Clinical policies
Practice guideline adoption and recommended use
PacificSource Community Solutions, PacificSource Medicare, and PacificSource Health Plans support the use of practice guidelines based on nationally recognized, valid, and reliable evidence-based clinical literature or a consensus of professionals in a particular field.
PacificSource adopts medical, behavioral, and oral health guidelines to assist providers and members in making decisions about appropriate healthcare choices. PacificSource practice guidelines are not meant to replace the clinical judgment of a treating provider. Guidelines are reviewed and updated as needed on an annual basis.
In all cases, benefit determinations should be based on the applicable contract coverage. Should there be any discrepancy between these guidelines and the contract language, the contract language will take precedence.
Asthma
GINA Report, Global Strategy for Asthma Management and Prevention (Global Initiative for Asthma)
COPD
Gold Reports for COPD Management (Global Initiative for Chronic Obstructive Lung Disease)
Diabetes
Standards of Medical Care in Diabetes (American Diabetes Association)
Coronary Artery Disease
AACE/ACE Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease
American College of Cardiology (ACC) Guidelines and Clinical Documents
Heart Failure
American College of Cardiology (ACC) Guidelines and Clinical Documents
Prenatal
American College of Obstetricians and Gynecologists Clinical Information (ACOG)
Breastfeeding Centers for Disease Control and Prevention (CDC) Guidelines
Obesity
Pain
Oregon Pain Guidance (OPG) Pain Treatment Guidelines
Cancer
National Comprehensive Cancer Network®
Immunizations and Preventive Services
CDC Adult Immunization Schedule. Recommendations for ages 19 years or older
CDC Vaccines for Children: Vaccines by Age
U.S. Preventive Services Task Force (USPSTF): Recommendations for primary care and prevention
Attention-deficit / hyperactivity disorder (ADHD) Children and Adolescents
Attention-deficit / hyperactivity disorder (ADHD) Adults
Anxiety
Autism
Depression
Eating Disorders
APA Practice Guideline for the Treatment of Patients with Eating Disorders (pdf)
Gender-Affirming Care
Bipolar Disorder
Psychotic Disorders
Practice Guidelines for Oregon Early Assessment and Support Alliance
Trauma-Informed Care
Trauma Specific Services: A resource for implementation and use, Trauma Informed Oregon
Substance Use Disorders
SAMHSA TIP (Treatment Improvement Protocols) 63: Medications for Opioid Use Disorder For Healthcare and Addiction Professionals, Policymakers, Patients, and Family: Executive Summary (pdf), Full Document (pdf)
SAMHSA Medication for the Treatment of Alcohol Use Disorder: A Brief Guide (pdf)
LOCUS and CALOCUS-CASII
CALOCUS-CASII Dimensions and Anchor Points for Level of Care/Service Intensity Scoring
CALOCUS-CASII Guide for Patients, Families, and Providers
CALOCUS-CASII Level of Care/Service Intensity Definitions & Utilization Criteria
ECSII Guide for Patients, Families, and Providers
LOCUS Guide for Patients, Families, and Providers
LOCUS: Levels of Care Descriptions