2025 Clinical Practice Guidelines

Clinical practice guidelines are designed to guide decisions about diagnosing and treating specific health conditions. These guidelines are based on scientific evidence, medical literature reviews, or established authority. All recommendations are grounded in published guidelines and do not prioritize treatments based solely on cost.

These guidelines serve as a guide for clinical decision-making, but clinicians and patients must collaborate to create individualized treatment plans tailored to each patient's unique needs and circumstances.

Molina Healthcare regularly reviews and updates these guidelines as new clinical evidence emerges. After review and necessary modifications by the Quality Improvement and Health Equity Transformation Committee, providers are notified of any changes via fax and/or mail.

To request a copy of any guidelines, please contact Molina Healthcare Provider Services.

The guidelines listed below were reviewed and adopted by the Molina Healthcare National Quality Improvement and Health Equity Transformation Committee, with approval dates indicated for 2023 and beyond. All guidelines undergo quarterly reviews and receive annual approval unless otherwise noted.

It's important to note that clinical guidelines are not used by Molina to determine benefit coverage. Instead, they are educational tools to aid clinical decision-making and are not considered a standard of care. Physicians should adapt the guidelines based on their clinical judgment.


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: May 2025

Revised: N/A

Molina approved:January 2023, February 2024, January 2025, May 2025

 

Anxiety/Panic Disorder

Molina Healthcare has adopted the guideline for Assessment and Treatment of Children and Adolescents from the American Academy of Child & Adolescent Psychiatry.

The Clinical Practice Guideline may be accessed HERE.

Published: October 2020

Revised: N/A

Molina approved: May 2025 

 

Molina Healthcare has adopted the guideline for Generalized Anxiety and Panic Disorder from American Family Physician.

The Clinical Practice Guideline may be accessed HERE.

Published: August 2022

Revised: N/A

Molina approved: May 2025 

 

Molina Healthcare has adopted the guideline for Social Anxiety Disorder from Anxiety & Depression Association of America.

The Clinical Practice Guideline may be accessed HERE.

Published: March 2022

Revised: N/A

Molina approved: May 2025 

 

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 approved: January 2023, February 2024, January 2025

 

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 approved: January 2023, February 2024, January 2025

 

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 approved: January 2023, February 2024, January 2025


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 approved: January 2023, February 2024, January 2025

 

Cancer Treatment and Prevention

Molina Healthcare has adopted the guideline for Cancer from The National Comprehensive Cancer Network® (NCCN®).

The Clinical Practice Guideline may be accessed HERE.

Published: N/A

Revised: N/A

Molina approved: January 2025


Children with Special Health Care Needs

Molina Healthcare has adopted the guideline for Access to Services for Children and Youth with Special Health Care Needs from The American Academy of Pediatrics.

The Clinical Practice Guideline may be accessed HERE.

Published: June 2022

Revised: N/A

Molina approved: January 2023, February 2024, January 2025

 

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 2024

Revised: N/A

Molina approved: January 2023, February 2024, January 2025


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 2025

Molina approved: January 2023, February 2024, January 2025  

 

Dementia

Molina Healthcare has adopted the guideline for Dementia from the Alzheimer’s Association.

The Clinical Practice Guideline may be accessed HERE.

Published: N/A

Revised: N/A

Molina approved: May 2025

                    

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 2022

Revised: N/A

Molina approved: January 2023, February 2024, January 2025

 

Molina Healthcare has adopted the guideline for Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts from the American Psychological Association.

The Clinical Practice Guideline may be accessed HERE.

Published: February 2019

Revised: N/A

Molina approved: May 2025


Diabetes Treatment and Prevention

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 2025

Molina approved: January 2023, February 2024, January 2025   

                                           
Hepatitis C

Molina Healthcare has adopted the clinical practice guideline for Hepatitis C from the Infectious Diseases Society of America.

The Clinical Practice Guideline may be accessed HERE.

Published: May 2023

Revised: N/A

Molina approved: May 2025

 

 

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 approved: January 2023, February 2024, January 2025

 

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 approved: January 2023, February 2024, January 2025

 

You may also visit the web site below for more information. 

National Health Care for Homeless Council HERE.

 

HIV/AIDS Treatment and Prevention

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 approved: September 2024, January 2025

 

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 approved: September 2024, January 2025

 

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 approved: January 2023, February 2024, January 2025

 

Incontinence

Molina Healthcare has adopted the clinical practice guidelines for Incontinence from the American Urological Association. Find them here:

Incontinence after Prostate Treatment

Overactive Bladder

Stress Urinary Incontinence

Published: 2019, July 2024, 2017

Revised: July 2024, July 2024, 2023

Molina approved: May 2025

 

Long-Term Services and Supports (LTSS)

Molina Healthcare has adopted the clinical practice guideline for Long-Term Services and Supports (LTSS) from Centers for Medicare and Medicaid Services (CMS).

The Clinical Practice Guideline may be accessed HERE.

Published: November 2020

Revised: N/A

Molina approved: May 2025

 

Osteoporosis

Molina Healthcare has adopted the guideline for Osteoporosis from American College of Physicians.

The Clinical Practice Guideline may be accessedHERE.

Published: N/A

Revised: N/A

Molina approved: May 2025

 

Parkinson’s Disease

Molina Healthcare has adopted the clinical practice guideline for Parkinson’s Disease from the American Physical Therapy Association.

The Clinical Practice Guideline may be accessed HERE.

Published: December 2021

Revised: August 2022

Molina approved: May 2025

 

Molina Healthcare has adopted the clinical practice guideline for Parkinson’s Disease from the American Family Physician.

The Clinical Practice Guideline may be accessed HERE.

Published: December 2020

Revised: N/A

Molina approved: May 2025

 

Perinatal & Postpartum 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.

Published: July 2012

Revised: September 2017

Molina approved: January 2023, February 2024 , January 2025     

 

Molina Healthcare has adopted the guideline for Management of Pregnancy from the Department of Veterans Affairs & Department of Defense.

The Clinical Practice Guideline may be accessed HERE.

Published: June 2022

Revised: N/A

Molina approved: May 2025 

 

Molina Healthcare has adopted the guideline for Postpartum Care from the American College of Obstetricians and Gynecologists.

The Clinical Practice Guideline may be accessed HERE.

Published: June 2016

Revised: May 2018

Molina approved: January 2025

         

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 approved: January 2023, February 2024, January 2025

 

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 approved: January 2023, February 2024, January 2025

 

You may also visit the below websites for additional information on Sickle Cell Disease:

American Society of Hematology - HERE.

Centers for Disease Control and Prevention - HERE.


Substance Use Disorder

Molina Healthcare has adopted the guideline for Alcohol Withdrawal Management from the American Society of Addiction Medicine (ASAM).

The Clinical Practice Guideline may be accessed HERE.

Published: January 2020

Revised: N/A

Molina approved: May 2025

 

Molina Healthcare has adopted the guideline for Benzodiazepine Tapering from the American Society of Addiction Medicine (ASAM).

The Clinical Practice Guideline may be accessed HERE.

Published: March 2025

Revised: N/A

Molina approved: May 2025

 

Molina Healthcare has adopted the guideline for Stimulant Use Disorder from the American Society of Addiction Medicine (ASAM).

The Clinical Practice Guideline may be accessed HERE.

Published: June 2024

Revised: N/A

Molina approved: May 2025

 

Molina Healthcare has adopted the guideline for Management of Substance Use Disorder (SUD) from the Department of Veterans Affairs & Department of Defense.

The Clinical Practice Guideline may be accessed HERE.

Published: August 2021

Revised: N/A

Molina approved: May 2025

 

Molina Healthcare has adopted the guideline for Pharmacological Treatment of Patients with Alcohol Use Disorder from The American Psychiatric Association.

The Clinical Practice Guideline may be accessed HERE.

Published: January 2018

Revised: N/A

Molina approved: May 2025

 

Molina Healthcare has adopted the guideline for Substance Use Disorder Treatment for People with Co-Occurring Disorders from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The Clinical Practice Guideline may be accessed HERE.

Published: March 2020

Revised: N/A

Molina approved: May 2025

 

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 approved: January 2023, February 2024, January 2025

 

Molina Healthcare has adopted the 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 approved: January 2023, February 2024, January 2025

 

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 approved: January 2023, February 2024, July 2024, January 2025


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 approved: January 2023, February 2024, January 2025

 

Weight Management

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 approved: January 2023, February 2024, January 2025

 

Molina Healthcare has adopted the guideline for Weight Management from

The American Academy of Pediatrics (AAP)

The Journal of Obesity and Metabolic Syndrome

The National Institute of Health (NIH)

The American Psychological Association (APA)

The Clinical Practice Guidelines may be accessed below:

 

Preventing Obesity and Eating Disorders in Adolescents

Published: September 2016

Revised: June 2022

Molina approved: January 2025

Clinical Practice Guideline for Multicomponent Behavioral Treatment of Obesity and Overweight in Children and Adolescents .

Published: March 2018

Revised: N/A

Molina approved: January 2025

 

Obesity in Adults: clinical practice guideline

Published: August 2020

Revised: N/A

Molina approved:  January 2025

 

You may also visit the below websites for additional information on Weight Management:

American Academy of Pediatrics (AAP) - HERE.

National Institute of Health (NIH) - HERE.