Pautas
Respected professional and public health organizations create clinical practice guidelines that document best practices and recommendations for care. We’ve chosen certain clinical guidelines to help our providers give members high-quality, consistent care with effective use of services and resources. Estas pautas incluyen protocolos de tratamiento para afecciones específicas, así como también medidas de salud preventiva.
The intention of these guidelines is to clarify standards and expectations. No deben:
- Take precedence over your responsibility to provide treatment based on the member’s needs
- Sustituir como órdenes de tratamiento para un miembro
- Cobertura garantizada o pago por el tipo o nivel de atención propuesto o proporcionado
Pautas de práctica clínica
Alcohol Use Disorder
- American Society of Addiction Medicine Alcohol Withdrawal Management- January 2020
- Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions (November 2018)
Anxiety Disorder
National Institute of Mental Health: Anxiety Disorder
Asma
- National Heart, Lung and Blood Institute (NHLBI)-2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group
- National Heart, Lung and Blood Institute (NHLBI)- Asthma Management Guidelines: Focused Updates 2020
Attention-deficit/hyperactivity disorder
tratamientos y servicios de salud conductual
- American Psychiatric Association Clinical Practice Guidelines (legacy – 2025)
- American Academy of Child and Adolescent Psychiatry Guidelines, Updates and Parameters (2010- 2024)
- Behavioral Health Services (2023)
Cancer screenings
- Centers for Disease Control and Prevention: Screening for Breast Cancer
- Centers for Disease Control and Prevention: Screening for Prostate Cancer
Cardiovascular medicine
Journal of the American College of Cardiology: Guidelines and Clinical Documents
Chronic obstructive lung disease (COPD)
Insuficiencia cardiaca congestiva
Cognitive impairment
Instituto Nacional sobre el Envejecimiento: Assessing Cognitive Impairment in Older Patients
Reintegración en la comunidad
Enfermedades de las arterias coronarias
Journal of the American College of Cardiology: Primary Prevention of CVD Guideline Hub
Servicios dentales
Academia Estadounidense de Pediatría: Oral Health
Diabetes care
American Diabetes Association: Standards of Medical Care in Diabetes, 2025
Diabetes standards of medical care
American Diabetes Association: Practice Guidelines Resources
Eating Disorder
Abuso de los adultos mayores
Centers for Disease Control and Prevention: Abuse of Older Persons
Elderly and disabled
Instituto Nacional sobre el Envejecimiento: Healthy Aging, Alzheimer’s, and More!
Hepatis C
High blood pressure in adults
- American Heart Association Professional Heart Daily: 2025 High Blood Pressure Guideline
- Centers for Disease Control and Prevention: Presión arterial alta
HIP
American Academy of Orthopaedic Surgeons: Management of Osteoarthritis of the Hip
VIH/SIDA
Health Resources & Services Administration: Ryan White HIV/AIDS Program
Home and community-based services
HCBS.org Clearinghouse: New and Notable Publications
Hipertensión
Vacunaciones
plomo
Bright Futures: Recommendations for Preventative Pediatric Health Care
Long-term care
Centers for Disease Control and Prevention: Long-term Care Facilities (LTCFs)
Low Back Pain
Trastorno depresivo grave
Obesidad
Obstructive Sleep Apnea
- American Academy of Sleep Medicine Clinical Practice Guideline (2017)
- American Academy of Pediatrics (Sept. 2012)
Opioids for chronic pain
- Use of Opioids in the Management of Chronic Pain (2022) VA/DoD Clinical Practice Guidelines
- CDC’s Clinical Practice Guideline for Prescribing Opioids for Pain|Guidelines|Healthcare Professionals | Opioids CDC
Pediatric Preventative Health
Bright Futures: Recommendations for Preventative Pediatric Health Care
Prenatal Care
- The American College of Obstetricians and Gynecologists: Tailored Prenatal Care Delivery for Pregnant Individuals 5/2025
- Ambulatory Adult Prenatal Care Guideline
- The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Prenatal Care Recommendations
Preventive care for Medicaid members
Medicaid.gov: Early and Periodic Screening, Diagnostic, and Treatment
Preventive Screenings, Counseling and Preventive Medication ― USPSTF Guidelines (Pediatric, Adult, Senior)
Departamento Preventative Services Task Force: Recommendations
Postpartum care (may require ACOG membership to access)
The American College of Obstetricians and Gynecologist: Optimizing Postpartum Care
Esquizofrenia
Sickle Cell Anemia
American Society of Hematology: ASH Clinical Practice Guidelines on Sickle Cell Disease (SCD)
Seizure Disorder/Epilepsy
American Epilepsy Society: Pautas
Accidente cerebrovascular
AHA|ASA Journals: Guidelines for the Primary Prevention of Stroke
Trastorno de abuso de sustancias
- American Society of Addiction Medicine Consensus Statement — Appropriate Use of Drug Testing in Clinical Addiction Medicine (Reviewed December 2019)
- American Society of Addiction Medicine Treatment of Opioid Use Disorder (2020)
Suicide Prevention
Para dejar de usar tabaco
- Tobacco and Nicotine Cessation During Pregnancy ACOG. Number 807 (May 2020)
- Cessation Material for State Tobacco Control Programs
Atención informada con respecto al trauma
National Council for Mental Wellbeing: Healthy Minds – Strong Communities
Vaccine recommendations
Center for Disease Control and Prevention: ACIP Vaccine Recommendation and Guidelines
Boletines sobre políticas clínicas
These bulletins state our policy about the medical necessity or investigational status of medical technologies and other services to help with coverage decisions. A national review team creates the bulletins and bases them on:
- Published medical literature
- Formal technology assessments
- Structured evidence reviews
- Evidence-based consensus statements
- Expert opinions
- Evidence-based guidelines from professional and public health entities
Aetna® clinical policy bulletins