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Clinical Practice Guidelines

Molina Participating Providers must comply with all applicable laws and licensing requirements. In addition, Participating Providers must furnish covered evidence-based services in a manner consistent with standards, including nationally recognized clinical protocols and guidelines, related to medical and surgical practices that are generally accepted in the medical and professional community at the time of treatment.

Participating Providers must also comply with Molina’s adopted clinical practice guidelines, which include the following:

Behavioral Health Guidelines



Preventative Health Guidelines



Immunizations

Adult Members may receive immunizations as recommended by the Centers for Disease Control and Prevention (CDC) and prescribed by the Member’s PCP.

All Providers administering vaccines to children under age nineteen (19) must participate in the New York State Vaccines for Children (VAC) Program. The VFC program provides the vaccines free of charge. For more information about the VFC and how to obtain vaccines, Providers should contact VFC directly. More information on the program can be found at:
https://www.health.ny.gov/prevention/immunization/vaccines_for_children.htm

Molina is responsible for all costs associated with vaccine administration associated with childhood immunizations. Molina Healthcare covers immunizations not covered through Vaccines for Children (VFC).

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 Members under twenty-one (21) years are timely according to required preventive guidelines. All Members 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.

Molina Providers must comply with the EPSDT/CTHP standards. The EPSDT/CTHP Provider Manual can be found on eMedNY.

Prenatal Care

Molina has adopted the NYSDOH Prenatal Care standards. The standards provide a comprehensive model of care that integrates the psychosocial and medical needs, and reflects the special needs of the Medicaid population. The standards of care include:

  • Prenatal Care Provider requirements
  • Access to care standards
  • Prenatal risk assessment, screening and referral for care
  • Psychosocial risk assessment, screening, counseling, and referral for care
  • Nutritional screening, counseling, and referral for care
  • Health education
  • Development of a care plan and care coordination
  • Prenatal care services
  • Postpartum services

 

The NYS DOH Prenatal Care Standards can be found on the NYS DOH web site at http://www.health.ny.gov/health_care/medicaid/standards/prenatal_care/

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