Clinical Practice Guidelines - Washington State Local Health Insurance - CHPW
Community Health Plan of Washington Apple Health Medicaid Plan Community Health Plan of Washington Apple Health Medicaid Plan

Clinical Practice Guidelines

Clinical Practice Guidelines for Behavioral Health and Medical Conditions and Preventive Services

Community Health Plan of Washington uses guidelines for chronic diseases (including medical and behavioral health conditions) and for preventive services, as listed below. Reference is made to the pertinent evidence-based, peer-reviewed guidelines from Nationally recognized agencies. The guidelines are intended to help guide providers in their care of our members including  Medicare, Apple Health , Cascade Select, and Behavioral Health Services Only members. The guidelines also ensure that the Clinical Coverage Criteria used for utilization management decisions are aligned with the current evidence-based guidelines.

All guidelines are reviewed at a minimum of once every two years. The Clinical Quality Improvement Committee (CQIC), which includes network medical and behavioral health providers and quality specialists, participates in this review, and approves any changes. Paper copies of the guidelines are available for members or providers on request, as well as at the links provided.

CHPW also participates and follows recommendations of the Bree Collaborative. Every year, the Bree Collaborative identifies health care services with high variation in the way that care is delivered, that are frequently used but do not lead to better care or patient health, or that have patient safety issues. Topics that are selected for review are reviewed by an expert workgroup to develop evidence-based recommendations. Recommendations take into account existing quality improvement programs and the work done by other organizations and are then sent to the Washington State Health Care Authority to guide the type of health care provided to Apple Health enrollees, state employees, and other groups. Topics include behavioral health, pain management, oncology, surgery, reproductive health, and aging. Providers should review the recommendations from the Bree Collaborative to ensure that they are delivering care that follows best practices.

Download the current Clinical Practice Guidelines

Last updated Jan 29, 2024, posted March 26, 2024


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