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Clinical Practice Guidelines

GLO-PRV-Clinical Practice Guidelines intro

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.

GLO-PRV-Clinical Practice Guidelines

Practice Guidelines Documents
Guideline Source

Behavior Health Clinical Practice Guidelines

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

Clinical Guideline for the Diagnosis, Evaluation and Management of Adults and Children with Asthma

Diagnosis and Management of Asthma

Adopted from the NYS DOH “Clinical Guideline for the Diagnosis, Evaluation and Management of Adults and Children with Asthma” developed by the New York State Consensus Asthma Guideline Expert Panel and Endorsed by the New York State Department of Health updated July, 2017” and the NHLB National Heart, Lung, and Blood Institute: Guidelines for the Diagnosis and Management of Asthma (EPR-3). Reviewed March 2018 Next review March 2020.

ADHD Guideline

Adopted from the American Academy of Pediatrics: Reviewed March 2018. Next review March 2020.

Assessment and Management to Reduce Cardiovascular Risk

Adopted from the American Heart Association February 2018. Next review February 2020. 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 February 2018. Next review February 2020. 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

Treatment of Patients With Major Depressive Disorder

Adopted the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition 2010". Guideline reviewed March 2018. Next review March 2020

Diabetes Clinical Practice Recommendations

Adopted from the American Diabetes Association. Guideline reviewed March 2019. Next review March 2020

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 October 2019 Next review October 2021.

Perinatal HIV Care

Adopted from the New York State Department of Health. Reviewed October 2019 Next review June 2020.

Immunization Guidelines for Vaccinating Pregnant Women

Adopted from the Center Disease Control (CDC). Guideline reviewed October 2019. Next review October 2021

Clinical Practice Guidelines Accordion

Excellus 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 March 2019. Next scheduled for review March 2020.

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 June 2019. Next scheduled for review June 2020.
NYS Lead Screening Recommendations
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 March 2019. Next scheduled review March 2020. Adopted from the U.S. Preventive Services Task Force (USPSTF). Recommendations for Adults.

Excellus 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 June 2019 Next review June 2020.
NYS DOH HIV Testing Requirements
HIV Guidelines
HIV Guidelines Ordering Publications

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