Clinical Practice Guidelines

Clinical Practice Guidelines are evidence-based statements and recommendations designed to assist clinicians by providing an analytical framework for the evaluation and treatment of patients.  Clinical guidelines are based on the most current scientific evidence and are adopted or adapted from standards published by recognized sources.  A scheduled review of each guideline is conducted by health plan staff and approved by the plans' Quality Monitoring Committee.

Practice Guidelines Documents
Guideline Source

Behavior Health Clinical Practice Guidelines

Keep informed about guidelines and policies pertaining to Behavioral Health care.

Asthma Guideline __ 2020 Focused Updates to the Asthma Management

Adopted National Heart Lung and Blood Institute (NHLBI) National Institutes of Health (NIH) Reviewed 12/21, next review 12/23

Assessment and Management to Reduce Cardiovascular Risk

Adopted from the American Heart Association Reviewed 12/21, next review 12/23. The American Heart Association is a national voluntary health agency to help reduce disability and death from cardiovascular diseases and stroke.

Diagnosis and Management of Heart Failure

Adopted from the American Heart Association Reviewed 12/21, next review 12/23. The American Heart Association is a national voluntary health agency to help reduce disability and death from cardiovascular diseases and stroke.

Community Principles of Pain Management

Diabetes Clinical Practice Recommendations

Adopted from the American Diabetes Association. Guideline Reviewed 12/21, next review 12/23

AAP/ACOG Guidelines for Perinatal Care

NYSDOH Medicaid Prenatal Guidelines

Adopted from the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (AAP/ACOG)Guidelines for Perinatal Care, Eighth Edition. September 2017 and New York State Department of Health. Reviewed Oct 2021, Next review Oct 2023.

Perinatal HIV Care

Adopted from the New York State Department of Health. Reviewed Oct 2021, Next review Oct 2023

Immunization Guidelines for Vaccinating Pregnant Women

Adopted from the Center Disease Control (CDC). Guideline Reviewed Oct 2021, Next review Oct 2023

Univera Healthcare has adopted from the American Academy of Pediatrics and Bright Futures Recommendations for Preventive Pediatric Health Care (Periodicity Schedule) and Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents Anticipatory Guidance/Counseling at Preventive Health Visits. Reviewed 12/21 and next review 12/23.

The following exceptions to the American Academy of Pediatrics and Bright Futures recommendations: 

New York State Department of Health (NYSDOH) Lead Health Screening Recommendations
NYS Lead Screening Recommendations

New York State Department of Health (NYSDOH) HIV Screening and Testing Requirements - Reviewed 6/21 and next review 6/22.
NYS DOH HIV Testing Requirements
HIV Guidelines
HIV Guidelines Ordering Publications

Centers for Disease Control Advisory Committee on Immunization Practices
Immunization Schedule for Children and Adolescents

Reviewed 12/21 and next review 12/23. Adopted from the U.S. Preventive Services Task Force (USPSTF). Recommendations for Adults.

Univera Healthcare has adopted the following exceptions to the USPSTF recommendations:

Health Resources and Services Administration (HRSA) Women's Preventive Services
Recommendations for Women’s Preventive Services

New York State Department of Health screening and testing requirements for HIV. Adopted from the New York State Department of Health. Reviewed 6/21 and next review 6/22.
NYS DOH HIV Testing Requirements
HIV Guidelines
HIV Guidelines Ordering Publications

Centers for Disease Control Advisory Committee on Immunization Practices
Immunization Schedule for Adults

 

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