Clinical Guidelines

Health Plan of Nevada (HPN) and Sierra Health and Life (SHL) uses evidence-based clinical guidelines from nationally recognized sources to guide quality and health management programs and for the clinician's use in managing common and important medical conditions.

The guidelines constitute a framework only. In all cases, the provider's clinical judgment can override the guideline if the provider feels that strict adherence is not in the patient's best interest. If the provider decides to deviate, the medical record should indicate the rationale for this variation.

 

Search For:

Last Published 01.04.2024

The guideline presents discussion of a new treatment for congenital athymia, allogeneic processed thymus tissue (Rethymic®), and the circumstances under which it is considered medically necessary.

Last Published 04.19.2024

These guidelines outline the diagnosis and management of asthma.

Last Published 04.19.2024

This clinical guideline addresses recommendations for the optimum management of atrial fibrillation.

Last Published 04.19.2024

This guideline outlines information regarding behavioral health.

Last Published 04.19.2024

This guideline addresses the primary prevention of cardiovascular disease in adults.

Last Published 04.19.2024

These guidelines outline the evaluation of acute or stable chest pain or other anginal equivalents, in various clinical settings, with an emphasis on the diagnosis on ischemic causes.

Last Published 12.29.2023

This guideline outlines general information and indications for chimeric antigen t-cell therapy and provides links to relevant Ohio Administrative Code(s).

Last Published 05.06.2024

This guideline outlines general information and indications for chimeric antigen t-cell therapy.

Last Published 04.19.2024

This guideline outlines recommendations to address the practical management of individuals with high blood cholesterol and related disorders.

Last Published 04.19.2024

This clinical guideline addresses the management of chronic coronary disease.

Last Published 04.19.2024

These practice parameters detail the assessment and treatment modalities for individuals with chronic obstructive lung disease.

Last Published 04.19.2024

This guideline outlines information regarding the optimal management of COVID-19.

Last Published 04.19.2024

This practice guideline contains general and specific treatment recommendations for patients with Alzheimer’s disease and other dementias.

Last Published 04.19.2024

This clinical guideline outlines the care of the diabetic patient including screening, diagnosis, and treatment options.

Last Published 04.19.2024

This guideline provides information and advice for choosing a healthy eating pattern that focuses on nutrient-dense foods and beverages and contributes to achieving and maintaining a healthy weight.

Last Published 05.03.2024

This guideline provides an evidence-based approach to infertility management, infertility surgery, and the use of single embryo transfer in addition to describing the limitations of and recommendations for infertility treatment.

Last Published 05.06.2024

This guideline contains general information, indications, and special considerations for the administration of ex vivo gene therapy.

Last Published 04.19.2024

This guideline outlines the stages of heart failure and describes a range of generally acceptable approaches for the diagnosis, management, and prevention of heart failure.

Last Published 04.19.2024

This guideline outlines the diagnosis, management, and treatment of hemophilia.

Last Published 04.19.2024

These guidelines outline the management of adults and adolescents infected with HIV.

Last Published 04.19.2024

This clinical guideline addresses the prevention, detection, evaluation, and management of high blood pressure in adults.

Last Published 04.19.2024

These guidelines provide evidence-based recommendations to aid clinicians in the treatment of particular diseases or groups of patients for all stages of chronic kidney disease (CKD) and related complications.

Last Published 12.29.2023

This guideline outlines the indications, minimum evaluation requirements, contraindications, and special considerations for the use of long-term, durable mechanical circulatory support devices.

Last Published 05.09.2024

This policy provides the medical necessity criteria consistent with CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 30.5 for covered chiropractic services provided to Medicare Advantage members.

Last Published 05.09.2024

This policy provides the medical necessity criteria consistent with CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 30.5 for covered chiropractic services provided to Medicare Advantage members.

Last Published 05.09.2024

This policy provides direction for the determination of medical necessity clinical coverage criteria for habilitation, rehabilitation, or maintenance therapies requiring the skills of a licensed physical, occupational, or speech therapist provided to Medicare Advantage members.

Last Published 04.19.2024

These guidelines outline interventions and practices for maintaining a healthy weight in children, adolescents, and adults.

Last Published 04.19.2024

This guideline addresses psychological assessments and interventions for persons with disabilities.

Last Published 04.19.2024

This guideline provides information and guidance on the types and amounts of physical activity that provide substantial health benefits.

Last Published 04.19.2024

This guideline outlines the recommendations for preventive pediatric care from infancy to adolescence.

Last Published 04.19.2024

This guideline addresses a collection of evidence-based recommendations on clinical preventive services such as screenings, counseling services, and preventive medications.

Last Published 04.19.2024

This guideline outlines the early management and resuscitation of patients with sepsis or septic shock and includes the definition of sepsis/septic shock.

Last Published 04.19.2024

These guidelines address the treatment of adult and pediatric sickle cell disease.

Last Published 04.19.2024

This guideline defines the core components of a comprehensive, coordinated, and family-centered system of care for children and youth with special health care needs.

Last Published 04.19.2024

This guideline addresses the assessment of cigarette smoking and nicotine dependence, as well as behavioral, pharmacological, and supportive interventions that can be used in both inpatient and outpatient settings.

Last Published 12.29.2023

This guideline outlines the general information, indications, contraindications, and special considerations for hematopoietic stem cell transplantation and provides links to relevant Ohio Administrative Code(s).

Last Published 12.29.2023

This guideline outlines the general information, indications, contraindications, and special considerations for hematopoietic stem cell transplantation.

Last Published 12.29.2023

This guideline outlines the general information, indications, contraindications, and special considerations for solid organ transplantation and provides links to relevant Ohio Administrative Code(s).

Last Published 12.29.2023

This guideline outlines the general information, indications, contraindications, and special considerations for solid organ transplantation and provides links to relevant Ohio Administrative Code(s).

Last Published 12.29.2023

This guideline outlines general information, indications, universal and organ-specific contraindications, and special considerations for solid organ transplantation.

Last Published 12.29.2023

This guideline outlines general information, indications, universal and organ-specific contraindications, and special considerations for solid organ transplantation.

Last Published 04.19.2024

This guideline address ethical principles of the medical profession and physicians’ responsibility in promoting the well-being of patients.

For questions, please contact your local Network Management representative or call the Provider Services number on the back of the member’s ID card.