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XI-B Pre-authorization Guidelines - Leaf Plans | XIII-A Notice Of Medicare Non-Coverage

Appendix XII — Clinical Practice Guidelines

2015 Clinical Practice Guidelines and Protocols
 
Conditions
Clinical Practice Guideline
Source
 
Respiratory
 
Asthma
 
National Heart, Lung, and Blood Institute. National Asthma Education and Prevention Program. Expert Panel Report 3:
Guidelines for the Diagnosis and Management of Asthma:
August 28, 2007
 
National Heart, Lung and Blood Institute/National Institutes of Health
 
 
Chronic Obstructive Pulmonary Disease (COPD)
* COPD Essentials for Health Professionals
NIH Publication No. 07-5845
Reprinted September 2013
 
National Heart, Lung and Blood Institute/National Institutes of Health
 
 
Tuberculosis
 
 
TESTING AND TREATMENT
FOR LATENT TB INFECTION
April 2006
Citation: Munsiff S, Nilsen D, King L, Dworkin F.
Testing and Treatment for Latent TB Infection. City Health Information. 2006;25(4)21-32.
 
New York City Department of Health & Mental Hygiene, Bureau of Tuberculosis Control
 
 
Treating Tobacco Use & Dependence
**Agency for Healthcare Research and Quality (AHRQ) Clinical Guidelines for Prescribing Pharmacotherapy for Smoking Cessation December 2012
AHRQ
 
 
Cardiovascular
 
Chronic Stable Coronary
Artery Disease
American College of Cardiology Foundation (ACCF)
American Heart Association (AHA)
Physician Consortium for Performance Improvement® (PCPI™) ACCF, AHA, PCPI Approved January 2011
 
American Medical Association
 
 
 
Congestive Heart Failure (CHF)
2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013:62:e147–239.
 
American College of Cardiology
 
 

Coronary Heart Disease
(CHD)
 
 
 
* AHA/ACCF Secondary Prevention and Risk Reduction
Therapy for Patients With Coronary and Other
Atherosclerotic Vascular Disease: 2011 Update
 
A Guideline From the American Heart Association and American College of Cardiology Foundation
American Heart Association
http://circ.ahajournals.org/content/early/2011/11/01/CIR.0b013e318235eb4d.full.pdf
 
 
 
 
Hyperlipidemia
 
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
American Heart Association
 
 
 
 
Hypertension
 
 
 
**2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)
 
The Journal of the American Medical Association
 
 
 
Diabetes
* American Diabetes Association Standards of Medical Care in Diabetes – 2015
American Diabetes Association
 
 
Prevention of Cardiovascular Disease
U.S. Preventive Services Task Force. Aspirin for the Prevention of Cardiovascular Disease: Recommendation Statement. AHRQ Publication No. 09-05129-EF-2, March 2009. Agency for Healthcare Research and Quality, Rockville, MD.
 
2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
 
2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
U.S. Preventive Services Task Force
 
 
AHA/ACC Guideline
 
 
AHA/ACC Guideline
 
 
Mental Health
 
Attention Deficit Hyperactivity Disorder  (ADHD)
 
American Academy of Pediatrics
ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
 
Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management Pediatrics 2011;128;1007; originally published online October 16, 2011
DOI: 10.1542/peds.2011-2654
 
American Academy of Pediatrics
 
 
Depression
 
 
Treatment of Patients with Major Depressive Disorder, Third Edition –  May 2010
American Psychiatric Association
 
 
 
Use of Buprenorphrine in the Treatment of Opioid Addiction
 
Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction: A Treatment Improvement Protocol TIP 40 – 2004
US DHHS: Substance Abuse Mental Health Services Administration
 
 
Psychiatric Disorders
 
American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders
American Psychiatric Association
Practice Guidelines
 
Preventive and Screening Guidelines
 
Pediatric Care
 
 
Adult and Children
 
 
 
Child and Adolescent
Clinical Practice - Preventive Pediatric Health Care
Bright Futures/American Academy of Pediatrics
 
* The Guide to Clinical Preventive Services: 2014
US Preventive Services Task Force (USPSTF)
 
 
* Focus on Children and Adolescents. U.S. Preventive Services Task Force. February 2014
American Academy of Pediatrics/Bright Futures
 
AHRQ/U.S. Preventive Task Force
 
U.S. Preventive Task Force
 
 
Immunization Schedule
 
 
*Birth-18 Years & “Catch-up Immunization Schedules 2015
 
Centers For Disease Control and Prevention
 
 
Lead Screening
NYS Regulations for Lead Poisoning Prevention and Control - NYCRR Title X, Part 67. Public Health Law, Section 206 (amended June 20, 2009)
New York State Department of Health
 
 
EPSDT/CTHP
 
 
 
 
 
EPSDT/CTHP Provider Manual for Child Health Plus A (Medicaid) New York State Department of Health Office of Medicaid Management 2005
 
New York State Department of Health
 
 
Injury Prevention Program
 
 
Healthy Children Safety and Prevention © Copyright 2015 American Academy of Pediatrics
American Academy of Pediatrics
http://www.healthychildren.org/english/safety-prevention/Pages/default.aspx
 
Eye Examination
 
Recommended Eye Examination Frequency for Adult Patients and Comprehensive Adult Eye and Vision Examination: Revised April 2005 (2nd edition)
 
American Optometric Association
Prenatal Care
 
* New York State Department of Health Medicaid Prenatal Care Standard, March 2015
New York State Department of Health
 
Antibiotic Use
Children
 
 
 
Adult
Recommendations by CDC/AAP to promote appropriate antibiotic use in children; June 30, 2009
Pediatric Appropriate Treatment Summary
 
CDC Principles of Appropriate Antibiotic Use
Adult Appropriate Antibiotic Use Summary: Physician Information Sheet
(Adults); June 2012
 
 
Centers for Disease Control and Prevention/American Academy of Pediatrics
 
Centers for Disease Control and Prevention
 
 
Sexually Transmitted Diseases
STD
 
 
 
Guidelines for Treatment of Sexually Transmitted Diseases:  2015
 
* New York City STD Treatment Guidelines Table for Adults and Adolescents; updated 2013
Centers For Disease Control and Prevention
 
 
New York City Department of Health & Mental Hygiene
 
HIV
 
 
 
 
* Primary Care Approach To The  HIV-Infected Patient; updated November 2014
 
 
* New York City STD Treatment Guidelines Table for Adults & Adolescents, updated 2013
 
 
 
 
New York State Department of Health AIDS Institute
 
New York City Department of Health & Mental Hygiene
 
 
Obesity
Children
 
 
 
Adult
Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity: January 2007
 
2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults
A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society
American Medical Association/CDC/HHS
 
AHA/ACC/TOS
 
Low Back Pain
 
Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society; October 2007
American College of Physicians
 
Rheumatoid Arthritis
 
2012 Update of the 2008 American College of
Rheumatology Recommendations for the Use of
Disease-Modifying Antirheumatic Drugs and
Biologic Agents in the Treatment of
Rheumatoid Arthritis
American College of Rheumatology
 
Long Term Care
Transitions of Care
Transitions of Care in the Long-Term Care Continuum Clinical Practice Guideline. Columbia, MD: AMDA 2010.
American Medical Directors Association
 
Reference
 
InterQual Clinical Care Criteria for Payors
McKesson
 
 
** New guideline for adoption
* Updated guidelines
 
QIC Approved 6.24.2015