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This includes making a plan to improve safety and taking routine tests and health screenings to detect health problems and treat them early. Advanced Care Directive What’s an Advanced Care Directive and why do I need someone else to help me? Advanced Care Directive is a specific type of power of attorney or health care proxy, in which the person authorizes someone (an agent) to make decisions on their behalf when they are unable to do so. Decisions can be large and small.  For example, “Who will be responsible for communicating with your family?” or “In the final stages of living, do you want to be at home?” IEHP offers free Advanced Care Directive Workshops to help you. Call IEHP Health Education Department at 1-866-224-IEHP (4347) or 1-800-718-4347 for TTY users to see if a workshop is coming up near you! See also: Advanced Care Directive Guide (PDF) Advanced Care Directive Form (PDF) PREPARE: A California program to help you make medical decisions for yourself and others. National Library of Medicine: Seniors' Health You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader.

ing is not just about old age. At any age, a medical crisis could leave you too ill to make your own health care decisions. Even if you are not sick now, planning for health care in the future is an important step toward making sure you get the medical care you would want, if you are unable to speak for yourself and doctors and family members are making the decisions for you. MY LIFE. MY CHOICE. is IEHP’s Advance Care Planning program for IEHP DualChoice Members. The online program helps you fill out Advance Care Directive forms and gives you a place to keep them safe to share with your Doctor. IEHP can also store related documents like Physician Orders for Life-Sustaining Treatment, Living Wills, Health Care Power of Attorney and Do Not Resuscitate forms. MY LIFE. MY CHOICE. is accessible through the IEHP Member Portal. You can easily upload your Advance Care Directives and access them at any time from your home computer or smartphone. You can also share your forms with your family, friends and caregivers by email, SMS and fax. If you get sick and cannot make medical decisions, having these documents lets others know your wishes about medical care. This ensures you get the treatment and medical care you want. You can learn more about Advance Care Planning by accessing MY LIFE. MY CHOICE. through the IEHP Member Portal OR attending an in-person workshop.  Register online: Log in to the Member portal.  Log in to MY LIFE. MY CHOICE. Follow the steps to begin your Advance Care Planning. Register for an in-person workshop: Log in to the Member portal at www.iehp.org. Click the Health & Wellness tab. Choose “Senior Health” for a list of workshops with dates and times. Choose the workshop you want to attend.  For assistance with MY LIFE. MY CHOICE. please call IEHP Member Services at 1-800-440-IEHP (4347). TTY users should call 1-800-718-4347.

iding between the ER and Urgent Care. For medical advice before visiting the ER or an Urgent Care Clinic, you can call your Doctor or IEHP 24-Hour Nurse Advice Line (888) 244-4347, TTY 711. Note that ERs are open 24 hours a day and many Urgent Care clinics close in the late evening. When Should I Go to the ER? An emergency is when a person could die or be permanently hurt. The ER provides care for critical or life-threatening conditions.   Visit your closest ER or call 911 if you experience: Changes in mental status, such as confusion Chest pain or pressure Coughing or vomiting blood Difficulty breathing or shortness of breath Severe allergic reaction Severe or persistent vomiting or diarrhea Sudden dizziness, weakness or changes in vision Sudden or severe pain Visit Provider Search for listing of emergency room locations near you. When Should I go to an Urgent Care? Go to an Urgent Care Clinic when you need care after hours for non-life-threatening conditions.  Here are some examples of conditions: A common illness like the flu Minor fever or headache Painful sore throat Earache or sinus pain Minor injuries like a sprained ankle Back pain Cuts or small wounds Small burns Rash or minor allergic reactions Nausea Diarrhea Urinary tract infections There are more than 90 clinics in our IEHP network. Many are open late and on weekends. Search Provider Search or call the IEHP 24-Hour Nurse Advice Line (888) 244-4347, TTY 711.

ic of the moment, it may not always be clear where to go to get help. Besides the worry of the injury or illness itself, you may also be thinking, “does Medi-Cal cover urgent care?” Finding an urgent care clinic that takes Medi-Cal is not the only priority. You also need to think about what kind of treatment you need and where to go to get it. Consider the following example: It is a Saturday morning, and you have a severe stomachache and now start to have a fever. You want to get medical treatment as soon as possible but know your Doctor is closed on the weekend. So, you are not sure whether to go to an urgent care clinic or the emergency room. You also want to make sure there are urgent care clinics nearby that accepts Medi-Cal. Yes, many urgent care clinics do accept Medi-cal. At IEHP we have over 90 urgent care clinics in our network that offer Members care afterhours, on weekends and on holidays, when your primary care doctor might be closed. Click here to search for an IEHP urgent care clinic in your area. Now, that you know that urgent care clinics accept Medi-Cal, let’s review when you might need urgent vs emergency care.  Urgent Care vs. Emergency Room  Urgent care is not the same as emergency care. Urgent care centers are for illnesses and injuries that are not life-threatening, yet still require treatment. Some examples include common illness like the flu, minor fever or headache, painful sore throat, earache or sinus pain, back pain, minor injuries like a sprained ankle, etc. Most urgent care centers provide same-day services and usually have shorter waiting times than emergency rooms.   Emergency rooms (ER) are for life-threatening emergencies and accidents where immediate treatment is required. Emergency rooms are open 24 hours a day 7 days a week and provide care for critical or life-threatening conditions. Visit your nearest ER or call 911 if you experience: changes in mental status, such as confusion, chest pain or pressure, coughing or vomiting blood, difficulty breathing or shortness of breath etc.  When to Visit Urgent Care  Urgent care clinics are not a substitute for your regular doctor. When you can't reach your Doctor after-hours or your Doctor is not available, you have options to get your needed care. Many people don’t realize there is a middle ground between a doctor’s visit and a trip to the ER.  Urgent care centers regularly handle a range of medical problems, including: Fevers Dehydration Small wounds  Vomiting/diarrhea Sprains Allergies Bites Cold or flu symptoms Emergency rooms handle life threatening conditions, including:  Head injuries Broken bones Chest pains Breathing difficulties Heart attack Stroke Serious burns Serious bleeding Be Prepared  Does urgent care take medical history into account? Absolutely! Your medical records form an important part of your treatment and follow-up care. As such, we always recommend you are ready with the following details: Information on pre-existing conditions. Details of past surgeries, when you had them, and which hospital and doctors performed them. A list of prescription medications you take, the dosage, and how often you take them.  A list of any over-the-counter medications you take, the dosage, and how often you take them. Any allergies you have. Make sure to bring your IEHP Member Card While nobody likes to think about being in an accident or suffering a sudden illness, it is important to be prepared. Your Doctor understands your health and medical background. Doctors at urgent care clinics will not have access to the same depth of information as your primary doctor, therefore, we recommend you that you follow up with your primary care Doctor after visiting an urgent care.  After-Hour and Urgent Care Services for IEHP Members  If you think you need urgent care, it’s always recommended to call your doctor’s office. If your doctor’s office is closed, you can call the IEHP 24-Hour Nurse Advice Line at (888) 244-4347, TTY 711, or click here to search for an IEHP Urgent Care clinic.   Of course, always call 911 if immediate medical care is needed. At IEHP, we pride ourselves on improving lives by delivering quality and accessible healthcare and will not rest until our communities enjoy optimal care and vibrant health. If you have any questions about your Medi-Cal benefits please 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 to learn more.

Do you need help coordinating care with your Doctors? IEHP can help. Our Complex Care Management (CCM) Program was designed to assist Members who are ill. This includes a serious illness, like heart disease, lung disease, kidney disease, AIDS, Hepatitis C, spinal injury or any other chronic uncontrolled condition.  IEHP’s Care Management Team will work with you and your Doctor to make sure you get the care you need. We can help you manage your illness and medicines, coordinate care, work with your Providers and help you to get any needed medical equipment. We also offer and invite you to make use of an Interdisciplinary Care Team (ICT) to help you with your personalized plan of care. This Team consists of your Primary Care Doctor, Complex Care Manager and others who support your health care needs. You may be referred to the CCM program through the following options:  Medical Management Program Referral Discharge Planner Referral Practitioner Referral Caregiver Referral Self-Referral How to opt in to the CCM program First, we will need to complete a health survey with you to assess your needs. This will help determine if you are eligible for the program. If you are eligible for the program and wish to opt in, you will be automatically enrolled.  If you are not eligible for the CCM program but want more information on other Care Management Services available, please contact IEHP Member Services at 1-800-440-4347.  After enrollment into the CCM program, you will be assigned a Primary Case Manager. The Case Manager will contact you at least once every 30 days to discuss your health goals. They will also assist you with a plan to meet those goals.  To get started, 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.  How to opt out of the CCM Program  Once enrolled, you may opt out of the program at any time. Simply contact IEHP Member Services at 1-800-440-4347 and let them know you no longer wish to be involved with the program. Be sure to notify your Case Manager as well.     

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ppy or you are having problems with your care, talk to your Doctor. Your Doctor will help you. If you need more help, 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. You can also file a grievance. Ask your Doctor for a form or select from the options below. GRIEVANCE FORM Print and mail grievance form (PDFs are below) Call IEHP Member Services and we will mail you a form If you are mailing your grievance form please send it to: IEHP, Attention: Grievance Dept. P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader.   Medi-Cal Member Complaint Form (PDF) IEHP DualChoice (HMO D-SNP) Complaint Form Within 5 days of getting your complaint, we will send you a letter letting you know we received it. Within 30 days, we will send you another letter that tells you how we resolved your problem. If you call IEHP about a grievance that is not about health care coverage, medical necessity, or experimental or investigational treatment, and your grievance is resolved by the end of the next working day, you may not receive a letter.  

January 2, 2023 Martin Luther King, Jr. Day - Monday, January 16, 2023 President's Day - Monday, February 20, 2023 Memorial Day - Monday, May 29, 2023 Juneteeth - Monday, June 19, 2023 Day before Independence Day - Monday, July 3, 2023 Independence Day - Tuesday, July 4, 2023 Labor Day - Monday, September 4, 2023 In observance of Veteran's Day - Friday, November 10, 2023 Thanksgiving Day - Thursday, November 23, 2023 Day after Thanksgiving - Friday, November 24, 2023 Christmas Day - Monday, December 25, 2023    

ces and feedback guide our services. As a result, we are able to improve how we deliver care and services. The PPPC meets every three months. We bring together IEHP staff and Members to give our Members a platform for open discussion. During the meetings, Members will have the opportunity to give feedback on member materials and their overall experience while receiving care with IEHP. We also discuss the IEHP Cultural and Linguistic (C&L) services program. Members who are selected to participate, will get $75 for each meeting they attend. All meetings will take place at IEHP headquarters from 12 p.m. - 2 p.m.   2023 Meeting Schedule March 15, 2023 June 21, 2023 September 20, 2023 December 20, 2023  

at you can to protect yourself from the flu virus. Everyone should get the flu shot. Members who are especially high risk for complications are: 65 years of age or older. Pregnant. Residents of nursing homes and long-term care facilities. Children, 6 months or older. Remember, in many cases, the flu shot can prevent the flu, lessen the symptoms if you get the flu and reduce spreading it to others. Common myths about the flu shot Myth 1: I can get the flu from the flu shot. False. The flu shot is made from a virus that is not active, so it doesn’t cause infection. Myth 2: I’m healthy; I don’t need the flu shot. False. Healthy people can get sick, too. Very sick. The flu shot can help lower your chances of getting sick. Myth 3: I got a flu shot last year. I don’t need a shot this year. False. The flu virus changes every year and so does the flu shot. You need a flu shot every year to fight this year's flu.  Frequently Asked Questions Q: Where can I get the flu shot? A: Your Doctor’s office (for adults and children), certain network pharmacies like CVS, Rite Aid and Walgreens (for adults only). Q: What are ways I can avoid getting the flu? A: To avoid getting the flu, you should:   Get the flu shot. Avoid close contact with people who are sick. Wear something to cover your mouth and nose when in public. Wash your hands often with soap and water. If you don't have soap and water, use an alcohol-based hand sanitizer.  Avoid touching your eyes, nose, and mouth.  Eat healthy. Drink lots of fluids, especially water.  Get plenty of rest. Clean and disinfect surfaces around you. Q: What should I do if I get the flu? A: If you get the flu, be sure to: Stay home and rest. Avoid others.  Drink lots of fluids, like water and juice. See your Doctor if symptoms do not improve. If you have the flu but can’t reach your Doctor, call the IEHP 24-Hour Nurse Advice Line at 1-888-244-IEHP (4347) or 711 for TTY users. Our nurses can connect you with a Board-Certified Doctor by telephone or virtual visit via video chat.

Members using text messaging, this form of communication can reach our Members immediately. Although information isn't limited to this common communication channel, we may send you important healthcare notifications to: Inform you on how to get care and services with IEHP Remind you about key preventive care visits to help you stay healthy Let you know about health education and wellness programs that you are eligible for And much more To sign up, Members need to text “Healthy” to 90902. Message and data rates may apply. For help, text HELP to 90902 or email texthelp@iehp.org. Members can unsubscribe by replying STOP at any time. Message frequency varies.  This texting program is available to Members who are the subscribers of Boost, AT&T, T-Mobile®, Dobson, Verizon Wireless, U.S. Cellular, C Spire Wireless, Metro PCS, Cricket Communications, Virgin Mobile and other wireless carriers. Carriers are not liable for delayed or undelivered messages. Members must be 13 years of age or older to use this service. You also agree to IEHP Wireless Text Messaging Terms and Conditions.  We respect your privacy. Our privacy policy can be found here. Contact Info: 10801 Sixth Street Rancho Cucamonga, CA 91730 1-800-440-IEHP (4347) 1-800-718-IEHP (4347) for TTY Users 8AM-5PM PST texthelp@iehp.org www.iehp.org *This short code program is managed by mPulse. www.mpulsemobile.com  

ively manage members on multiple opioid therapies to prevent overutilization, identify unsafe and inappropriate opioid use, and address potential fraud, waste, and abuse. Identified members at risk of opioid overutilization will be evaluation through our Pharmacy Pain Management Program (PPM). A clinical team will be reviewing member therapy and reaching out to the primary provider to discuss the existence of multiple prescribing providers, member's total opioid utilization, appropriate level of opioid use for the member, and considerations for implementation of a member-level claim edit. After review and consultation with the prescribing provider, if the member's therapy is determined to be appropriate and medically necessary, no further action will be taken.  Results of consultation with provider and findings will be documented. After review and consultation with the prescribing provider, if the member's therapy is determined to be inappropriate, and the provider recommends member-level point of sale claim edit, the member will be mailed a notification letter-that entrails the provider's recommendation.  Medicare members will receive the notice 30 days in advance of the point of sale claim edit implementation. Member may also be referred for evaluation and monitoring by a pain management specialist.   You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website. Resources and Tools: Pain Management CPG (PDF) Pain Quick Reference Guide (PDF) For convenience, the URL link to the State of California Department of Justice's Controlled Substance Utilization Review and Evaluation Systems (CURES), California Prescription Drug Monitoring Program (PDMP) site. By clicking on this link, you will be leaving the IEHP website. http://oag.ca.gov/cures-pdmp   Information on this page is current as of January 1, 2022  

here to download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website.   To view IEHP’s current Pharmacy Network under IEHP DualChoice (HMO D-SNP) - Medicare-Medicaid Plan, please use this link: Under “How to Access Care” tab, click on “2022 IEHP DualChoice Provider and Pharmacy Directory (PDF)".   To view IEHP’s future Pharmacy Network under IEHP DualChoice (HMO D-SNP), please use this link: Under “How to Access Care” tab, click on “2023 IEHP DualChoice Provider and Pharmacy Directory (PDF)".   Information on this page is current as of November 02, 2022.

IEHP. The network includes approximately 100 representatives from community-based organizations, service agencies, clinics, and schools. Attendees share healthcare news, resources and discuss how to enroll uninsured children in a health program which they qualify for. Most of all — attendees bring their specialty to connect and collaborate on ways to help families in the Inland Empire. How can I join the IEHP Community Partner Network? If you are interested in joining the IEHP Community Partners Network, please email communityhealthreps@iehp.org for information. Click here if your organization is interested in becoming an IEHP Community Partner. When are the meetings held? The following is the schedule for the IEHP Community Partner meetings. 2023 Schedule Thursday, February 16 Thursday, April 20 Thursday, June 15 Thursday, August 17 Thursday, October19 Thursday, December 14 Location: Virtually Time: 11:00am - 12:30pm

EHP's contracted Providers understand how IEHP functions and understand the rules and regulations IEHP must comply with, as governed by the California Department of Health Care Services (DHCS), California Department of Managed Health Care (DMHC), the Centers for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA). The Delegate or Provider has the responsibility to ensure review, understanding, and attestation of the information contained in the Manual. Acknowledgement of Receipt (AOR) 2023 Providers: 2023 Provider eAOR Providers are encouraged to attest electronically using the following recommended browsers: Google Chrome, Microsoft Edge, Mozilla Firefox 2023 Hospital & IPA AORs For more information regarding 2023 Manuals, click here.

pating Network Provider private hospitals through uniform dollar increases for select inpatient and outpatient services based on actual utilization of qualifying services as reflected in encounter data reported to DHCS. PHDP utilization-based payments will be calculated by DHCS in accordance with the CMS approved preprint, and must be issued by IEHP to private hospitals, in six-month increments: January through June, and July through December Enhanced Payment Program (EPP) EPP provides supplemental reimbursement to Network Provider DPHs through uniform dollar increases for select inpatient and non-inpatient services, based on the actual utilization of qualifying services as reflected in encounter data reported to DHCS. In addition, for Network Provider DPHs that are primarily reimbursed on a capitated basis, DPH EPP provides supplemental reimbursement through uniform percentage increases to their contracted capitation rates. EPP utilization-based payments and Capitation based payments will be calculated by DHCS in accordance with the CMS-approved preprint and must be issued by to DPHs, in six-month increments: January through June, and July through December For more information about PHDP and EPP Programs, please visit the DHCS website at https://www.dhcs.ca.gov/services/Pages/DirectedPymts.aspx. District and Municipal Public Hospital Quality Incentive Pool and Designated Public Hospital Quality Incentive Pool QIP provides supplemental incentive payments to participating DPH and DMPH systems based on their performance on specified quality measures that address primary, specialty, and inpatient care, including measures of appropriate resource utilization. QIP payments are linked to delivery of services under MCP contracts. For additional details on QIP incentive program please visit DHCS website at https://www.dhcs.ca.gov/services/Pages/DP-DPH-QIP.aspx or contact DHCS at qip@dhcs.ca.gov. For disputes of payments issued under Private Hospital Directed Payment Program (PHDP) and or Enhanced Payment Program (EPP)- Hospital is to send email to PHDP-EPP@iehp.org stating the service period and dispute reason in detail. Hospital has six months from IEHP’s payment check date to dispute payment. FAQ’s on Hospital Directed Payments Please e-mail any inquiries related to the PHDP or EPP Program to PHDP-EPP@iehp.org.   You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

aboratively with the IEHP Governing Board to set the strategic vision and provide executive leadership for one of the 10 largest Medicaid health plans and the largest not-for-profit Medicare- Medicaid Plan in the U.S.  He cultivates IEHP’s strong partnership with Providers, hospitals and hundreds of community partners to deliver quality whole-person care to more than 1.6 million Members.  

responsible for the overall financial management of IEHP, its financial reporting and transparency, and for multiple plan financial functions, including accounting, purchasing, capitation, cost recovery, risk management and the coordination of fiscal and other operational audits. He also oversees contracting, product system configuration, facilities/property management development and security teams.

advancement of IEHP’s strategic focus on quality through transformative payment incentives, data driven initiatives, innovative solutions, program connections and strong internal and external partnerships. In this role, Dr. Juhn also ensures the health plan’s commitment to providing the highest quality of care.