Clinical practice guidelines are documents which seeks to guide decisions about the diagnosis and treatment of certain health conditions. Clinical practice guidelines are based on scientific evidence, review of the medical literature, or appropriately established authority. All recommendations are based on published agreed on guidelines and do not favor any particular treatment based solely on cost considerations.
The recommendations for care are suggested as guides for making clinical decisions. Clinicians and their patients must work together to develop individual treatment plans that are tailored to the specific needs and circumstances of each patient.
Molina Healthcare reviews and revises guidelines 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 Healthcare Provider Services.
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: June 2023
Molina adopted/reviewed: March 2020, March 2021, April 2022, January 2023, February 2024
Anxiety/Panic Disorder
Molina Healthcare has adopted the guideline for Anxiety/Panic Disorder from the American Academy of Clinical Psychiatrists.
The Clinical Practice Guideline may be accessed HERE.
Published: February 2021
Revised: February 2024
Molina adopted/reviewed: March 2020, March 2021, April 2022, January 2023, February 2024
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: January 2007
Revised: February 2021
Molina adopted/reviewed: March 2015, March 2016, February 2017, March 2018, April 2019, March 2020, March 2021, April 2022, January 2023, February 2024
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, January 2023, February 2024
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 adopted/reviewed: September 2021, April 2022, January 2023, February 2024
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 adopted/reviewed: March 2020, March 2021, April 2022, January 2023, February 2024
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, January 2023, February 2024
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, January 2023, February 2024
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: January 2024
Molina adopted/reviewed: March 2015, March 2016, February 2017, March 2018, February 2019, April 2019, March 2020, March 2021, January 2022, April 2022, January 2023, February 2024
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 2023
Revised: May 2023
Molina adopted/reviewed: March 2015, March 2016, August 2017, March 2018, April 2019, March 2020, March 2021, April 2022, January 2023, February 2024
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: January 2024
Molina adopted/reviewed: March 2015, March 2016, February 2017, March 2018, February 2019, April 2019, March 2020, March 2021, February 2022, April 2022, January 2023, February 2024
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 adopted/reviewed: March 2015, March 2016, August 2017, March 2018, April 2019, March 2020, March 2021, April 2022, July 2022, January 2023, February 2024
You may also visit the web site below for more information.
American College of Cardiology:HERE.
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, January 2023, February 2024
HIV/AIDS
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 adopted/reviewed: September 2024
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 adopted/reviewed: September 2024
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 adopted/reviewed: March 2015, March 2016, February 2017, March 2018, February 2019, April 2019, March 2020, March 2021, April 2022, January 2023, February 2024
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, January 2023, February 2024
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 accessedHERE.
Published: June 2015
Revised: January 2020
Molina adopted/reviewed: July 2017, March 2018, April 2019, March 2020, March 2021, April 2022, January 2023, February 2024
Molina Healthcare has adopted the guideline CDC 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 adopted/reviewed: April 2019, March 2020, March 2021, April 2022, November 2022, January 2023, February 2024
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, January 2023, February 2024
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 2022
Molina adopted/reviewed: April 2019, March 2020, March 2021, April 2022, October 2022, January 2023, February 2024
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, January 2023, February 2024
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 adopted/reviewed: July 2017, March 2018, April 2019, March 2020, March 2021, April 2022, January 2023, February 2024
Substance Use Disorder
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, January 2023, February 2024
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 adopted/reviewed: August 2021, April 2022, January 2023, February 2024
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, January 2023, February 2024