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Clinical Practice Guidelines

Clinical Practice Guidelines are best-practice recommendations based on available clinical outcome and scientific evidence. WellCare Clinical Practice Guidelines reference expert professional and clinical society recommendations, ensuring that the guidelines contain the highest level of evidence-based content. Clinical Practice Guidelines are also used to guide efforts to improvement the quality of care in our membership.

Guidelines listed as In Review are currently in the approval process; the date listed is the most current copy of the guideline.

Guidelines listed as Revised have been reviewed and are current as of the date listed.

Behavioral Health

Attention Deficit Hyperactivity Disorder is a neurobehavioral disorder of children, adolescents and adults characterized by persistent pattern of difficulty paying attention, excessive activity, and impulsivity that interferes with or reduces the quality of cognitive, academic, social, emotional, behavioral or occupational functioning.

Chronic, Preventive, and Other CPGs

Asthma is a chronic inflammatory disease of the airways. In those susceptible to asthma, this inflammation causes the airways to spasm and swell periodically so that the airways narrow.

Heart and blood vessel disease — cardiovascular disease, also called heart disease — includes numerous problems, many of which are related to a process called atherosclerosis.

Diabetes mellitus (DM) is a group of metabolic diseases in which a person has high blood sugar. This high blood sugar produces the symptoms of frequent urination, increased thirst, and increased hunger.

High blood pressure is a common condition in which the force of the blood against artery walls is high enough that it may eventually cause health problems, such as heart disease.

Adopted Clinical Practice and Preventive Health Guidelines

Adopted Clinical Practice and Preventive Health Guidelines

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Last Updated On: 3/23/2022
Medicare Members: Protect yourself against Medicare fraud and Identify theft! The U.S. Department of Health and Human Services Office of Inspector General is alerting the public about a fraud scheme involving genetic testing. Learn how to protect yourself.
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