Simply Healthcare Plans, Inc. Medicaid Managed Care Clinical Practice Guidelines www.simplyhealthcareplans.com/provider Simply Healthcare Plans, Inc. is a Managed Care Plan with a Florida Medicaid contract. SFLPEC-0456-18 July 2018 Condition/disease Guideline title Recognized source(s) URL Adult behavioral health (child and adolescent behavioral health, with exception of bipolar disorder, located under pediatric and adolescent health) Anxiety Treatment of Anxiety Disorders National Institute of Mental Health http://www.nimh.nih.gov/health/publications/anxiety- disorders/treatment-of-anxiety-disorders.shtml Alzheimer’s/ dementia Guideline Watch (October 2014): Practice Guideline for the Treatment of Patients with Alzheimer’s Disease and Other Dementias American Psychiatric Association (APA) http://psychiatryonline.org/pb/assets/raw/sitewide/practice_g uidelines/guidelines/alzheimerwatch.pdf Current Diagnostic Criteria and Guidelines for Alzheimer's Disease Alzheimer’s Association https://www.alz.org/research/diagnostic_criteria/overview.asp Bipolar disorder* *Addresses diagnosis and treatment of bipolar disorder in special populations such as children and adolescents Bipolar Disorder: Assessment and Management (update 2017) National Institute for Health and Care Excellence (NICE) https://www.nice.org.uk/guidance/cg185/resources/bipolar- disorder-assessment-and-management-pdf-35109814379461 Evidence-Based Guidelines for Treating Bipolar Disorder: Revised Third Edition Recommendations from the British Association for Psychopharmacology (2016) British Association for Psychopharmacology https://www.bap.org.uk/pdfs/BAP_Guidelines-Bipolar.pdf Behavioral health screening, assessment and treatment Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition (2015) Agency for Healthcare Research and Quality http://www.guideline.gov/content.aspx?id=49527
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Simply Healthcare Plans, Inc. Medicaid Managed Care
Clinical Practice Guidelines
www.simplyhealthcareplans.com/provider Simply Healthcare Plans, Inc. is a Managed Care Plan with a Florida Medicaid contract. SFLPEC-0456-18 July 2018
Condition/disease Guideline title Recognized source(s) URL
Adult behavioral health (child and adolescent behavioral health, with exception of bipolar disorder, located under pediatric and adolescent health)
Anxiety
Treatment of Anxiety Disorders
National Institute of Mental Health http://www.nimh.nih.gov/health/publications/anxiety-disorders/treatment-of-anxiety-disorders.shtml
Alzheimer’s/ dementia
Guideline Watch (October 2014): Practice Guideline for the Treatment of Patients with Alzheimer’s Disease and Other Dementias
American Psychiatric Association (APA) http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/alzheimerwatch.pdf
Current Diagnostic Criteria and Guidelines for Alzheimer's Disease
Alzheimer’s Association https://www.alz.org/research/diagnostic_criteria/overview.asp
Bipolar disorder* *Addresses diagnosis and treatment of bipolar disorder in special populations such as children and adolescents
Bipolar Disorder: Assessment and Management (update 2017)
National Institute for Health and Care Excellence (NICE)
Evidence-Based Guidelines for Treating Bipolar Disorder: Revised Third Edition Recommendations from the British Association for Psychopharmacology (2016)
British Association for Psychopharmacology https://www.bap.org.uk/pdfs/BAP_Guidelines-Bipolar.pdf
Behavioral health screening, assessment and treatment
Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition (2015)
Agency for Healthcare Research and Quality http://www.guideline.gov/content.aspx?id=49527
Simply Healthcare Plans, Inc. Medicaid Managed Care
Clinical Practice Guidelines Page 2 of 12
Updated: Commercial/Exchange Quality Improvement Committee Quality Improvement Committee (GBD) Behavioral Health National Clinical Advisory Committee CPGs are applicable to all LOBs
Condition/disease Guideline title Recognized source(s) URL
Behavioral health screening, assessment and treatment
The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition (2015)
APA https://psychiatryonline.org/doi/full/10.1176/appi.books.9780890426760.pe02
Depression Depression in Adults: Screening (2016)
U.S. Preventive Services Task Force (USPSTF) https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/depression-in-adults-screening1
Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition (2010)
APA http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
Depression: The Treatment and Management of Depression in Adults (Updated Edition) Clinical Practice Guideline 90 (2016)
National Collaborating Centre for Mental Health commissioned by NICE
Schizophrenia Treatment of Patients with Schizophrenia, Second Edition (2010)
APA http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/schizophrenia.pdf
Trauma care A Treatment Improvement Protocol: Trauma-Informed Care in Behavioral Health Services (2014) Trauma-Informed Care in Behavioral Health Services: Treatment Improvement Protocol (TIP) Series
Substance Abuse and Mental Health Services Administration (SAMHSA)
Simply Healthcare Plans, Inc. Medicaid Managed Care
Clinical Practice Guidelines Page 3 of 12
Updated: Commercial/Exchange Quality Improvement Committee Quality Improvement Committee (GBD) Behavioral Health National Clinical Advisory Committee CPGs are applicable to all LOBs
Condition/disease Guideline title Recognized source(s) URL
Substance use
Substance use Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse (2013)
Simply Healthcare Plans, Inc. Medicaid Managed Care
Clinical Practice Guidelines Page 4 of 12
Updated: Commercial/Exchange Quality Improvement Committee Quality Improvement Committee (GBD) Behavioral Health National Clinical Advisory Committee CPGs are applicable to all LOBs
Condition/disease Guideline title Recognized source(s) URL
Coronary artery disease* *An update of the Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease
AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and Other Atherosclerotic Vascular Disease (2011)
American Heart Association (AHA) and American College of Cardiology Foundation (ACCF)
http://circ.ahajournals.org/content/124/22/2458
Treatment of Hypertension in Patients With Coronary Artery Disease (2015)
AHA, ACCF and American Society of Hypertension (ASH)
Simply Healthcare Plans, Inc. Medicaid Managed Care
Clinical Practice Guidelines Page 5 of 12
Updated: Commercial/Exchange Quality Improvement Committee Quality Improvement Committee (GBD) Behavioral Health National Clinical Advisory Committee CPGs are applicable to all LOBs
Condition/disease Guideline title Recognized source(s) URL
Chronic kidney disease
The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI)™ Evidence-Based Clinical Practice Guidelines for All Stages of Chronic Kidney Disease (CKD) and Related Complications
National Kidney Foundation https://www.kidney.org/professionals/guidelines/guidelines_commentaries
Simply Healthcare Plans, Inc. Medicaid Managed Care
Clinical Practice Guidelines Page 6 of 12
Updated: Commercial/Exchange Quality Improvement Committee Quality Improvement Committee (GBD) Behavioral Health National Clinical Advisory Committee CPGs are applicable to all LOBs
Condition/disease Guideline title Recognized source(s) URL
Gender dysphoria/ incongruence
Endocrine Treatment of Gender Dysphoric/ Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline (2017)
The Endocrine Society https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2017-01658
Heart failure ACCF/AHA/HFSA Guideline for the Management of Heart Failure (Focused Update 2017)
ACCF; AHA Task Force on Practice Guidelines; Heart Failure Society of America
Hypertension 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for The Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
ACCF; AHA; American Academy of Physician Assistants; Association of Black Cardiologists; American College of Preventive Medicine; American Geriatrics Society; American Pharmacists Association; ASH; American Society for Preventive Cardiology; National Medical Association; Preventive Cardiovascular Nurses Association
Simply Healthcare Plans, Inc. Medicaid Managed Care
Clinical Practice Guidelines Page 7 of 12
Updated: Commercial/Exchange Quality Improvement Committee Quality Improvement Committee (GBD) Behavioral Health National Clinical Advisory Committee CPGs are applicable to all LOBs
Condition/disease Guideline title Recognized source(s) URL
Simply Healthcare Plans, Inc. Medicaid Managed Care
Clinical Practice Guidelines Page 8 of 12
Updated: Commercial/Exchange Quality Improvement Committee Quality Improvement Committee (GBD) Behavioral Health National Clinical Advisory Committee CPGs are applicable to all LOBs
Condition/disease Guideline title Recognized source(s) URL
HIV/AIDS 2017 HIVMA of IDSA Clinical Practice Guideline for the Management of Chronic Pain in Patients Living with HIV
HIV and Adolescents: Guidance for HIV Testing and Counselling and Care for Adolescents Living with HIV Guidance Document (2013)
WHO http://apps.who.int/iris/bitstream/10665/94334/1/9789241506168_eng.pdf?ua=1
Pediatric/adolescent health (See adult behavioral health for resources for bipolar disorder in the pediatric and adolescent population.)
ADHD Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2011)
American Academy of Pediatrics (AAP) http://pediatrics.aappublications.org/content/128/5/1007.full.pdf
Autism Practice Parameter for the Assessment and Treatment of Children and Adolescents With Autism Spectrum Disorder (2014)
American Academy of Child and Adolescent Psychiatry (AACAP)
Simply Healthcare Plans, Inc. Medicaid Managed Care
Clinical Practice Guidelines Page 9 of 12
Updated: Commercial/Exchange Quality Improvement Committee Quality Improvement Committee (GBD) Behavioral Health National Clinical Advisory Committee CPGs are applicable to all LOBs
Condition/disease Guideline title Recognized source(s) URL
Celiac disease Guideline for the Diagnosis and Treatment of Celiac Disease in Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (2005)
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
Obesity Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report (2007)
Simply Healthcare Plans, Inc. Medicaid Managed Care
Clinical Practice Guidelines Page 10 of 12
Updated: Commercial/Exchange Quality Improvement Committee Quality Improvement Committee (GBD) Behavioral Health National Clinical Advisory Committee CPGs are applicable to all LOBs
Condition/disease Guideline title Recognized source(s) URL
Obesity Clinical Report: The Role of the Pediatrician in Primary Prevention of Obesity (2015)
Trends in the Prevalence of Preexisting Diabetes and Gestational Diabetes Mellitus Among a Racially/Ethnically Diverse Population of Pregnant Women (1999–2005 Diabetes Care 31:899–904, 2008)
Simply Healthcare Plans, Inc. Medicaid Managed Care
Clinical Practice Guidelines Page 11 of 12
Updated: Commercial/Exchange Quality Improvement Committee Quality Improvement Committee (GBD) Behavioral Health National Clinical Advisory Committee CPGs are applicable to all LOBs
Condition/disease Guideline title Recognized source(s) URL
Gestational Diabetes ACOG http://www.acog.org/Search?Keyword=gestational+ diabetes (This is not a link to a specific document but to the ACOG documents on gestational diabetes.)
Postpartum Screening for Abnormal Glucose Tolerance in Women Who Had Gestational Diabetes Mellitus
WHO Recommendations for Prevention and Treatment of Pre-Eclampsia and Eclampsia (2011)
WHO http://whqlibdoc.who.int/publications/2011/9789241548335_eng.pdf
Committee Opinion 455 Magnesium Sulfate before Anticipated Preterm Birth for Neuroprotection (Reaffirmed 2016)
ACOG; Society for Maternal Fetal Health https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Magnesium-Sulfate-Before-Anticipated-Preterm-Birth-for-Neuroprotection
Clinical Management Guidelines for Obstetrician-Gynecologists Pre-Gestational Diabetes Mellitus Number 60 (Reaffirmed 2016)
Simply Healthcare Plans, Inc. Medicaid Managed Care
Clinical Practice Guidelines Page 12 of 12
Updated: Commercial/Exchange Quality Improvement Committee Quality Improvement Committee (GBD) Behavioral Health National Clinical Advisory Committee CPGs are applicable to all LOBs
Condition/disease Guideline title Recognized source(s) URL
Obstetrical care Management of Preterm Labor (Number 174, October 2016)
Guidelines for the Identification and Management of Substance Use and Substance Use Disorders in Pregnancy (2014)
WHO http://apps.who.int/iris/bitstream/10665/107130/1/9789241548731_eng.pdf?ua=1
Smoking cessation during pregnancy
Smoking Cessation during Pregnancy ACOG Committee Opinion 731 (October 2017)
ACOG https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Smoking-Cessation-During-Pregnancy The guide, pocket reminder card and slide lecture can be ordered by writing to [email protected].