental and behavioral screening;
  • vision and hearing tests;
  • dental assessment and services; and
  • health education (anticipatory guidance including child development, healthy lifestyles, and accident and disease prevention).

Diagnostic services, treatment, or services Medically Necessary to correct or ameliorate defects, physical or mental illnesses, and conditions discovered during a screening or testing must be provided or arranged for either directly or through referrals. Any condition discovered during the screening examination or screening test requiring further diagnostic study or treatment must be provided if within the Member’s Covered Benefit Services. Members should be referred to an appropriate source of care for any required services that are not Covered Services.

Molina shall have no obligation to pay for services that are not Covered Services.