2026 Clinical Practice Guidelines
Clinical practice guidelines are designed to guide decisions about diagnosing and treating specific health conditions. These guidelines are based on scientific evidence, medical literature reviews or established authority. All recommendations are grounded in published guidelines and do not prioritize treatments based solely on cost.
These guidelines serve as a guide for clinical decision-making, but clinicians and patients must collaborate to create individualized treatment plans tailored to each patient's unique needs and circumstances.
Molina regularly reviews and updates these guidelines as new clinical evidence emerges. After review and necessary modifications by the National Quality Improvement Committee and Health Outcomes Committee (QI-HOC), providers are notified of any changes via fax and/or mail.
To request a copy of any guidelines, please contact Molina Healthcare Provider Services at mhidprovidersvcreq@molinahealthcare.com.
The guidelines listed below were reviewed and adopted by the Molina Healthcare National Quality Improvement and Health Outcomes Committee (QI-HOC), with approval dates indicated for 2024 and beyond. All guidelines undergo quarterly reviews and receive annual approval unless otherwise noted.
It is important to note that Molina does not use clinical guidelines to determine benefit coverage. Instead, they are educational tools to aid clinical decision-making and are not considered a standard of care. Physicians should adapt the guidelines based on their clinical judgment.
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 LINK: https://www.ptsd.va.gov/
Published: N/A
Revised: N/A
Molina approved: January 2023, February 2024, January 2025, May 2025
You may also visit the web site below for more information.
Anxiety/Panic Disorder
Molina Healthcare has adopted the guideline for Assessment and Treatment of Children and Adolescents from the American Academy of Child & Adolescent Psychiatry.
The Clinical Practice Guideline may be accessed HERE.
Published: October 2020
Revised: N/A
Molina approved: May 2025
Molina Healthcare has adopted the guideline for Generalized Anxiety and Panic Disorder from American Family Physician.
The Clinical Practice Guideline may be accessed HERE.
Published: August 2022
Revised: N/A
Molina approved: May 2025
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: December 2020
Revised: February 2021
Molina approved: January 2023, February 2024, January 2025
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 approved: January 2023, February 2024, January 2025
Autism
Molina Healthcare has adopted the guideline for Identification, Evaluation, and Management of Children with Autism Spectrum Disorder from The American Academy of Pediatrics.
The Clinical Practice Guideline may be accessed HERE.
Published: January 2020
Revised: N/A
Molina approved: January 2023, February 2024, January 2025
Bipolar Disorder
Molina Healthcare has adopted the guideline for Bipolar Disorder from the Department of Veterans Affairs & Department of Defense.
The Clinical Practice Guideline may be accessed HERE.
Published: May 2023
Revised: N/A
Molina approved: January 2023, February 2024, January 2025
Cancer Treatment and Prevention
Molina Healthcare has adopted the guideline for Cancer from The National Comprehensive Cancer Network® (NCCN®).
The Clinical Practice Guideline may be accessed LINK https://www.cancer.org/health-care-professionals/american-cancer-society-prevention-early-detection-guidelines.html
Published: N/A
Revised: N/A
Molina approved: January 2025, February 2026
Children with Special Health Care Needs
Molina Healthcare has adopted the guideline for Access to Services for Children and Youth with Special Health Care Needs from The American Academy of Pediatrics.
The Clinical Practice Guideline may be accessed HERE.
Published: June 2022
Revised: N/A
Molina approved: January 2023, February 2024, January 2025
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 2024
Revised: N/A
Molina approved: January 2023, February 2024, January 2025
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 LINK https://goldcopd.org/2026-gold-report-and-pocket-guide/
Published: 2011
Revised: January 2025
Molina approved: January 2023, February 2024, January 2025, February 2026
Dementia
Molina Healthcare has adopted the guideline for Dementia from the Alzheimer’s Association.
The Clinical Practice Guideline may be accessed HERE.
Published: N/A
Revised: N/A
Molina approved: May 2025
Depression
Molina Healthcare has adopted the guideline for VA/VOD Clinical Practice Guideline for the Management of Major Depressive Disorder from the Department of Veterans Affairs & Department of Defense.
The Clinical Practice Guideline may be accessed HERE.
Published: February 2022
Revised: N/A
Molina approved: January 2023, February 2024, January 2025
Molina Healthcare has adopted the guideline for Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts from the American Psychological Association.
The Clinical Practice Guideline may be accessed HERE.
Published: February 2019
Revised: N/A
Molina approved: May 2025
Diabetes Treatment and Prevention
Molina Healthcare has adopted the guideline for Diabetes from the American Diabetes Association (ADA).
The Clinical Practice Guideline may be accessed https://diabetesjournals.org/
Published: January 2015
Revised: January 2025
Molina approved: January 2023, February 2024, January 2025, February 2026
Elder Abuse
Molina Healthcare has adopted the guideline for Elder Abuse from the National Institute on Aging.
The Clinical Practice Guideline may be accessed HERE.
Published: N/A
Revised: N/A
Molina approved: August 2025
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.
Published: 2013
Revised: May 2022
Molina approved: January 2023, February 2024, January 2025
You may also visit the web site below for more information.
- American College of Cardiology HERE.
Hepatitis C
Molina Healthcare has adopted the clinical practice guideline for Hepatitis C from the Infectious Diseases Society of America.
The Clinical Practice Guideline may be accessed HERE.
Published: May 2023
Revised: N/A
Molina approved: May 2025
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 approved: January 2023, February 2024, January 2025
You may also visit the web site below for more information.
- National Health Care for Homeless Council HERE.
HIV/AIDS Treatment and Prevention
Molina Healthcare has adopted the guideline for Use of Antiretroviral Agents in Adults and Adolescents with HIV from the Department of Health and Human Services.
The Clinical Practice Guideline may be accessed HERE.
Published: April 2015
Revised: September 2024
Molina approved: September 2024, January 2025
Molina Healthcare has adopted the guideline for HIV/AIDS from the National Center for Biotechnology Information.
The Clinical Practice Guideline may be accessed HERE.
Published: January 2024
Revised: July 2024
Molina approved: September 2024, January 2025
You may also visit the web site below for more information.
- Clinical Practice Guidelines for HIV/AIDS HERE.
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: May 2018
Molina approved: January 2023, February 2024, January 2025
Incontinence
Molina Healthcare has adopted the clinical practice guidelines for Incontinence from the American Urological Association. Find them here:
Incontinence after Prostate Treatment
Overactive Bladder
Stress Urinary Incontinence
Published: 2019, July 2024, 2017
Revised: July 2024, July 2024, 2023
Molina approved: May 2025
Long-Term Services and Supports (LTSS)
Molina Healthcare has adopted the clinical practice guideline for Long-Term Services and Supports (LTSS) from Centers for Medicare and Medicaid Services (CMS).
The Clinical Practice Guideline may be accessed HERE.
Published: November 2020
Revised: N/A
Molina approved: May 2025
Osteoporosis
Molina Healthcare has adopted the guideline for Osteoporosis from American College of Physicians.
The Clinical Practice Guideline may be accessed HERE.
Published: N/A
Revised: N/A
Molina approved: May 2025
Parkinson’s Disease
Molina Healthcare has adopted the clinical practice guideline for Parkinson’s Disease from the American Physical Therapy Association.
The Clinical Practice Guideline may be accessed HERE.
Published: December 2021
Revised: August 2022
Molina approved: May 2025
Molina Healthcare has adopted the clinical practice guideline for Parkinson’s Disease from the American Family Physician.
The Clinical Practice Guideline may be accessed HERE.
Published: December 2020
Revised: N/A
Molina approved: May 2025
Perinatal & Postpartum 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.
Published: N/A
Revised: N/A
Molina approved: January 2023, February 2024, January 2025
Molina Healthcare has adopted the guideline for Management of Pregnancy from the Department of Veterans Affairs & Department of Defense.
The Clinical Practice Guideline may be accessed HERE.
Published: July 2023
Revised: N/A
Molina approved: May 2025
Molina Healthcare has adopted the guideline for Postpartum Care from the American College of Obstetricians and Gynecologists.
The Clinical Practice Guideline may be accessed HERE.
Published: June 2016
Revised: May 2018
Molina approved: January 2025
Pressure Ulcers
Molina Healthcare has adopted the guideline for Pressure Ulcers from the National Pressure Injury Advisory Panel.
The Clinical Practice Guideline may be accessed HERE.
Published: 2009
Revised: November 2023
Molina approved: August 2025
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 approved: January 2023, February 2024, January 2025
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: January 2020
Molina approved: January 2023, February 2024, January 2025
You may also visit the websites below for additional information on Sickle Cell Disease:
- American Society of Hematology - HERE.
- Centers for Disease Control and Prevention - HERE.
Substance Use Disorder
Molina Healthcare has adopted the guideline for Alcohol Withdrawal Management from the American Society of Addiction Medicine (ASAM).
The Clinical Practice Guideline may be accessed HERE.
Published: January 2020
Revised: N/A
Molina approved: May 2025
Molina Healthcare has adopted the guideline for Benzodiazepine Tapering from the American Society of Addiction Medicine (ASAM).
The Clinical Practice Guideline may be accessed HERE.
Published: March 2025
Revised: N/A
Molina approved: May 2025
Molina Healthcare has adopted the guideline for Stimulant Use Disorder from the American Society of Addiction Medicine (ASAM).
The Clinical Practice Guideline may be accessed HERE.
Published: June 2024
Revised: N/A
Molina approved: May 2025
Molina Healthcare has adopted the guideline for Management of Substance Use Disorder (SUD) from the Department of Veterans Affairs & Department of Defense.
The Clinical Practice Guideline may be accessed HERE.
Published: August 2021
Revised: N/A
Molina approved: May 2025
Molina Healthcare has adopted the guideline for Pharmacological Treatment of Patients with Alcohol Use Disorder from The American Psychiatric Association.
The Clinical Practice Guideline may be accessed HERE.
Published: January 2018
Revised: N/A
Molina approved: May 2025
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 approved: January 2023, February 2024, January 2025
Molina Healthcare has adopted the guideline for Prescribing Opioids for Chronic Pain from the Centers for Disease Control and Prevention.
The Clinical Practice Guideline may be accessed HERE.
Published: March 2016
Revised: November 2022
Molina approved: January 2023, February 2024, January 2025
Suicide Prevention
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: April 2024
Molina approved: January 2023, February 2024, July 2024, January 2025
Trauma-Informed Primary Care
Molina Healthcare has adopted the guideline for Trauma Informed Care from American Psychological Association.
The Clinical Practice Guideline may be accessed HERE.
Published: N/A
Revised: N/A
Molina approved: January 2023, February 2024, January 2025, October 2025
Weight Management
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 approved: January 2023, February 2024, January 2025
Molina Healthcare has adopted the guideline for Weight Management from
The American Academy of Pediatrics (AAP)
The Journal of Obesity and Metabolic Syndrome
The National Institute of Health (NIH)
The American Psychological Association (APA)
The Clinical Practice Guidelines may be accessed below:
Preventing Obesity and Eating Disorders in Adolescents
Published: September 2016
Revised: June 2022
Molina approved: January 2025
Clinical Practice Guideline for Multicomponent Behavioral Treatment of Obesity and Overweight in Children and Adolescents
Published: March 2018
Revised: N/A
Molina approved: January 2025
Obesity in Adults: clinical practice guideline
Published: August 2020
Revised: N/A
Molina approved: January 2025
You may also visit the websites below for additional information on Weight Management:
- American Academy of Pediatrics (AAP) - HERE.
- National Institute of Health (NIH) - HERE.
Therapeutic Foster Care (TFC)
Molina has adopted the guidelines below for Therapeutic Foster Care.
The Clinical Practice Guidelines are noted below:
Medical Necessity
- Medical Necessity Criteria for Admission:
- The recommended level of care determined using CALOCUS/ECSII shall be used to demonstrate sufficient necessity for admission to the indicated level of care without requiring additional PA for a period of no less than 30 days,
- The recommendation for TFC shall come through the CFT practice specified in AMPM Policy 580, i. An interim service plan coordinated through Integrated Rapid Response can be used to establish this recommendation for admission, prior to the establishment of a full CFT.
- An assessment, as outlined in AMPM Policy 320-O and AAC Title 9, Chapter 10, which indicates the member has been diagnosed with a behavioral health condition and indicates symptoms and behaviors to be treated, and
- Special consideration will be given to children with two or more of following:
- Multiple out-of-home placements (foster homes, Behavioral Health Residential Facility (BHRF), Behavioral Health Inpatient Facility (BHIF), Residential Treatment Center (RTC), etc.),
- History of disruption from a foster home due to behaviors,
- One or more hospitalizations due to a behavioral health condition in the last year,
- Chronic pattern of suspensions from school, daycare, or day programming,
- Adoption disruption or potential adoption disruption,
- Significant trauma history or trauma-related diagnosis,
- Placed or at-risk of placement in a congregate care setting,
- At-risk of placement disruption due to behaviors requiring a higher level of supervision,
- Identified as a potential victim of trafficking,
- Criminal justice involvement,
- Co-occurring developmental disability, and
- At-risk of being removed from their home by Department of Child Safety (DCS) due to behavioral concerns.
- As a result of the diagnosed behavioral health condition, there is evidence that the member has a moderate functional impairment as indicated by the CALOCUS/ECSII score and/or other clinical indicators. This moderate functional and/or psychosocial impairment per the behavioral health assessment and ISP, reviewed and signed by a BHP:
- Has not improved or cannot be reasonably expected to improve in response to a less intensive level of care, or
- Could improve with appropriate community-based treatment but treatment is not available, therefore, warranting a more intensive level of care.
- Does not require or meet clinical criteria for a higher level of care.
- Criteria for Continued Stay:
- An assessment which indicates the member has been diagnosed with a behavioral health condition and indicates symptoms and behaviors to be treated,
- An expectation by the CFT that continued treatment at the TFC shall improve the member’s condition so that this type of service shall no longer be needed, and
- The member continues to demonstrate moderate functional or psychosocial impairment as a result of a behavioral health condition,
- Criteria for Discharge:
- The member demonstrates sufficient symptom or behavior relief as evidenced by completion of the TFC treatment goals,
- The member’s functional capacity is improved, at minimum, as evidence by an improved CALOCUS/ECSII score and/or other clinical indicators of improved functioning,
- The member can be safely cared for in a less restrictive level of care, as identified by the CFT,
- The CFT has identified that appropriate services, providers, and support are available to meet the member’s current behavioral health needs at a less restrictive level of care,
- There is no evidence to indicate that continued treatment in TFC would improve the member’s clinical outcome,
- There is potential risk that continued stay in TFC may precipitate regression or decompensation of the member’s condition, or
- A current assessment of the member’s symptoms, behaviors, and treatment needs by the CFT has established that continued care in TFC is no longer adequate to provide for the member’s safety and treatment and therefore a higher level of care is.
2026 Preventive Health Guidelines
Preventive health guidelines can be beneficial for both providers and patients. These guidelines are based on scientific evidence, reviews of medical literature, or established authority. All recommendations are grounded in published consensus guidelines and do not prioritize treatments based solely on cost considerations.
These guidelines aim to recommend a standard level of care but do not preclude the delivery of additional preventive services based on the individual needs of each patient.
Molina Healthcare regularly reviews and updates these guidelines as new clinical evidence emerges. After review and necessary modifications by the National Quality Improvement Committee and Health Outcomes Committee (QI-HOC), providers are notified of any changes via fax and/or mail.
To request a copy of any guideline, please contact Molina Healthcare Provider Services at mhidprovidersvcreq@molinahealthcare.com
The guidelines listed below were reviewed and adopted by the Molina Healthcare National Quality Improvement Committee and Health Outcomes Committee (QI-HOC), with approval dates indicated for 2024 and beyond. All guidelines undergo quarterly reviews and receive annual approval unless otherwise noted.
It is important to note that Molina does not use preventive health guidelines to determine benefit coverage. Instead, they are educational tools to aid clinical decision-making and are not considered a standard of care. Physicians should adapt the guidelines based on their clinical judgment.
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: June 2025
Molina approved: January 2023, February 2023, April 2024, May 2024, January 2025, May 2025, August 2025
Recent updates recommended include the following:
- Latent Tuberculosis Infection in Adults: Screening (Revised May 2023)
- Depression and Suicide Risk in Adults: Screening (Revised June 2023)
- Anxiety Disorders in Adults: Screening (Revised June 2023)
- Folic Acid Supplementation to Prevent Neural Tube Defects: Preventive Medication (Revised August 2023)
- Prevention of Acquisition of HIV: Preexposure Prophylaxis (Revised August 2023)
- Hypertensive Disorders of Pregnancy: Screening (Revised September 2023)
- Breast Cancer Screening (Revised April 2024)
- Falls Prevention in Community-Dwelling Older Adults: Interventions (Revised June 2024)
- Osteoporosis to Prevent Fractures: Screening (Revised January 2025)
- Breastfeeding: Primary Care Behavioral Counseling Interventions (Revised April 2025)
- Syphilis Infection During Pregnancy: Screening (Revised May 2025)
- Intimate Partner Violence and Caregiver Abuse of Older or Vulnerable Adults: Screening (June 2025)
Adult Vision Screening
Molina Healthcare has adopted the guideline for Adult Vision Screening from the American Optometric Association.
The Clinical Practice Guideline may be accessed HERE.
Published: January 2023
Revised: N/A
Molina approved: January 2025
Dental Health
Molina Healthcare has adopted the guideline for Dental Health from The American Dental Association (ADA).
The Clinical Practice Guideline may be accessed HERE.
Published: N/A
Revised: N/A
Molina approved: January 2025
Fall Risk Reduction
Molina Healthcare has adopted the guideline for Fall Risk Reduction from the Centers for Disease Control and Prevention (CDC)- Stopping Elderly Accidents, Deaths, & Injuries (STEADI) Initiative.
The Clinical Practice Guideline may be accessed HERE.
Published: N/A
Revised: N/A
Molina approved: May 2025
Pediatric Preventive Services Recommendations
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: June 2024
Molina approved: January 2023, April 2023, February 2024, January 2025
Recent updates recommended include the following: No current updates
Molina Healthcare has adopted the guideline for Pediatric/Adolescent Preventive Services Recommendations from U.S. Preventive Services Task Force.
The Clinical Practice Guideline may be accessed HERE.
Published: 2013
Revised: June 2024
Molina approved: August 2024, July 2024, January 2025
Recent updates recommended include the following:
- High Body Mass Index in Children and Adolescents: Interventions (June 2024)
- You may also visit the Healthy Children web site for more information HERE.
Pediatric Vision Screening
Molina Healthcare has adopted the guideline for Pediatric Vision Screening from the American Optometric Association.
The Clinical Practice Guideline may be accessed HERE.
Published: February 2017
Revised: N/A
Molina approved: January 2025
Recommended Adult Immunization Schedule for ages 19 Years or Older, United States, 2025
Molina Healthcare has adopted the guideline for Adult Immunization Schedule, 19 Years and Older, 2025 from Centers for Disease Control and Prevention.
The Clinical Practice Guideline may be accessed HERE.
Published: December 2014
Revised: August 2025
Molina approved: January 2023, February 2023, February 2024, April 2024, July 2024, October 2024, January 2025, August 2025, October 2025
Recent updates recommended include the following:
- Updated Meningococcal and RSV vaccine recommendations (June 2025)
- Updated Influenza vaccine recommendations (July 2025)
Recommended Child and Adolescent Immunization Schedule for ages 18 Years and Younger, United States, 2025
Molina Healthcare has adopted the guideline for Recommended Child and Adolescent Immunization Schedule for ages 18 years and younger, 2025 from Centers for Disease Control and Prevention.
The Clinical Practice Guideline may be accessed HERE.
Published: December 2014
Revised: August 2025
Molina approved: January 2023, February 2023, February 2024, July 2024, October 2024, January 2025, August 2025, October 2025
Recent updates recommended include the following:
- Updated Meningococcal vaccine recommendation (June 2025)
- Updated Influenza vaccine recommendation (July 2025)
- Updated RSV vaccine recommendation (August 2025)