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Special Programs - Independent Living and Diversity Resources
A resource for health providers, IPAs and others interested in the Americans with Disabilities Act, California law as it related to accessibility and Universal Design. In partnership with our Provider Network, IEHP strives to break down barriers to medical care and promote health and wellness for Members with disabilities. With accessibility issues often cited as an obstacle to care, we publish this site to help all stakeholders in the health care system understand the barriers and in some cases the solutions. We invite you to browse these topics: Information on the Americans with Disabilities Act (ADA) Accessibility of Doctor's offices, clinics, and other health care providers is essential in providing medical care to people with Disabilities. Find out more by following the link to the ADA's Access Guide (PDF). The Federal Americans with Disabilities Act (ADA) of 1990 prohibits discrimination on the basis of disability and sets national standards for accessibility. Each page in this section gives you a summary of ADA related documents and a link to the actual Federal resource. By clicking on this link, you will be leaving the IEHP website. View the full text of the law at the ADA Website. Enforcement Lawsuits for ADA Violations U.S. Department of Justice (DOJ) 1994 Status reports, briefs, and settlement information will help you stay up-to-date on precedent-setting ADA litigation. Unsuccessful negotiations or mediation may lead to federal lawsuits. Courts can order compensatory damages, back pay, or civil penalties up to $55,000 for the first violation and $110,000 for any subsequent one. Read more about DOJ Litigation Alternative to Litigation U.S. Department of Justice (DOJ) Mediation Program Established: 1994 Mediation, which is confidential and voluntary, can resolve some ADA disputes quickly and satisfactorily – without the expense and delay of formal investigation and litigation. Read more about DOJ Mediation Facts and Information Diagnosing & Treating Members with Auditory Disability Communicating with People Who Are Deaf or Hard of Hearing in Hospital Settings U.S. Department of Justice (DOJ) Disability Rights Section, Civil Rights Division Published 2003 Interactive doctor-patient discussions with individuals who are deaf or hard-of-hearing may require an interpreter to ensure proper diagnosis and treatment. DOJ’s brief outlines the types of interpreter services including sign language, oral interpretation, cued speech, and Computer Assisted Real-time Transcription (CART). Read the Full Article: HTM PDF Phone Calls & Auditory/Speech Disabilities Phone Calls & Auditory/Speech Disabilities - Technology Breaks Communication Barriers Created by IEHP, 2006 Learn about FREE options for effective telephone communication with individuals who have auditory and/or speech disabilities: National Telecommunication Relay Service (TRS) – two-way translation between individuals using a TTY and a standard telephone Speech-to-Speech (STS) Relay Service – assistance for individuals with speech disabilities by repeating their message verbatim. Read the Full Article Fact Sheet - PDF Fact Sheet - TXT Dispelling ADA Myths Just the Facts on the ADA Adapted from 1995 DOJ fact sheet IEHP, 2006 Get the facts on common ADA misconceptions. ADA Myths & Facts PDF Text Accessibility Pays Off at Tax Time Tax Incentives for ADA Compliance Take advantage tax incentives that help eligible businesses comply with the Americans with Disabilities Act. The Federal and California state governments offer Tax Credits and/or Deductions for improving accessibility and/or employing persons with disabilities. Attorney General’s ADA Tax Incentives Packet Your practice/health care facility may be eligible for tax credits and/or deductions to help offset the costs of improving accessibility for patients and employees with disabilities. The Attorney General’s packet includes a fact sheet and Internal Revenue Service (IRS) form and instructions. Download IEHP's Fact Sheet PDF Text Download the Attorney General's information packet: Website Legal Obligations Standards for Accessible Design ADA Accessibility Guidelines U.S. Department of Justice (DOJ) 1991 The ADA Accessibility Guidelines (ADAAG) include stringent criteria for health care Providers as well as additional requirements based on building use (special application 6 – Medical Care Facilities). The Standards for Accessible Design apply to the architecture and construction of new buildings/facilities as well as alterations to existing structures. Download the Standards Standards - PDF Standards - HTM Download Special Application 6 (Health Care Facilities) Access to Medical Care for Individuals with Mobility Disabilities (PDF) Access to Medical Care for Individuals with Mobility Disabilities (HTM) Removing Existing Barriers Checklist for Readily Achievable Barrier Removal Adaptive Environments Center, Inc. and Barrier Free Environments, Inc. 1995 Identify accessibility problems and solutions for eliminating physical/architectural and communication barriers. Use this informal checklist as a guide to meet your obligations under the ADA (for existing facilities only, not new construction or alterations). Download the checklist for readily achievable barrier removal Checklist - PDF Checklist - HTM ADA Regulations for Health Care Providers Nondiscrimination on the Basis of Disability U.S. Department of Justice (DOJ) 1991 Federal regulations for accessibility at Health care facilities include standards for the architecture of buildings, alterations, and new construction (ADA, Title III). DOJ article - PDF DOJ article - HTM Basic ADA Requirements for Health Care Providers ADA Title III Highlights U.S. Department of Justice (DOJ) Disability Rights Section, Civil Rights Division Published 1990 This functional outline of the ADA’s Title III (section covering health care providers) helps you become familiar with key requirements that impact you and your patients. DOJ’s overview provides details in bullet format for quick reference. See the Full DOJ Article Practical Guidance for ADA Compliance Title III Technical Assistance Manual U.S. Department of Justice (DOJ) 1993 and 1994 This manual (with supplement) outlines ADA requirements for businesses to ensure access to goods, services, and facilities. The reader-friendly format offers: Lay terms and practical examples (limited legalese) Focused, systematic description of requirements Questions/answers and illustrations Read the full Manual Read the Supplement Technical Assistance DOJ ADA Information and Technical Assistance on the Americans with Disabilities Act The official ADA website of the U.S. Department of Justice (DOJ) offers the most up-to-date information and practical guidance on design, construction, and operation: Regulations and standards impacting Providers and Members Accessibility and reasonable accommodations guidelines Solutions for ensuring access within your budget Tax credits and incentives Technical assistance and materials/publications Visit DOJ's ADA Homepage Avoid Costly Building Mistakes Common ADA Errors and Omissions in New Construction and Alterations U.S. Department of Justice (DOJ) Disability Rights Section, Civil Rights Division Published 1997 Incorporating ADA Standards into initial building/alteration plans helps ensure patient safety as well as cost-effectiveness. Review some of the most common accessibility errors/omissions identified through DOJ’s ongoing enforcement efforts. Following each error/omission, you’ll find an explanation of its significance and reference to the appropriate requirement under the ADA Standards for Accessible Design. Online ADA Course Reaching Out to Customers with Disabilities U.S. Department of Justice (DOJ) with Representatives of Business and Disability Communities 2005 Learn about ADA compliance in an online course with 10 short lessons. Policies, Practices, and Procedures Communicating with Customers Who Have Disabilities New Buildings, Additions, and Remodeling Removing Barriers in Buildings That Are Not Being Remodeled Providing Access When Removing Barriers Is Not Readily Achievable Maintaining Accessibility Transporting Customers ADA Compliance Costs and Tax Incentives Enforcement of the ADA Information Sources Take the ADA online course Pacific Region ADA Technical Assistance Disability Business Technical Assistance Center (DBTAC) Region IX National Institute on Disability and Rehabilitation Research U.S. Department of Education 1995 Get information on your compliance obligations, problem-solving assistance, and referrals from ADA experts – without the high cost of a consultant. The 10 regional ADA & IT Technical Assistance Centers serve strictly as educational entities to help you understand your rights and responsibilities and have no enforcement or advocacy responsibilities. Federal Region IX, Pacific, serves: Arizona, California, Hawaii, Nevada, and the Pacific Basin. Visit Pacific ADA Center Visit DBTAC Homepage Visit NIDRR Community Based Adult Services (CBAS) Reminder: Community-Based Adult Center (PDF) SPD Awareness Training By clicking on these links, you may be leaving the IEHP website. By making your facilities accessible you convey a sense of welcome for people with disabilities. Most of all, you comply with the requirements set by the Americans with Disabilities Act (ADA) of 1990. This is a civil rights law that prohibits discrimination against persons with disabilities on the basis of their disability in programs and services that receive federal financial assistance. Please see the resources below for more detailed information. Office Accessibility How to Make Your Medical Office More Accessible (PDF) Guidebook: How to Safely Transfer Patients with Disabilities to an Exam Table (PDF) Video #1: How to Safely Transfer Patients with Disabilities to an Exam Table Video #2: Using an Accessible Scale to Weigh Patients with Disabilities Accessibility Checklist (PDF) Community Resources Community Resources Guide (PDF) Disability Competency and Sensitive Training Disability Etiquette Guide (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Coronavirus (COVID-19) Announcements
of Phase 1A of its vaccination roadmap, vaccines will be distributed to caregivers with In-Home Support Services (IHSS), intermediate care centers, and public and community health centers, including facilities for mental health. Click here to learn more. 1/12/21: San Bernardino County introduces a coronavirus quarantine and isolation calculator. This tool allows people to determine how long they should self-isolate after testing positive for COVID-19, being sick with COVID-19, or being exposed to someone with COVID-19. Click here for more info. 12/7/20: The governor announced a stay at home order for Southern California regions, including Riverside and San Bernardino County, for a minimum of three weeks. This order is in response to a rapid growth in COVID-19 cases and a substantial increase in hospitalizations and ICU admissions. Click here to learn more. 9/11/20: To continue to help slow the spread of COVID-19, Riverside County is urging residents to get tested. In addition, increased testing will help the county move into the next level of the state’s reopening plan. For testing locations, visit gettested.ruhealth.org. 8/21/20: Health officials urge Riverside County residents to get tested for COVID-19, whether or not they are experiencing symptoms. For testing locations, visit gettested.ruhealth.org. 8/21/20: To stop the spread of COVID-19, San Bernardino County Public Health Director urges all residents to get tested. Watch this video to learn more. 7/24/20: Fraud reports have increased due to uncertainty surrounding COVID-19, leaving many San Bernardino residents unsure how to avoid scams or report them to authorities. Scams include fake at-home COVID-19 testing kits or vaccinations, IRS impersonators, illegal robocalls and fake charities. For more information visit the San Bernardino County Public Website. 6/29/20: San Bernardino County is encouraging all residents, including those who have not experienced symptoms of COVID-19, to be testing for the Coronavirus. Click here for testing locations. 6/19/20: Governor Newsom requires California residents to wear face coverings while in public. Click here to learn more. For information on how to wear a proper face covering, watch this short video. 6/12/20: A COVID-19 testing site returns to Blythe. Testing started on June 10th and will continue for two weeks. In addition, a testing site opens at the Edgemont Women’s Club in Moreno Valley and will operate June 17 through June 19th. Click here for more information. 5/29/20: Cooling Centers open throughout Riverside County, offering residents an escape from extreme heat and are open to the public at no cost. The centers will be available through October. Click here for more information. 5/29/20: New COVID-19 testing sites open in San Bernardino County. They are scheduled to run through June with appointment registrations opening weekly. For a complete list of testing locations click here: Click here for a complete list of testing locations. 5/27/20: A drive up COVID-19 testing site will be opened at the old Sears parking lot in Riverside, replacing the testing location at Harvest Christian Fellowship that is closing. Click here for a complete list of testing. 5/22/20: Riverside County added three new COVID-19 testing sites in Corona, San Jacinto and Temecula. Click here for a complete list of testing locations. 4/30/20: Riverside County’s Public Health Officer is extending his order requiring residents to wear face coverings when outside and to continue practicing social distancing through June 19. Residents are still required to remain in their primary residence under Governor Newsom’s existing “stay at home” order unless they are engaged in an essential business or activity, such as grocery shopping or visiting the doctor. Click here for more information. 4/28/20: San Bernardino County opens up criteria for COVID-19 testing. Beginning April 30th, residents 65 and older, healthcare workers, emergency responders, and law enforcement can get tested without displaying symptoms of COVID-19. For testing information, visit the San Bernardino County website. 4/24/20: In response to an increasing number of requests for resources, Riverside County released an online map to connect residents to local food resources. Resources include senior meal sites, school district meal sites and food pantries. Click here to find food resources. 4/20/20: Testing for COVID-19 has been expanded to all Riverside County residents, including those who do not have any COVID-19 symptoms. In addition, a fifth COVID-19 testing site will be established at the Blythe Fairgrounds on April 22nd. All residents interested in testing must call 800-945-6171 for an appointment. Click here for more information. 4/13/20: A fourth drive-up COVID-19 testing site opens in Riverside County on Tuesday, April 14th. The site has been established at the Perris Fairgrounds, located at 18700 Lake Perris Drive. Perris, California. Residents who want to get tested must have symptoms to make an appointment, symptoms include fever, cough, sore throat, runny nose or cough. Residents must call 800-945-6171 to make an appointment. For more information on testing locations, visit the Riverside County Public Health website. 4/13/20: San Bernardino County Public Health will conduct a community drive-through event for COVID-19 testing in Montclair on Tuesday, April 14. This event is open to San Bernardino County residents by appointment only. Residents can make an appointment online at http://wp.sbcounty.gov/dph/coronavirus/ at 2 p.m. on Monday, April 13 or by calling (909) 387-3911. Additional community drive-through events are scheduled throughout this month in Yucaipa, Big Bear Lake, Joshua Tree, and Rancho Cucamonga, California. For more information visit the San Bernardino County website. 4/8/20: Arrowhead Regional Medical Center will begin a COVID-19 drive-thru testing site on Thursday, April 9th. Appointments are required. To make an appointment call 855-422-8029. For more information visit Arrowhead Regional Medical Center. 4/7/20: CalWORKs and CalFresh renewals and SAR 7 status reports do not need to be submitted for March, April or May. This does not apply to Transitional CalFresh or Transitional Nutrition benefits. To access your benefits, visit: c4youself.com or call 877-410-8829 (San Bernardino County) 877-410-8827 (Riverside County). 4/7/20: The San Bernardino County’s Acting Health Officer ordered everyone in San Bernardino County to wear face coverings when leaving home and interacting with other people. Face coverings may include homemade cloth ear loop covers, bandannas and handkerchiefs, and neck gaiters. Also, orders all religious services to be done electronically, including upcoming Easter celebrations.Click here for more information. 4/4/20: The Riverside County Public Health Officer orders the public to stay home and cover their face when leaving and interacting with other people, including essential workers. Face coverings can be bandanas, scarves, neck gaiters or other clothing that does not have visible holes. Click here to learn more. 4/4/20: The Small Business Association (SBA) is offering forgivable loans that help businesses keep their workforce employed during the Coronavirus (COVID-19) crisis. The Paycheck Protection Program is a loan designed to provide a direct incentive for small businesses to keep their workers on the payroll. The loan application period opens on Friday, April 3, 2020. For more information visit the SBA website. 3/31/20: San Bernardino County will conduct a drive-thru sample collection event for COVID-19 in the High Desert on April 2nd. This event is open to San Bernardino County residents only. Residents can request an appointment online at sbcovid19.com or by calling (909) 387-3911. For more information on this event visit: http://www.sbcounty.gov/main/default.aspx 3/30/20 – A third drive-up COVID-19 testing site opens in Riverside County on April 1st. The site has been established at Harvest Christian Fellowship church in Riverside. Residents must have symptoms to make an appointment, which include fever, cough, sore throat, runny nose or cough. Residents must call 800-945-6171 to make an appointment. For more information on testing locations, visit the Riverside County Public Health website. 3/30/20 – A COVID-19 testing site in Indian Wells will be relocated to the Riverside County Fairgrounds in Indio. The first day of testing at the fairgrounds is Tuesday (March 31). Residents must have symptoms to make an appointment, which include fever, cough, sore throat, runny nose or cough. Appointments must be scheduled by calling 800-945-6171. For more information on testing locations, visit the Riverside County Public Health website. 3/27/20: San Bernardino County Public Health will conduct a drive-thru specimen collection for COVID-19 on Friday, March 27. The specimen collection for COVID-19 testing will be available for the public by appointment only. Appointment sign-up and details will be available on the county website. 3/25/20: COVID-19 testing for IEHP Members is now available at SAC Health Systems in San Bernardino. IEHP Members must call (909) 771-2911 to schedule a telephone appointment with a Doctor. The Doctor will evaluate the Member and determine if they need COVID-19 testing and will provide details on how to obtain testing. 3/20/2020: Gov Gavin Newsom announces a California statewide order for residents to “stay at home,” excluding essential entities which include grocery stores, take-out and delivery and health care organizations. IEHP is an essential entity and will continue operations to support our Members and Providers through telephonic contact only. OUR BUILDINGS ARE CLOSED TO NON-EMPLOYEES. We highly encourage you (our Members and Providers) to call us if you need any services or have any questions. Continue to visit our website for frequent updates and news from Gov Gavin Newsom. 3/19/2020: IEHP Chief Medical Officer, Dr. Hansberger, has an important message for our Members in the Coachella Valley region about the COVID-19 situation and ways for them to protect their health. Click here. 3/18/2020: To help our IEHP Members stay home and avoid public places, we encourage Members to use mail order delivery service for both new and refill prescriptions. By using this service, Members can get medicines mailed to their home at no cost by using standard shipping. 3/13/2020: We are requesting when you (including Members, Providers, Community Partners, Vendors, and all Visitors) need IEHP services, please call IEHP or your IEHP contact directly to get the help you need. If you must visit IEHP in person, please ensure that you do not have a fever, cough or breathing problem. 3/13/2020: All classes and events at IEHP’s Community Resource Centers are canceled until further notice for the protection and safety of our community during the Coronavirus (COVID-19) situation. We apologize for any inconvenience and expect to resume classes as soon as possible.
Provider Resources - Health and Wellness
and achieve health goals. IEHP’s Health & Wellness Programs help Members learn how to manage their health and make healthy lifestyle changes. You can refer your IEHP Members to these programs anytime by logging into the Secure Provider Website and completing the Health Education Program Request Form. Health Resources Kids and Teens Managing Your Illness Pregnancy and Postpartum Senior Health Weight Management Health & Wellness Brochures and Handouts Inland Empire Health Plan (IEHP) offers many Wellness Programs that focus on the health and well-being of our Members. All of our programs are free, join us at our next session and learn ways to stay healthy. Get information on important health topics through our health education brochures and handouts: Controlling Asthma (PDF) Diabetes. What's next? (PDF) Eat Healthy, Feel Better (PDF) Fever in Children (PDF) Flu Decision Guide (PDF) Flu Shot (PDF) High Blood Pressure (PDF) Immunizations - English (PDF) Immunizations - Spanish (PDF) Immunizations - Chinese (PDF) Immunizations - Vietnamese (PDF) PAP and HPV Tests: What to Expect (PDF) Diabetes Prevention Program (DPP) - Live the Life You Love Format: Online (small group) Duration: One year Ages: 18 years and over This online year-long lifestyle change program helps you make real changes that last. During the first 6 months, you will meet weekly with a small online group to learn how to make healthy choices into your life. In the second 6 months, you will meet monthly to practice what you have learned. No person is alike, so the program will be tailored to meet your needs and honor your customs and values. You will also be paired with a health coach for one year to help you set your goals, such as how to: Eat healthier Add physical activity into your daily life Reduce stress Improve problem-solving and coping skills Studies have shown that those who finish the program can lose weight and prevent Type 2 Diabetes. Small changes can have big results! Let's start living the best version of you and living the life you love. Find out if you qualify! Click here to visit the Skinny Gene Project online, or Call Skinny Gene Project at (909) 922- 0022, Monday - Friday 8am – 5pm., or Email firstname.lastname@example.org For Providers DPP Rx Pad (PDF) Educational Resources 2021 Population Needs Assessment (PNA) Report IEHP’s Population Needs Assessment (PNA) identifies Member health status and behaviors, Member health education priorities, cultural/linguistics needs, health disparities, and gaps in service related to these issues. The findings of the PNA may help Providers better understand and serve our Members. For questions, please contact IEHP Health Education Department at email@example.com 2021 Population Needs Assessment (PNA) Report Loving Support Program IEHP supports and sponsors the Loving Support Program that is run by Riverside University Health System (RUHS). Loving Support is a program committed to helping mothers achieve their breastfeeding goals. This service offers help and support with the first days at home, return to work, support groups, and timely answers to challenges nursing mothers face. Members can directly contact the Loving Support 24/7 Helpline at 888-451-2499. No referral is necessary. English and Spanish-speaking certified lactation specialists and Internationally Board Certified Lactation Consultants (IBCLCs) are available 24 hours a day, 7 days a week to answer questions. Messages are recorded after hours and promptly addressed. Member Education Resources The following websites are good sources of easy-to-read patient information that can be downloaded, printed, or ordered. By clicking on these links, you will be leaving the IEHP website. RESOURCE DESCRIPTION Medline Plus A service of the US National Library of Medicine and the National Institutes of Health. Easy to read information and audio tutorials on many health topics in English and Spanish. Topics are available in multiple languages. Food and Drug Administration - Office of Women's Health Easy-to-read handouts in English, Spanish and other languages on nutrition, diabetes, depression, and other topics related to women’s health. Learning About Diabetes, Inc. Easy to read “Handouts and Visual Aids” in color on diabetes care and nutrition to help patients eat the right foods to control blood sugar. Weight Control Information Network An extensive list of health education materials about healthy weight and physical activity in English and Spanish. Materials can be printed or ordered. Health Information Translations Easy-to-read educational handouts on many health topics and in multiple languages. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Testimonials - Frank
lly, you Zumba. The Victorville resident discovered Zumba classes last year at IEHP’s Community Resource Center (CRC) and it has become one of his favorite things to do. Diagnosed with high blood pressure, Frank started visiting the CRC because he had heard it offered no-cost health and fitness classes for the community. What he found though, was so much more. “I met with a CRC Health Navigator and she was able to help me get assistance with behavioral health services, housing, even with my resume,” he said. “She also signed me up for classes like Tai Chi, Meditation and, of course, Zumba.” After several months, Frank noticed his body and his spirt were growing stronger by the day. He lost 50 pounds, learned how to eat better, got his blood pressure under control and learned important coping skills that helped him deal with depression and anxiety. “The staff is wonderful, the classes provided are outstanding and I love the fact that when you walk in, you’re treated like family,” Frank said. “When I arrive in the morning, I’m ready to start my day when I feel the positive energy from this facility and the people inside.” Today, Frank is an unofficial ambassador for the CRC. He visits almost every day and tells everyone he meets about how the CRC and IEHP helped him change his life and live healthier. Even still, he’s not shy when it comes to sharing feedback with the staff if he thinks something can be done even better. “They listen to everything I say because they really want to help. IEHP is in touch with the needs of the community and for that I’m grateful,” he said.
Managing Your Illness - Diabetes
thy lives. Although having diabetes can put you at risk for serious health problems, there is a lot you can do to stay well and delay or prevent any complications. The Diabetes Self-Management Workshop is for people with type 2 diabetes and their relatives or that need information on diabetes self-management. Diabetes Self-Management Workshop Format: Group Duration: 6 weeks (2 hours per workshop) Ages: Any age if diagnosed with type 2 diabetes (anyone under 18 years old must be accompanied by parent or guardian) Participants have the opportunity to ask questions, offer comments, and share their experiences and ideas about managing and controlling diabetes. We will have weekly action plans to help you, your friends and your family learn and practice self-management skills. In this workshop participants will learn about: Diabetes and health risks How to manage diabetes Healthy lifestyle changes Meal planning Diabetes medicines This workshop is offered in Riverside and San Bernardino. Call IEHP Health Education Department at 1-866-224-IEHP (4347) or 1-800-718-4347 for TTY users to sign up! Additional Resources By clicking on the links below, you will be leaving the IEHP site. Loma Linda Diabetes Treatment Center IEHP Members can call 909-558-3022 to make an appointment. American Diabetes Association Learn more about diabetes, meal planning, and eating out. This website also gives you free recipes. www.diabetes.org Center for Disease Control & Prevention (CDC) Diabetes Home Diabetes and Your Feet Learn how to protect your feet and kee them healthy for an active life. National Diabetes Education Program Learn how you can avoid problems related to diabetes. You can select topics you want to learn more. www.ndep.nih.gov You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader.
Special Programs - Services for Teen Patients
Healthy Living - Smoking Cessation
right medicine to help you quit, and stress management. Below are resources that will assist you in quitting smoking. By clicking on the links below you will be leaving the IEHP website. Community Resources Kick it California Ready to take the next steps to quit smoking, chewing, or vaping now? The CA Smokers’ Helpline has all you need to reach your goal! They have many free services such as phone counseling, texting, and referrals to other local programs. They can also give step-by-step help on making a quit plan, tips on dealing with triggers, and support to help you stay quit. Call 1-800-300-8086 and give promo code 84 to get started! Or visit their website at https://kickitca.org/ Arrowhead Regional Medical Center 400 N. Pepper Avenue, Colton Click here to visit their website. 909-580-6167 Kaiser Permanente 2055 Kellogg Avenue, Corona Click here to visit their website. (866) 883-0119 (No cost for Kaiser Members only) Rim Family Services 28545 Highway 18, Skyforest Click here to visit their website. (909) 336-1800 Beaver Medical Group 1150 Brookside Avenue, Redlands Click here to visit their website. (909) 335-4131 Kaiser Permanente 17296 Slover Avenue, Fontana Click here to visit their website. (909) 609-3000 (No cost for Kaiser Members only) Loma Linda University Health - Center for Health Promotion 24785 Stewart Street, Loma Linda Click here to visit their website. (909) 558-4594 Websites By clicking on the links below you will be leaving the IEHP website. American Heart Association A step-by-step guide to smoke-free living, knowing the benefits, making a plan, dealing with urges, and staying quit. Center for Disease Control and Prevention (CDC) Featuring all you need to set up a quit plan, this site also links you to social media for ongoing support through the quitting process. Plus, you’ll be able to view videos of past smokers, hear their stories and learn through their experiences. Smokefree.gov Support and tools to help you or someone you love to quit. You can also opt for versions geared to veterans, women, seniors, and teens. Mobile Apps iOs Apps Smoke Free QuitNow! Quit Guide Kwit no butts No Vape Android Apps Quit Now Quit Guide Kwit no butts No Vape Interactive Tool Stop Smoking You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Click here to download a free copy by clicking Adobe Acrobat Reader.
Helpful Information and Resources - Medical and Government Links
alth information. All the links will open in a new window and you will leave the IEHP website. Medical Links Medscape: free medical news, journal articles, and more. Yahoo! Health: medical dictionary, disease symptoms, and treatments. KidsHealth: animations, games, and articles for parents, teens, and kids. First 5 San Bernardino: statewide initiative to improve the early development of children. First 5 Riverside: statewide initiative to improve the early development of children. Text4Baby: get FREE messages each week on your cell phone to help you through your pregnancy and your baby's first year. Government Links San Bernardino County Department of Public Health: get information on WIC, child car seat safety and more. Riverside County Department of Public Health: get information on injury prevention, WIC, HIV, family health and more. PubMed: life science journals from the United States National Library of Medicine. Healthy Finder: 1600 health-related topics. NCQA (National Committee for Quality Assurance): reports on the quality of care delivered by managed care plans. NIH (National Institutes of Health): get health information, clinical trials, research, and more. CDC (Centers for Disease Control and Prevention): get information on healthy living, disease, Zika virus, emergencies, workplace safety, and environmental health. Quality of Care Report Card: get quality ratings of health plans. California Department of Managed Health Care California Department of Health Care Services
Medi-Cal Dental Coverage Insurance Information - Medi-Cal Dental Coverage Insurance Information
ms can start in our mouths, that's why Medi-Cal dental coverage is so vital to California residents. Medi-Cal is the name for the California Medi-Cal Assistance Program, the regions Medicaid program. Medi-Cal provides health and medical dental insurance coverage for qualified families and individuals in California. Does Medi-Cal Cover Dental? Yes, Medi-Cal covers a wide range of dental services through their Medi-Cal Dental Program. This benefit is included with your Medi-Cal coverage at little to no cost to you. To access Medi-Cal's dental services, you can visit a Medi-Cal dental provider. They will let you know what the best form of treatment is under your Medi-Cal dental coverage. If you have any questions or need help finding a Medi-Cal dental provider, call the Medi-Cal Dental Customer Service Line at 1-800-322-6384, or visit www.smilecalifornia.org. What Does Medi-Cal Cover for Dental? Medi-Cal dental coverage includes the following: Diagnostic and preventive dental hygiene (e.g., examinations, x-rays, and teeth cleanings) Emergency services for pain control Tooth extractions Fillings Root canal treatments (anterior/posterior) Crowns (prefabricated/laboratory) Scaling and root planing Periodontal maintenance Complete and partial dentures; and Orthodontics for kids who qualify Does Medi-Cal cover root canals? Yes, Medi-Cal dental will cover both anterior and posterior root canals. Does Medi-Cal cover braces? Orthodontics are only covered for kids who qualify for this type of specialist treatment under Medi-Cal's dental services. Why You Need Dental Insurance It is a fact that your mouth can give a clear sign of your overall health. This is because dental health and hygiene link to other areas of the body, including the heart. It is vital to visit the dentist on a regular basis, to make sure your oral health is not causing you any problems. That said, dental work can be costly. Even more costly as we get older, and our teeth and gums start to weaken. Medi-Cal dental helps all Medi-Cal members save money on preventative and restorative dental work. Here are some reasons why dental health insurance is so important: Insurance pays for expensive dental care. For some people, dental care means two visits a year for checkups and teeth cleaning. For others, it means thousands of dollars in restorative surgery bills. Whether you brush your teeth three times a day or not, dental problems can come without notice. To prevent paying expensive dental bills apply for Medi-Cal coverage and visit a Medi-Cal registered dentist. Medi-Cal will pay some or all of the costs of your dental procedures. Keep great oral health and hygiene. The best way to save money on dental health bills (besides applying for Medi-Cal coverage) is to keep up to date on the overall health of your mouth. Regular dental checkups will help to make sure that your oral health is checked. Medi-Cal dental will cover *routine checkups. Give your kids a head start. According to the Pew Center on the States, about 20% of a child's healthcare expenses come from dental costs. Tooth decay is one of the most common and preventable childhood diseases. It's five times more common than asthma and seven times more prevalent than fever in U.S kids. Twenty percent of kids 0-5 do not get yearly dental checkups. Kids with oral health problems have a hard time learning in school. The U.S Department of Health and Human Services estimates that kids lose over 51 million school hours per year due to dental issues. How to Apply for Medi-Cal Dental Coverage If you have Medi-Cal, you will be able to use your dental benefits at any Medi-Cal Dental provider in California. All you need to do is make an appointment and show your Medi-Cal card when you visit the dentist. To apply to Medi-Cal, call our professional Enrollment Advisors at (866) 294-4347, Monday – Friday, 8am – 5pm. TTY users should call (800) 720-4347. You can also call Health Care Options at 1-800-430-4263 or visit www.healthcareoptions.dhcs.ca.gov. TTY users should call 1-800-430-7077. At IEHP, we are happy to answer any questions you may have regarding Medi-Cal dental coverage. We can also help you apply for Medi-Cal online. *For more information on guidelines and coverage for Medi-Cal Dental age groups, please visit the covered services section on the Smile California website.
How to Renew MediCal - Medical Renewal Form
members meet the guidelines to renew your Medi-Cal insurance program. You can renew your Medi-Cal online. You must fill out a Medi-Cal renewal form. This step is known as Medi-Cal redetermination. Be sure to look over your health plan during the Medi-Cal renewal process. This may help you get extra aid from the state of California. If your situation changed, the government could help you to lower your monthly health insurance costs. The amount of aid depends on where you live, your family income, and the number of people in your household. How to Check Medi-Cal Status Once your Medi-Cal is approved, the California Department of Health Care Services (DHCS) will send you a Benefits Identification Card (BIC) in the mail. If you do not get your BIC in the mail, or a letter from DHSC asking for more information, call or visit your local Social Services Office to ask for status. You can also check your Medi-Cal status on the Covered California website. How to Check if My Medi-Cal is Active Visit the Social Services agency in person In Riverside County visit the Riverside County Department of Public Services for a local office. If you live in San Bernardino County visit the Transition Assistance Department – San Bernardino to find a local office. Call Medi-Cal by phone Before you renew your Medi-Cal, check the status of your Medi-Cal by calling the Medi-Cal hotline at (800) 541-5555. If you don’t have your Benefits Identification Card, the automated system will ask for the last four numbers of your Social Security number and the month and year of your birth. You can also call your local county office. Send a request by mail To check the status of your Medi-Cal by mail send a letter to: Medi-Cal Eligibility Division, P.O. Box 997417, MS 4607, Sacramento, CA 95899-7417 How to Renew Medi-Cal As a Medi-Cal member, you must renew your Medi-Cal each year to keep your health care benefits. For most members Medi-Cal is automatically renewed. If your county cannot confirm all your information to automate the renewal, a packet will be mailed to you. All forms inside this packet must be filled out and returned. As a Medi-Cal member, you can return this information over the phone, by mail, or by fax. You can also return your packet to your local Social Services office. If you do not complete this renewal process your Medi-Cal benefits can be canceled. Medi-Cal Redetermination Form As stated above, Medi-Cal must be renewed each year. The county runs a review to find out if people or households still can get Medi-Cal. This review is known as annual redetermination. If you’ve changed jobs, had a pay rise, lost your job, or the number of people living in your house has changed, it may or may not help you get Medi-Cal. The purpose of an annual redetermination is for the state to get as much data from you to find out what aid you should be able to get. Or what amount, if any, you should pay for Medi-Cal. The Medi-Cal office will try to renew your households’ Medi-Cal automatically. But, if your personal data cannot be verified, your Medi-Cal redetermination package will come in the mail. Once the packet comes, you need to fill out all the data needed and send the forms back ASAP. This helps avoid any delay in Medi-Cal renewal and keeps you covered in case of an emergency. What Happens After I Return My Form? The county will send you a letter letting you know if you still qualify for Medi-Cal coverage. How long do I have before I get disenrolled from Medi-Cal? If you do not renew your Medi-Cal on time, you only have 90 days after your Medi-Cal benefits expire to file for renewal. After 90 days, you will have to submit a brand new Medi-Cal application. To apply for Medi-Cal or discuss your Medi-Cal renewal, call our IEHP Enrollment Advisors at (866) 294-4347, Monday – Friday, 8am – 5pm. TTY users should call (800) 720-4347. *Due to the COVID-19 health crisis, Riverside and San Bernardino County continue to delay the processing of Medi-Cal annual redeterminations.
Pharmacy Services - Cal MediConnect
ect Plan (Medicare-Medicaid Plan)? IEHP DualChoice is a Cal MediConnect Plan. A Cal MediConnect Plan is an organization made up of doctors, hospitals, pharmacies, providers of long-term services and supports, behavioral health providers, and other providers. It also has care coordinators and care teams to help you manage all your providers and services. They all work together to provide the care you need. What is the goal of this program? The goal is to improve care by integrating the following healthcare services: Medicare and Medi-Cal benefits Long-term care Behavioral health Home and community-based services (HCBS) such as Community-Based Adult Services (CBAS) and Multipurpose Senior Services Program (MSSP). Who is eligible for IEHP DualChoice? People who have both Medicare and Medi-Cal. For a complete list of who is included or excluded, visit Who Qualifies? Plans and Benefits IEHP DualChoice integrates healthcare services to better coordinate care and improve health. How to Enroll To enroll, please call: IEHP DualChoice Medicare Team at 1-800-741-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY/TDD users should call 1-800-718-4347, OR Health Care Options (HCO) at 1-844-580-7272, 8am – 5pm (PST), Monday – Friday. TTY/TDD users should call 1-800-430-7077. For more information, visit the DHCS website. By clicking on this link, you will be leaving the IEHP DualChoice website. You may also call IEHP DualChoice for help at 1-877-273-IEHP (4347), 8am – 8pm (PST), 7 days a week, including holidays. TTY/TDD users should call 1-800-718-4347 (4347). Plan Benefits and Cost-Sharing: Find out about plan benefits which are the types of medical care that are covered. Also view information on cost-sharing which is how much you will pay for services or prescription drugs, including monthly plan premium and co-payment. Part D Prescription Drugs: Get information on pharmacy benefits, IEHP network pharmacies, out-of-network coverage, pharmacy transition process, drug utilization management, and prescription mail order. Provider Access Information: Learn about network providers, primary care providers, specialists and how to choose a provider in our network. Read about our quality assurance activities and find out what happens if your doctor leaves our plan. Grievances, Coverage Determination and Appeals Process: Find out what to do if you have a problem or complaint about your medical care or Part D. Helpful Information: View your rights and responsibilities upon disenrollment and as a Member of IEHP. You will also find important forms for 2018 such as our Privacy Notice, Plan Transition Process and the section of CMS' website regarding Best Available Evidence. Service Area: Find out which zip codes in Riverside and San Bernardino counties are included in our service area. IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Information on this page is current as of October 15, 2018. H5355_CMC_19_1059755 Accepted
technologies for individuals with disabilities by generating content that conforms to the Web Content Accessibility Guidelines (WCAG) 2.0, and Section 508 of the Rehabilitation Act meeting the requirements within the Americans with Disabilities Act. As part of the development process and ongoing website maintenance, IEHP tests the site using assistive technologies, including screen readers, screen magnifiers, speech recognition software and text-only browsers. IEHP uses tools, such as the W3C HTML. Validator, WAVE by WebAIM and the Color Contrast Analyzer, to ensure the best experience possible for all visitors. Should you have any feedback or concerns related to the accessibility of this webpage and resources contained within it, please contact us via email at firstname.lastname@example.org If applicable, please include the web address, brief description of the issue encountered and your contact information.
IEHP DualChoice - Grievances, Coverage Determination and Appeals Process
caid Plan): You can call IEHP Member Services at (877) 273-IEHP (4347) and ask for a Member Complaint Form. If you need help to fill out the form, IEHP Member Services can assist you. You can complete the Member Complaint Form online. You can give the completed form to any IEHP Provider or mail it to: P.O Box 1800, Rancho Cucamonga, CA 91729-1800 You can fax the completed form to (909) 890-5877. You can file a grievance online. This form is for IEHP DualChoice as well as other IEHP programs. For some types of problems, you need to use the process for coverage decisions and making appeals. For other types of problems you need to use the process for making complaints. Both of these processes have been approved by Medicare. To ensure fairness and prompt handling of your problems, each process has a set of rules, procedures, and deadlines that must be followed by us and by you. Long-Term Services and Supports: If you are having a problem with your care, you can call the Cal MediConnect Ombuds Program at (855) 501-3077 for help. For problems and concerns regarding eligibility determinations, assessments, and care delivered by our contracted Community Based Adult Services (CBAS) centers, Multipurpose Senior Services Program (MSSP) sites, or Nursing Facilities/Sub-Acute Care Facilities, you should follow the process outlined below. Community Based Adult Services (CBAS) You can call IEHP Member Services at (877) 273-IEHP (4347) and ask for a Member Complaint Form. If you need help to fill out the form, IEHP Member Services can assist you. You can give the completed form to any IEHP Provider or mail it to: P.O Box 1800 Rancho Cucamonga, CA 91729-1800 You can fax the completed form to (909) 890-5877. You can file a grievance online. This form is for IEHP DualChoice as well as other IEHP programs. Help in Handling a Problem You can contact Medicare. Here are two ways to get information directly from Medicare: You can call (800) MEDICARE (800) 633-4227, 24 hours a day, 7 days a week, TTY (877) 486-2048. You can visit the Medicare website By clicking on this link, you will be leaving the IEHP DualChoice website. Get Help from an Independent Government Organization We are always available to help you. But in some situations, you may also want help or guidance from someone who is not connected with us. You can always contact your State Health Insurance Assistance Program (SHIP). This government program has trained counselors in every state. The program is not connected with us or with any insurance company or health plan. The counselors at this program can help you understand which process you should use to handle a problem you are having. They can also answer your questions, give you more information, and offer guidance on what to do. The services of SHIP counselors are free. You can call SHIP at (800) 434-0222. Get Help and Information from DHCS Call: (916) 445-4171 MCI from TDD at (800) 735-2929 MCI from Voice Telephone: (800) 735-2922 Sprint from TDD at (800) 877-5378 Sprint from Voice Telephone: (800) 877-5379 Write to: Department of Health Care Services 1501 Capitol Ave., P.O. Box 997413, Sacramento, CA 95899-7413 Website:www.dhcs.ca.gov By clicking on this link, you will be leaving the IEHP DualChoice website. Get Help and Information from Medi-Cal The Cal MediConnect Ombuds Program can answer your questions and help you understand what to do to handle your problem. The Cal MediConnect Ombuds Program is not connected with us or with any insurance company or health plan. They can help you understand which process to use. Call: (855) 501-3077 (TTY (855) 847-7914) Monday through Friday, 9 a.m. to 5 p.m. Visit their website at: www.healthconsumer.org/ By clicking on this link, you will be leaving the IEHP DualChoice website. Get Help and Information from Livanta Call: (877) 588-1123, TTY (855) 887-6668 For appeals: (855) 694-2929 For all other reviews: (844) 420-6672 Write to: Livanta BFCC-QIO Program, 10820 Guilford Road, Suite 202, Annapolis Junction, Maryland 20701 Website: www.livanta.com By clicking on this link, you will be leaving the IEHP DualChoice website. How to obtain an aggregate number of grievances, appeals, and exceptions filed with IEHP DualChoice MediConnect Plan (Medicare - Medicaid Plan)? Please call or write to IEHP DualChoice Member Services. Call: (877) 273-IEHP (4347). Calls to this number are free. 8am - 8pm (PST), 7 days a week, including holidays, TTY: (800) 718-4347. This number requires special telephone equipment. Calls to this number are free. Fax: (909) 890-5877 Write: IEHP DualChoice, P.O. Box 1800, Rancho Cucamonga, CA 91729-1800 Email: email@example.com Visit: 10801 Sixth Street, Suite 120, Rancho Cucamonga, CA 91730 IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Information on this page is current as of October 08, 2021. H5355_CMC_22_2246727 Accepted
COVID-19 - Resources
19. Below you will find resources and information on how to protect yourself and your loved ones during this time. How vaccines build immunity While the COVID-19 vaccines are relatively new - the technology and science behind the vaccines have been in development for decades. In the video below, we demonstrate how years of vaccine research and advanced technology allowed researchers and scientists worldwide to be prepared to develop an mRNA vaccine that could help fight the spread of a global infectious disease. COVID-19: Home isolation tips If you or someone in your household has been diagnosed with COVID-19, there are necessary steps you can take to reduce the risk of it spreading to those you live with. COVID-19: What to do when you're sick IEHP Chief Medical Officer, Dr. Karen Hansberger, is here to discuss what you need to do if you find yourself sick from COVID-19. Face Mask Resources Proper use of face coverings (CDC) How to make a homemade mask How to make your own face mask (whether or not you know how to sew) Refer to the following resources for information on self isolation during COVID-19. Riverside County COVID-19 Self Isolation Recommendations For IEHP DualChoice Members A healthcare fraud alert has been issued in relation to COVID-19 complaints. Scammers are giving COVID-19 tests to Medicare Members in trade for personal details. They are reaching out to Medicare Members by sales calls, social media platforms, and door to door visits. The personal details taken may be used to falsely bill Federal health care programs and the COVID-19 test kits may cause harm to Members. If you suspect COVID-19 fraud, call IEHP right away at: Compliance Hotline: (866) 355-9038 Fax: (909) 477-8536 E-mail: firstname.lastname@example.org Mail: IEHP Compliance Officer P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 Click here to report a compliance issue online. Refer to the following websites/resources for more information on coronavirus (COVID-19). Centers for Disease Control and Prevention (CDC) Riverside County Public Health San Bernardino Public Health State of California Coronavirus (COVID-19) Updates CA COVID-19 Rent Relief Portal California Workplace Rights Immigrant Eligibility for Public Programs during COVID-19 Protections for Housing and Utility Shutoff Order ConnectIE Below you will find resources and information on local food pantries in your area. Riverside County Pantries: A list of food pantries in Riverside County San Bernardino County Pantries: A list of food pantries in San Bernardino County Connect IE: A free website that provides community resources 24/7. It can connect you to housing services, job training's, food pantries and more. High Desert Food Distribution:The High Desert is hosting a food distribution on the last Thursday of every month.
IEHP DualChoice - Important Resources
rm (PDF) Medicare Complaint Form (by clicking this link, you will be leaving the IEHP DualChoice website) The IEHP DualChoice Privacy Notice describes how medical information about you may be used and disclosed, and how you can get access to this information. IEHP DualChoice Privacy Notice (PDF) Centers for Medicare and Medicaid Services The following link will take you to the Centers for Medicaid and Medicare Services website, where you can look through the CMS Best Available Evidence Policy using the following link: CMS Best Available Evidence Policy. By clicking on this link, you will be leaving the IEHP DualChoice website. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here. By clicking on this link, you will be leaving the IEHP DualChoice website. IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Information on this page is current as of October 08, 2021. H5355_CMC_22_2246727 Accepted
Community Partners - About our Partners
de and San Bernardino counties. Visit our Community Calendar to find upcoming partner events near you. How can you become a Community Partner with IEHP? Read about the Community Partner Network Meeting to learn more. Please contact our Community Outreach Team for help. If your organization is interested in becoming an IEHP Community Partner, please sign up here. How can I find resources in my community? ConnectIE is a new one-stop, interactive website that makes it easy to link people to community resources in the Inland Empire. Visit ConnectIE to find out more!
Medical Benefits & Coverage Of Medi-Cal In California
d services as a Member of IEHP. Your covered services are at no cost if they are medically necessary, and you get the approved services from our Provider network. “Medically necessary” means it is reasonable and needed to protect life, to keep you from becoming seriously ill or disabled, or to reduce pain from a diagnosed disease, illness or injury. To learn more about IEHP’s benefits and services, read Chapter 4 of the IEHP Medi-Cal Member Handbook (PDF) or call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347. IEHP offers these types of services: Outpatient (ambulatory) services* Emergency services Transgender services* Hospice and palliative care* Hospitalization* Maternity and newborn care Mental health services Prescription drugs Rehabilitative and habilitative services and devices* Laboratory and radiology services, such as X-rays* Preventive and wellness services and chronic disease management Sensitive services Substance use disorder treatment services Pediatric services Vision services* Non-emergency medical transportation (NEMT) Non-medical transportation (NMT) Long-term services and supports (LTSS) Telehealth services Some of the services listed are covered only if IEHP or your IPA approves first. Covered services that may need an approval from IEHP or your IPA or medical group first are marked by an asterisk (*). Vision services The plan covers: Routine eye exam once every 24 months; IEHP may pre-approve (prior authorization) additional services as medically necessary. Eyeglasses (frames and lens) once every 24 months; contact lens when required for medical conditions such as aphakia, aniridia and keratoconus Limitations Single vision lenses only. Members under 18 automatically get polycarbonate lenses. Contacts in lieu of glasses only if medically necessary. Dental services The Medi-Cal Dental Program covers some dental services, such as: Diagnostic and preventive dental hygiene (e.g., examinations, x-rays, and teeth cleanings) Emergency services for pain control Tooth extractions Fillings Root canal treatments Prosthetic appliances Orthodontics for children who qualify Members can access dental services through providers enrolled in the Medi-Cal Dental Program. They will advise you on the best course of treatment and when these services may be attained. To learn more about dental services, call the Medi-Cal Dental Program at 1-800-440-IEHP (4347) / TTY (800) 718-4347. You may also visit the Denti-Cal website at www.smilecalifornia.org. Transportation services Your Medi-Cal benefits include round trip transportation for plan-covered health services and Medi-Cal-covered services, such as mental health, substance abuse and dental, within San Bernardino and Riverside counties. The plan covers: Visits to your Primary Care Doctor, Specialists and urgent care clinics. Visit for dental, mental health, substance abuse and other services. Exclusions and Limitations IEHP does not cover: One-way trips and non-medical visits. Visits to Social Security, Workers Compensation Claims, Personal Injury cases, Courts, Parole or Probation or Social Services Offices. IEHP offers two types of transportation: Bus passes* for Non-Medical Transportation (NMT): approved when you do not have any physical or medical issue that does not allow you to travel by bus, car, taxi or other forms of public transportation. Uber for Non-Medical Transportation (NMT): approved when your area doesn’t support bus passes, or you are crossing counties. For this type of transportation, you need to wait for your ride at the curb. Non-Emergent Medical Transportation (NEMT): approved when your medical or physical issue does not allow you to travel by bus, car, taxi or other forms of public transportation. For this type of transportation, your Doctor must submit a Physicians’ Certification Statement online. Effective March 1, 2020, transportation for routine medical visits including Behavioral Health and Substance Use must be scheduled five business days before your appointment. To set up transportation, call IEHP Transportation Department at 1-800-440-4347 (option two), Monday – Friday, 8am – 5pm. TTY users should call 1-800-718-4347 (option two). *For bus passes, call American Logistics Company at 855-673-3195 selection option 1. Once you get your bus pass, you can use this for all of your health care visits. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. To download a free copy click Adobe Acrobat Reader. The Postpartum Care Extension Program The Postpartum Care Extension Program provides extended coverage for Medi-Cal members during both the pregnancy and after pregnancy. The Postpartum Care Extension Program extends coverage by IEHP for up to 12 months after the end of the pregnancy regardless of income, citizenship, or immigration status and no additional action is needed. Rapid Whole Genome Sequencing Rapid Whole Genome Sequencing (rWGS), including individual sequencing, trio sequencing for a parent or parents and their baby, and ultra-rapid sequencing, is a covered benefit for any Medi-Cal member who is one year of age or younger and is receiving inpatient hospital services in an intensive care unit. rWGS is an emerging method of diagnosing conditions in time to affect ICU care of children one year of age or younger. If your child is eligible for California Children’s Services (CCS), CCS may be responsible for covering the hospital stay and the rWGS. Referrals For some types of care, your PCP or specialist will need to ask IEHP for permission before you get the care. This is called asking for prior authorization, prior approval, or pre-approval. It means that IEHP must make sure that the care is medically necessary or needed based on appropriateness of care and services and existence of coverage. Care is medically necessary if it is reasonable and necessary to protect your life, keeps you from becoming seriously ill or disabled, or reduces severe pain from a diagnosed disease, illness or injury. For some services, you need pre-approval (prior authorization). Under Health and Safety Code Section 1367.01(h)(2), IEHP will decide routine pre-approvals within 5 working days of when IEHP gets the information reasonably needed to decide. For requests in which a provider indicates or IEHP determines that following the standard timeframe could seriously jeopardize your life or health or ability to attain, maintain, or regain maximum function, IEHP will make an expedited (fast) pre-approval decision. IEHP will give notice as quickly as your health condition requires and no later than 72 hours after receiving the request for services. If IEHP does not approve the request, IEHP will send you a Notice of Action (NOA) letter. The NOA letter will tell you how to file an appeal if you do not agree with the decision. IEHP will contact you if IEHP needs more information or more time to review your request. Continuity of Care If you now go to providers who are not in the IEHP network (out-of-network), in certain cases you may get continuity of care and be able to go to them for up to 12 months. If your providers do not join the IEHP network by the end of 12 months, you will need to switch to providers in the IEHP network. If you are a new Member, you may request to keep getting medical services from an out of network provider if you were getting this care before enrolling in IEHP. IEHP will decide if this treatment with an out of network provider is medically appropriate. Continuity of care does not extend to durable medical equipment, transportation, ancillary services, carved out services or services not covered by Medi-Cal. To learn more about continuity of care and eligibility qualifications, call IEHP Member Services at 1-800-440-IEHP (4347). Prescription drugs Most prescription drugs are covered by Medi-Cal Rx, some drugs may be covered by IEHP. Your provider can prescribe you drugs that are on the Medi-Cal Rx Contract Drugs List. To find out if a drug is on the Contract Drug List or to get a copy of the Contract Drug List, call Medi-Cal Rx at 1-800-977-2273 (TTY 1-800-977-2273 and press 5 or 711), visit the Medi-Cal Rx website at www.MediCalRx.dhcs.ca.gov/home/, or call IEHP Member Services at 1-800-440-IEHP (4347), Monday-Friday, 8am-5pm. TTY users should call 1-800-718-4347 or 711. Pharmacies If you are filling or refilling a prescription, you must get your prescribed drugs from a pharmacy that works with Medi-Cal Rx. You can find a list of pharmacies that work with Medi-Cal Rx in the Medi-Cal Rx Pharmacy Directory at www.Medi-CalRx.hcs.ca.gov/home/. You can also find a pharmacy near you by calling Medi-Cal Rx at 1-800-977-2273 (TTY 1-800-977-2273 and press 5 or 711). Or call IEHP Member Services at 1-800-440-IEHP (4347), Monday-Friday, 8am-5pm. TTY users should call 1-800-718-4347 or 711.
IEHP DualChoice - 2022 Plan Benefits
ll pay: Benefits Doctor Visit: $0 Vision Care: $150 limit every two years for contact lenses and eyeglasses (frames and lenses) Inpatient Hospital Care: $0 Home Health Agency Care: $0 Ambulance Services: $0 Transportation: $0. Including bus pass. Call American Logistics Company (ALC) at (866) 880-3654, for TTY users, call your relay service or California Relay Service at 711. For reservations call Monday-Friday, 7am-6pm (PST). Call at least 5 days before your appointment. Diagnostic Tests, X-Rays & Lab Services: $0 Durable Medical Equipment: $0 Home and Community Based Services (HCBS): $0 Community Based Adult Services (CBAS): $0 Long Term Care that includes custodial care and facility: $0 You pay nothing for a one-month or long term-supply of drugs With IEHP DualChoice, you pay nothing for covered drugs as long as you follow the plan’s rules. Tier 1 drugs are: generic drugs. They have a copay of $0. Tier 2 drugs are brand name drugs. They have a copay of $0. Tier 3 drugs are over-the-counter drugs. They have a copay of $0. After your coverage begins with IEHP DualChoice, you must receive medical services and prescription drug services in the IEHP DualChoice network. To learn more about the plan’s benefits, cost-sharing, applicable conditions and limitations, refer to the IEHP DualChoice Member Handbook. 2022 Summary of Benefits (PDF) 2022 Annual Notice of Changes (PDF) 2022 IEHP DualChoice Member Handbook (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Click here to download a free copy of Adobe Acrobat Reader.By clicking on this link, you will be leaving the IEHP DualChoice website. Plan Premium There is no plan premium for IEHP DualChoice. Plan Deductible There is no deductible for IEHP DualChoice. Because you are eligible for Medi-Cal, you qualify for and are getting “Extra Help” from Medicare to pay for your prescription drug plan costs. You do not need to do anything further to get this Extra Help. You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, you can contact: (800) 633-4227 (MEDICARE), TTY users should call (877) 486-2048, 24 hours a day/7days a week The Social Security Office at (800) 772-1213 between 7 a.m. and 7 p.m., Monday through Friday, TTY users should call (800) 325-0778; or Your State Medicaid Office How to get care coordination Do you need help getting the care you need? A care team can help you. A care team may include your doctor, a care coordinator, or other health person that you choose. A care coordinator is a person who is trained to help you manage the care you need. You will get a care coordinator when you enroll in IEHP DualChoice. This person will also refer you to community resources, if IEHP DualChoice does not provide the services that you need. To speak with a Care Coordinator, please call IEHP DualChoicenat (877) 273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY users should call 1-800-718-4347. Prior Authorization and Out of Network Coverage What kinds of medical care and other services can you get without getting approval in advance from your Primary Care Provider (PCP) in IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan)? You can get services such as those listed below without getting approval in advance from your Primary Care Provider (PCP). Routine women’s health care, which includes breast exams, screening mammograms (X-rays of the breast), Pap tests, and pelvic exams as long as you Urgently needed care from in-network providers or from out-of-network providers when network providers are temporarily unavailable or inaccessible, e.g., when you are temporarily outside of the plan’s service area. Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area. (If possible, please call IEHP DualChoice Member Services before you leave the service area so we can help arrange for you to have maintenance dialysis while you are away.) How to get care from specialists and other network providers A specialist is a doctor who provides health care services for a specific disease or part of the body. There are many kinds of specialists. Here are a few examples: Oncologists care for patients with cancer. Cardiologists care for patients with heart conditions. Orthopedists care for patients with certain bone, joint, or muscle conditions. You will usually see your PCP first for most of your routine healthcare needs such as physical checkups, immunization, etc. When your PCP thinks that you need specialized treatment or supplies, your PCP will need to get prior authorization (i.e., prior approval) from your Plan and/or medical group. This is called a referral. Your PCP will send a referral to your plan or medical group. It is very important to get a referral (approval in advance) from your PCP before you see a Plan specialist or certain other providers. If you don’t have a referral (approval in advance) before you get services from a specialist, you may have to pay for these services yourself. PCPs are usually linked to certain hospitals and specialists. When you choose a PCP, it also determines what hospital and specialist you can use. What if a specialist or another network provider leaves our plan? Sometimes a specialist, clinic, hospital or other network provider you are using might leave the plan. When a provider leaves a network, we will mail you a letter informing you about your new provider. If you prefer a different one, please call IEHP DualChoice Member Services and we can assist you in finding and selecting another provider. How to get care from out-of-network providers When your doctor recommends services that are not available in our network, you can receive these services by an out-of-network provider. In order to receive out-of-network services, your Primary Care Provider (PCP) or Specialist must submit a referral request to your plan or medical group. All requests for out-of-network services must be approved by your medical group prior to receiving services. IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. This information is not a complete description of benefits. Contact the plan for more information. Information on this page is current as of October 8, 2021. H5355_CMC_22_2246727 Accepted
IEHP DualChoice - Problems with Part D
have problems getting a Part D drug or you want us to pay you back for a Part D drug. Your benefits as a member of our plan include coverage for many prescription drugs. Most of these drugs are “Part D drugs.” There are a few drugs that Medicare Part D does not cover but that Medi-Cal may cover. Can I ask for a coverage determination or make an appeal about Part D prescription drugs? Yes. Here are examples of coverage determination you can ask us to make about your Part D drugs. You ask us to make an exception such as: Asking us to cover a Part D drug that is not on the plan’s List of Covered Drugs (Formulary) Asking us to waive a restriction on the plan’s coverage for a drug (such as limits on the amount of the drug you can get) You ask us if a drug is covered for you (for example, when your drug is on the plan’s Formulary but we require you to get approval from us before we will cover it for you). Please note: If your pharmacy tells you that your prescription cannot be filled, you will get a notice explaining how to contact us to ask for a coverage determination. You ask us to pay for a prescription drug you already bought. This is asking for a coverage determination about payment. If you disagree with a coverage decision we have made, you can appeal our decision. What is an exception? An exception is permission to get coverage for a drug that is not normally on our List of Covered Drugs, or to use the drug without certain rules and limitations. If a drug is not on our List of Covered Drugs, or is not covered in the way you would like, you can ask us to make an “exception.” When you ask for an exception, your doctor or other prescriber will need to explain the medical reasons why you need the exception. Here are examples of exceptions that you or your doctor or another prescriber can ask us to make: Covering a Part D drug that is not on our List of Covered Drugs (Formulary). If we agree to make an exception and cover a drug that is not on the Formulary, you will need to pay the cost-sharing amount that applies to drugs in Tier 2 for brand name drugs or Tier 1 for generic drugs. You cannot ask for an exception to the co-payment or coinsurance amount we require you to pay for the drug. Removing a restriction on our coverage. There are extra rules or restrictions that apply to certain drugs on our Formulary. The extra rules and restrictions on coverage for certain drugs include: Being required to use the generic version of a drug instead of the brand name drug. Getting plan approval before we will agree to cover the drug for you. (This is sometimes called “prior authorization.”) Being required to try a different drug first before we will agree to cover the drug you are asking for. (This is sometimes called “step therapy.”) Quantity limits. For some drugs, the plan limits the amount of the drug you can have. If we agree to make an exception and waive a restriction for you, you can still ask for an exception to the co-pay amount we require you to pay for the drug. Important things to know about asking for exceptions Your doctor or other prescriber must give us a statement explaining the medical reasons for requesting an exception. Our decision about the exception will be faster if you include this information from your doctor or other prescriber when you ask for the exception. Typically, our Formulary includes more than one drug for treating a particular condition. These different possibilities are called “alternative” drugs. If an alternative drug would be just as effective as the drug you are asking for, and would not cause more side effects or other health problems, we will generally not approve your request for an exception. We will say Yes or No to your request for an exception. If we say Yes to your request for an exception, the exception usually lasts until the end of the calendar year. This is true as long as your doctor continues to prescribe the drug for you and that drug continues to be safe and effective for treating your condition. If we say No to your request for an exception, you can ask for a review of our decision by making an appeal. Coverage Decision What to do Ask for the type of coverage decision you want. Call, write, or fax us to make your request. You, your representative, or your doctor (or other prescriber) can do this. You can call us at: (877) 273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY users should call 1-800-718-4347. You can fax us at: (909) 890-5877 You can to write us at: IEHP DualChoice P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 You or your doctor (or other prescriber) or someone else who is acting on your behalf can ask for a coverage decision. You can also have a lawyer act on your behalf. You do not need to give your doctor or other prescriber written permission to ask us for a coverage determination on your behalf. If you are requesting an exception, provide the “supporting statement.” Your doctor or other prescriber must give us the medical reasons for the drug exception. We call this the “supporting statement.” Your doctor or other prescriber can fax or mail the statement to us. Or your doctor or other prescriber can tell us on the phone, and then fax or mail a statement. Request for Medicare Prescription Drug Coverage Determination (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Click here to download a free copy by clicking Adobe Acrobat Reader. These forms are also available on the CMS website: Medicare Prescription Drug Determination Request Form (for use by enrollees and providers) By clicking on this link, you will be leaving the IEHP DualChoice website. Deadlines for a “standard coverage decision” about a drug you have not yet received If we are using the standard deadlines, we must give you our answer within 72 hours after we get your request or, if you are asking for an exception, after we get your doctor’s or prescriber’s supporting statement. We will give you our answer sooner if your health requires it. If we do not meet this deadline, we will send your request on to Level 2 of the appeals process. At Level 2, an Independent Review Entity will review the decision. If our answer is Yes to part or all of what you asked for, we must approve or give the coverage within 72 hours after we get your request or, if you are asking for an exception, your doctor’s or prescriber’s supporting statement. If our answer is No to part or all of what you asked for, we will send you a letter that explains why we said No. The letter will also explain how you can appeal our decision. Deadlines for a “standard coverage decision” about payment for a drug you have already bought We must give you our answer within 14 calendar days after we get your request. If we do not meet this deadline, we will send your request to Level 2 of the appeals process. At level 2, an Independent Review Entity will review the decision. If our answer is Yes to part or all of what you asked for, we will make payment to you within 14 calendar days. If our answer is No to part or all of what you asked for, we will send you a letter that explains why we said No. This statement will also explain how you can appeal our decision. If your health requires it, ask us to give you a “fast coverage decision” We will use the “standard deadlines” unless we have agreed to use the “fast deadlines.” A standard coverage decision means we will give you an answer within 72 hours after we get your doctor’s statement. A fast coverage decision means we will give you an answer within 24 hours after we get your doctor’s statement. You can get a fast coverage decision only if you are asking for a drug you have not yet received. (You cannot get a fast coverage decision if you are asking us to pay you back for a drug you have already bought.) You can get a fast coverage decision only if using the standard deadlines could cause serious harm to your health or hurt your ability to function. If your doctor or other prescriber tells us that your health requires a “fast coverage decision,” we will automatically agree to give you a fast coverage decision, and the letter will tell you that. If you ask for a fast coverage decision on your own (without your doctor’s or other prescriber’s support), we will decide whether you get a fast coverage decision. If we decide that your medical condition does not meet the requirements for a fast coverage decision, we will use the standard deadlines instead. We will send you a letter telling you that. The letter will tell you how to make a complaint about our decision to give you a standard decision. You can file a “fast complaint” and get a response to your complaint within 24 hours. Deadlines for a “fast coverage decision” If we are using the fast deadlines, we must give you our answer within 24 hours. This means within 24 hours after we get your request. Or, if you are asking for an exception, 24 hours after we get your doctor’s or prescriber’s statement supporting your request. We will give you our answer sooner if your health requires us to. If we do not meet this deadline, we will send your request on to Level 2 of the appeals process. At Level 2, an outside independent organization will review your request and our decision. If our answer is Yes to part or all of what you asked for, we must give you the coverage within 24 hours after we get your request or your doctor’s or prescriber’s statement supporting your request. If our answer is No to part or all of what you asked for, we will send you a letter that explains why we said No. The letter will also explain how you can appeal our decision. Level 1 Appeal for Part D drugs To start your appeal, you, your doctor or other prescriber, or your representative must contact us. If you are asking for a standard appeal, you can make your appeal by sending a request in writing. You may also ask for an appeal by calling IEHP DualChoice Member Services at 1-877-273-IEHP (4347), 8am – 8pm (PST), 7 days a week, including holidays. TTY/TDD users should call 1-800-718-4347. If you want a fast appeal, you may make your appeal in writing or you may call us. Make your appeal request within 60 calendar days from the date on the notice we sent to tell you our decision. If you miss this deadline and have a good reason for missing it, we may give you more time to make you appeal. For example, good reasons for missing the deadline would be if you have a serious illness that kept you from contacting us or if we gave you incorrect or incomplete information about the deadline for requesting an appeal. You can ask for a copy of the information in your appeal and add more information. You have the right to ask us for a copy of the information about your appeal. If you wish, you and your doctor or other prescriber may give us additional information to support your appeal. You may use the following form to submit an appeal: Coverage Determination Form (PDF) Can someone else make the appeal for me? Yes. Your doctor or other provider can make the appeal for you. Also, someone besides your doctor or other provider can make the appeal for you, but first you must complete an Appointment of Representative Form. The form gives the other person permission to act for you. If the appeal comes from someone besides you or your doctor or other provider, we must receive the completed Appointment of Representative form before we can review the appeal. Deadlines for a “standard appeal” If we are using the standard deadlines, we must give you our answer within 7 calendar days after we get your appeal, or sooner if your health requires it. If you think your health requires it, you should ask for a “fast appeal.” If you are asking us to pay you back for a drug you already bought, we must give you our answer within 14 calendar days after we get your appeal. If we do not give you a decision within 7 calendar days, or 14 days if you asked us to pay you back for a drug you already bought, we will send your request to Level 2 of the appeals process. At Level 2, an Independent Review Entity will review our decision. If your health requires it, ask for a “fast appeal” If you are appealing a decision our plan made about a drug you have not yet received, you and your doctor or other prescriber will need to decide if you need a “fast appeal.” The requirements for getting a “fast appeal” are the same as those for getting a “fast coverage decision.” Our plan will review your appeal and give you our decision We take another careful look at all of the information about your coverage request. We check to see if we were following all the rules when we said No to your request. We may contact you or your doctor or other prescriber to get more information. Deadlines for a “fast appeal” If we are using the fast deadlines, we will give you our answer within 72 hours after we get your appeal, or sooner if your health requires it. If we do not give you an answer within 72 hours, we will send your request to Level 2 of the appeals process. At Level 2, an Independent Review Entity will review your appeal. If our answer is Yes to part or all of what you asked for, we must give the coverage within 72 hours after we get your appeal. If our answer is No to part or all of what you asked for, we will send you a letter that explains why we said No. Level 2 Appeal for Part D drugs If we say No to your appeal, you then choose whether to accept this decision or continue by making another appeal. If you decide to go on to a Level 2 Appeal, the Independent Review Entity (IRE) will review our decision. If you want the Independent Review Organization to review your case, your appeal request must be in writing. Ask within 60 days of the decision you are appealing. If you miss the deadline for a good reason, you may still appeal. You, your doctor or other prescriber, or your representative can request the Level 2 Appeal. When you make an appeal to the Independent Review Entity, we will send them your case file. You have the right to ask us for a copy of your case file. You have a right to give the Independent Review Entity other information to support your appeal. The Independent Review Entity is an independent organization that is hired by Medicare. It is not connected with this plan and it is not a government agency. Reviewers at the Independent Review Entity will take a careful look at all of the information related to your appeal. The organization will send you a letter explaining its decision. If we uphold the denial after Redetermination, you have the right to request a Reconsideration. See form below: Reconsideration Form (PDF) Deadlines for a “fast appeal” at Level 2 If your health requires it, ask the Independent Review Entity for a “fast appeal.” If the review organization agrees to give you a “fast appeal,” it must give you an answer to your Level 2 Appeal within 72 hours after getting your appeal request. If the Independent Review Entity says Yes to part or all of what you asked for, we must authorize or give you the drug coverage within 24 hours after we get the decision. Deadlines for “standard appeal” at Level 2 If you have a standard appeal at Level 2, the Independent Review Entity must give you an answer to your Level 2 Appeal within 7 calendar days after it gets your appeal. If the Independent Review Entity says Yes to part or all of what you asked for, we must authorize or give you the drug coverage within 72 hours after we get the decision. If the Independent Review Entity approves a request to pay you back for a drug you already bought, we will send payment to you within 30 calendar days after we get the decision. What if the Independent Review Entity says No to your Level 2 Appeal? No means the Independent Review Entity agrees with our decision not to approve your request. This is called “upholding the decision.” It is also called “turning down your appeal.” If the dollar value of the drug coverage you want meets a certain minimum amount, you can make another appeal at Level 3. The letter you get from the Independent Review Entity will tell you the dollar amount needed to continue with the appeals process. The Level 3 Appeal is handled by an administrative law judge. For more information see Chapter 9 of your IEHP DualChoice Member Handbook. IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Information on this page is current as of October 08, 2021. H5355_CMC_22_2246727 Accepted