![]() In the process, multiple functions are accomplished: As used by Carelon, the Guidelines establish objective and evidence-based criteria for medical necessity determinations where possible. The Carelon Clinical Appropriateness Guidelines (hereinafter “the Carelon Clinical Appropriateness Guidelines” or the “Guidelines”) are designed to assist providers in making the most appropriate treatment decision for a specific clinical condition for an individual. History Description and Application of the Guidelines Simultaneous Ordering of Multiple Diagnostic or Therapeutic Interventions All rights reserved.ĭescription and Application of the Guidelines © 2023 Carelon Medical Benefits Management, Inc. Please consult the applicable health plan for more details.Īppropriate Use Criteria: Imaging of the Spine Continue speech and language therapy (as indicated).Approval and implementation dates for specific health plans may vary.Monitor for behavior/emotional/mental health.Neurological referral for early symptoms of dementia: decline in function, memory loss, ataxia, seizures and incontinence of urine and/or stool.Clinical evaluation of functional abilities (consider accelerated aging) monitor loss of independent living skills.Health, abuse-prevention and sexuality education.If unable to perform, screen pelvic ultrasound (every 2-3 years).If not sexually active, single finger bimanual exam with finger-directed cytology exam.Pap smear and pelvic exam (every 1-3 yrs.Baseline Mammography (40 years follow up every other year until 50, then annual).Reinforce the need for subacute bacterial endocarditis prophylaxis (SBE) in susceptible adults with cardiac disease.Clinical evaluation of the heart to rule out mitral/aortic valve problems.Ophthalmologic exam, looking especially for keratoconus & cataracts (every 2 years).Cervical spine x-rays (as needed for sports) check for atlantoaxial dislocation.TSH and T4-Thyroid Function Test (annual).An electronic version can be accessed here: 1999: “Health Care Guidelines for Individuals with Down Syndrome” published in Down Syndrome Quarterly (Volume 4, Number 3, September 1999, pp.Additionally, the AAP Guide for Families of Children with Down Syndrome can be found here. ![]() An electronic version can be accessed here: /content/128/2/393. 2011: “Health Supervision for Children with Down Syndrome” published in Pediatrics (Vol.The current version (“Health Supervision for Children Down Syndrome”) was published in Pediatrics (Vol.The guidelines were recently updated to include prenatal guidance, building upon previous versions that provide age-based care and treatment. The American Academy of Pediatrics publishes a guideline for families and physicians to navigate the health needs of children with Down syndrome. Search online parent support groups or find your local Down syndrome organization for support.One of the best ways to find a professional in your area is to ask families of other children with Down syndrome in the area.Find a professional who will collaborate with you, and someone who is open to listening to parents and seeing them as partners.Selecting the right health care professional: For Physicians: Defines the medical vulnerabilities and the necessary screenings for the Down syndrome population.For Parents: Specialized guidelines help define for parents what is needed, so they can communicate with their primary care physician and say, “This is what is recommended.Significance of Down Syndrome healthcare-specific guidelines: They include specific recommendations for screening tests, information about common medical conditions, suggestions for early intervention, diet and exercise and other issues across the lifespan. The healthcare guidelines mentioned below help define the standards of quality care for individuals with Down syndrome.
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