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Latest News - SAC Health Receives IEHP’s Mission INSPIRE AWARD
C), received Inland Empire Health Plan’s (IEHP) Mission INSPIRE Award this month at the health plan’s second Annual Mission Conference. The award recognized SAC Health’s ongoing support and service to residents in Riverside and San Bernardino counties. SAC Health’s roots reach back as far as the 1960s, which have led to 35 specialties offered today at 10 locations, including a mobile unit that supports more than 144,000 patient visits each year. SAC Health is also one of IEHP’s most prominent partners, providing care to more than 50,000 of the Inland Empire’s most vulnerable residents and educating future physicians in the region. In collaboration with SAC Health, new health care clinics were developed in brand new service areas, supporting thousands of residents in Blythe and Barstow. “You can’t do this kind of work and truly impact the community and those that need the care without really strong partnerships. It takes a whole community to do that,” said Dr. Jason Lohr, CEO of SAC Health. “We are overwhelmed with gratitude and humility to be honored with this award.” SAC Health is one of the first recipients of the IEHP Mission INSPIRE Award. The award honors providers, community organizations and partners for their commitment to the health plan’s mission to “heal and inspire the human spirit.” “We are thrilled to honor SAC Health’s dedication and determination to consistently do the right thing for our communities and Members,” said Jarrod McNaughton, IEHP Chief Executive Officer. To learn more about the IEHP Mission Conference and how the health plan is charting a collaborative path forward, visit iehp.org.
Latest News - Student Health Reimagined at 2023 SBHIP Event
he Student Behavioral Health Incentive Program (SBHIP) event held Feb. 27 at Inland Empire Health Plan’s (IEHP) headquarters. IEHP, Molina Healthcare of California, Riverside University Health System Behavioral Health, San Bernardino Department of Behavioral Health, the Offices of Education in Riverside and San Bernardino Counties, local school districts and charter schools gathered to acknowledge their collaboration and planning efforts over the last year. These efforts are in response to the California Department of Health Care Services' (DHCS) goal to expand prevention and early intervention behavioral health services in and around schools. The initiative provides financial incentives to partnering school districts and charter schools. To move beyond planning and gear up for the implementation phase of the initiative, the group shared experiences and insight and raised awareness about their plans. Event speakers included Dr. Amy Young-Snodgrass, chief of the division of forensic pediatrics at LLU Children’s Hospital, Dr. Edwin Gomez, Riverside County Office of Education superintendent, Ted Alejandre, San Bernardino County Office of Education superintendent, Jarrod McNaughton, IEHP chief executive officer, Abbie Totten, plan president of Molina Healthcare of California and others. “Molina Healthcare of California is committed to improving access to behavioral health care services in our local schools,” said Totten. “We are grateful for the opportunity to collaborate with organizations that share in this mission as we move forward to implement innovative solutions addressing this critical issue.” The initiative’s implementation phase will include key interventions that focus on behavioral health wellness programs, care teams, expansion of the behavioral health workforce, substance use disorders and culturally appropriate and targeted populations. In addition, IEHP will be supporting SBHIP interventions through their Health Plan Navigators, stationed on local school campuses. “The relationships, processes and infrastructure we build together will redefine how we care for our children, and have a positive impact for generations to come,” said Amrita Rai, IEHP’s clinical director of community behavioral health. “Having the opportunity to reimagine our systems of care takes intention and it takes work. I’m so thankful for organizations that share that vision and are willing to make that future a reality.”
Latest News - IEHP Expands Healthcare Services to Entire Inland Empire
are services for more than 11,000 residents in Needles, Big River, Red Mountain, Blythe, Trona and surrounding areas in California. The expanded coverage, directed through the CalAIM initiative, will transition traditional services to managed care plans like IEHP and provide a new coordinated care service offering supporting all 27,408 miles of the Inland Empire. Prior to the expansion, residents in these rural areas received health coverage through Medi-Cal’s traditional fee-for-service model but did not have access to services like health education programs, telephone advice nurses, and coordinated care support. IEHP is currently in the process of contracting and credentialing available Providers in these areas to ensure Members are assigned to the Primary Care Providers nearest to their areas. “Just like the rest of our Membership, these new Members deserve the best care possible and should have access to a solid network of Providers and community supports,” said Susie White, IEHP Chief Operating Officer. “We’re thrilled some of our trusted Provider partners have made their way into our new service area and opened clinics to welcome our new Members. Teams across our organization continue to work on building a sustainable network for our entire community.” To help new Members become familiar with the health plan and the resources they now have access to, IEHP’s Community Health Teams have attended and hosted various events in the community, with the commitment to continue the support efforts moving forward. Earlier this year, IEHP joined community partners Young Visionaries, the Family & Kids Foundation, and Food Forward, to provide food, toys, household items, fresh produce, and vaccine opportunities for more than 300 residents in Trona. “As an IEHP Member, you can absolutely trust that we will do the right thing for you and your family and get you connected to the care you need,” said Jarrod McNaughton, IEHP Chief Executive Officer. “We are so excited to welcome our neighbors in these rural areas and support them in a way that complements and enhances their quality of life for years to come.”
Latest News - IEHP and Victor Valley College Continue Food Distribution in the High Desert
curity in the high desert. Community residents can receive a free food box at VVC’s Lower Campus every Monday from 11 a.m. to 12:30 p.m. While residents are encouraged to register online at tinyurl.com/vvcfoodboxreg, non-registered walk-ups are welcome at 12:30 p.m., while supplies last. Recipients must be 18 years or older, and boxes are limited to one per household. Prior to partnering with VVC, the health plan hosted weekly food box drive-thru distribution events at their Victorville Community Resource Center (CRC), totaling more than $5M in food from June 2020 to July 2021. “Food insecurity is one of the greatest needs in our region. We knew the distribution efforts had to continue,” said Delia Orosco, IEHP Victorville CRC Manager. “We are so grateful to VVC, a key community partner, for continuing to serve the community so our resource centers can prepare to reopen and serve again in the future.” To support high desert residents, food is ordered weekly through Community Action Partnership of San Bernardino, picked up each Monday morning by High Desert Second Chance, and delivered to VVC. IEHP Team Members, VVC students and faculty, and volunteers from God’s Hand Extended operate the event and work to distribute food directly to residents. “It is truly our pleasure to partner with such amazing organizations like IEHP and God’s Hand Extended. This is a collaborative effort and great example of how education, healthcare, and community organizations can come together with a common goal and purpose to serve,” said Amber Allen, VVC Special Grant Programs Director. “By bringing our community to the college to provide food, we are opening the doors to people who may not be aware of available opportunities at VVC. This effort helps us to meet people where they are, so they have the ability to focus on their goals, beyond just meeting their basic needs.” In addition to food distribution efforts, IEHP and VVC will launch on-campus health and wellness programs to support VVC students. Programs will include personalized wellness support for students, fitness classes and more. “These resources are brought to the community, by the community,” said Jarrod McNaughton, IEHP Chief Executive Officer. “These partnerships place life-changing resources within reach for so many of our most vulnerable residents. Times may be tough, and resources may be sparse, but partnerships and collaborations allow for hope and progress to be continuously made.” VVC hopes to continue the distribution effort for as long as it is needed. To learn more about the food box drive-thru, visit vvc.edu/events/free-weekly-food-box-drive-thru.
Innovations and Quality Performance - Quality Performance
rting our providers. We are committed to quality, driving us to create programs and services to meet the needs of our members and providers. In fact, IEHP is one of the top-rated Medicaid plans in California. Determined by both the Healthcare Effectiveness Data and Information Set (HEDIS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS), NCQA has awarded IEHP an Accreditation status for Medi-Cal. This status is only given to health plans that have clinical and service programs that meet or exceed NCQA standards. Learn more about how IEHP delivers quality services and care below. Quality Report Inside the 2023 Quality Report, we take you through our quality journey by looking at our performance over the past year with critical measures. We show you how that data translates into tangible outcomes for our Members, Providers and Team Members. While there were many areas where we excelled, there were also places where we found opportunities for improvement. The goal of this Quality Report is to be transparent—with you and with ourselves. This journey is ongoing, and we hope to learn from it so we can do better and be better for those who rely on us the most. 2023 Annual Quality Report (PDF) 2022 Annual Quality Report 2020 Annual Quality Report (PDF) Quality Management IEHP supports an active, ongoing, and comprehensive quality management program with the primary goal of continuously monitoring and improving the quality of care, access to care, patient safety, and quality of services delivered to IEHP Members. The Quality Management (QM) Program provides a formal process to systematically monitor and objectively evaluate, track and trend the health plan’s quality, efficiency and effectiveness. Quality Management Evaluation 2021 Quality Management Annual Evaluation (PDF) Quality Management Program Description 2022 Quality Management Program Description (PDF) HEDIS Every year, IEHP assesses the overall quality of health care experienced by IEHP members. To achieve this IEHP uses NCQA, a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS® which provides: a set of standardized performance measures based on statistically valid samples of members the public with information to compare health plan performance HEDIS Rate: 2021 Medi-Cal HEDIS Rates (PDF) 2021 Medicare HEDIS Rates (PDF) Physician Satisfaction IEHP values a strong partnership with our providers. To support them we offer many services from online support to a call center, to a dedicated service representative. That's why doctors think highly of IEHP. In fact, according to the 2022 Provider Satisfaction Survey conducted by SPH Analytics, 98.2% of physicians would recommend IEHP to other physicians. See the full results of the 2022 Provider Satisfaction Survey (PDF). Population Needs Assessment Every year, IEHP sends out a Population Assessment Survey to IEHP Members to learn more about their needs. View the results below. 2020 Population Needs Assessment Results You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader.
COVID-19 - Coronavirus
symptoms of COVID-19 People with COVID-19 have had a wide range of symptoms reported, ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. Anyone can have mild to severe symptoms, including: Fever or chills Cough Shortness of breath or difficulty breathing Fatigue Muscle or body aches Headache New loss of taste or smell Sore throat Congestion or runny nose Nausea or vomiting Diarrhea Go to the hospital or seek emergency medical attention right away if you develop severe COVID-19 symptoms, including: Trouble breathing Persistent pain or pressure in the chest New confusion Inability to wake or stay awake Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone What to do if you are feeling sick If you are experiencing any of these symptoms, consider the following actions: Get tested for COVID-19: It is free. IEHP will also pay for members who receive standard COVID-19 testing and doctor-ordered tests, no matter what type of test. Your doctor is required to bill IEHP directly for these tests. Visit your doctor or an urgent care center either in-person or telehealth access within 24 hours of symptoms starting. For IEHP members, if you can’t reach your doctor or if it’s after-hours, you can call IEHP’s 24-Hour Nurse Advice Line at 1-888-244-4347 or 711 for TTY users, 24 hours a day, seven days a week. Our trained nurses offer medical advice and, if needed, will connect you with a doctor via phone or video chat. Facts about COVID-19 treatments Most COVID-19 treatments are pills that you take at home. COVID-19 medications are free in California. You don’t need to have insurance or be a U.S. citizen. COVID-19 medications work best when started as soon as possible, within the first 5-7 days of symptoms. If you think you may have COVID, don’t wait for symptoms to get worse. COVID-19 medications are safe and effective at stopping COVID-19 illness from getting serious. They can lower the risk of serious illness, hospitalization, and death from COVID-19 by half or more. COVID-19 medications may help you test negative sooner and may reduce the risk of long COVID symptoms.* COVID-19 medications are recommended for people 12 years and older who have certain health conditions or other common factors that increase risk. A doctor can tell you if you are eligible to receive COVID-19 medications and which type is best for you. COVID-19 medications are effective whether you are vaccinated or not. If you test positive for COVID-19, have symptoms, and meet the following criteria, you should seek treatment: You are 50 years old or older –OR– You are unvaccinated or not up to date with COVID-19 vaccinations –OR– You have a health condition or other factors that increase risk. These include obesity, asthma, diabetes, lack of physical activity, smoking, mental health conditions such as depression, being of a racial/ethnic minority, and more. Learn more about medical conditions that increase the risk of serious illness from COVID-19. Click here for more information on mental health and mood conditions. * Early evidence suggests that the COVID-19 medication Paxlovid may decrease the risk of developing long COVID symptoms. These symptoms can last for weeks, months or years after a COVID-19 infection. How to get tested for COVID-19 It’s important to know how and when to test for COVID-19. Testing can give you peace of mind, provide you with information to help you make decisions about your health and help slow the spread of the virus in our community. Where to get tested for COVID-19 Visit our link for more information: https://www.iehp.org/en/members/covid-19?target=covid-19-testing-sites What if you test positive for COVID-19 Self-isolate to avoid spreading the virus to others; click here for tips about isolation and precautions for people with COVID-19 Immediately seek treatment options How to get treatment Contact your doctor’s office Contact your pharmacy Visit a test-to-treat location
Helpful Information and Resources - Member Newsletters
n programs, and important reminders to help you live a better life. The Pulse: this newsletter is for adults and families with children and who have Medi-Cal with IEHP. Health Spotlight: this newsletter is for IEHP Members with both Medi-Cal and Medicare (CMC). AccessAbility: this newsletter is for seniors and people with disabilities who have Medi-Cal with IEHP.
Pharmacy Services - IEHP DualChoice (HMO D-SNP)
P DualChoice (HMO D-SNP) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. It 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 (HMO D-SNP)? 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 (HMO D-SNP) integrates healthcare services to better coordinate care and improve health. How to Enroll To enroll, please call: IEHP DualChoice (HMO D-SNP) 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 (HMO D-SNP) website. You may also call IEHP DualChoice (HMO D-SNP) 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, such as our Privacy Notice, Plan Transition Process and the section of CMS' website regarding Best Available Evidence. Service Area: Only people who live in our service area can join IEHP DualChoice. Our service area includes all of Riverside and San Bernardino counties. IEHP DualChoice (HMO D-SNP) 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 April 19, 2023. H5355_CMC_19_1059755 Accepted
P4P - Proposition 56 - GEMT - Proposition 56 & GEMT
2016, now includes proposed supplemental payments for physicians participating in Medi-Cal Fee-For-Service (FFS) and Medi-Cal Managed Care. Proposition 56 FAQs SFY 19/20 (PDF) Published: October 24, 2022 Click on the following links to jump to that specific section: Electronic Payments Ground Emergency Medical Transport (GEMT) Payment Adverse Childhood Experiences Screening (ACES) Services HYDE Developmental Screening Services Proposition 56 and GEMT Payment Schedule Family Planning Services Proposition 56 Payment Dispute Process Electronic Payments With the current public health situation that our country is experiencing, it is necessary for IEHP to take additional precautions to ensure the health and well-being of our community. These precautions are being reviewed, and discussed daily, by our Executive leadership team and will be implemented as deemed necessary. Future COVID-19 precautions may include reduced on-site staffing and prioritization of electronic payments over printed checks. To minimize any disruption or delay in payment, we recommend that you sign up for electronic payments as soon as possible if you have not done so already. Our team is available to assist you with the necessary paperwork required to make this change or to answer any questions you may have. The team can be reached by e-mailing email@example.com or by calling (909) 294-3928 and selecting Option 1. Our priority remains keeping our Members, Providers, Vendors, and Team Members safe while doing what we can to minimize the potential spread of the virus. We will continue to work hard to provide you with the level of service you have come to expect during this uncertain time. (Back to Prop 56 Menu) Adverse Childhood Experiences Screening (ACES) Services Proposition 56 Adverse Childhood Experience Screening (ACES) Services (PDF) Published: May 15, 2020 FAQs on Proposition 56 Payment - Adverse Childhood Experience Screening (ACES) Services (PDF) Published: October 14, 2021 PSA Videos: Do More Ask Resilience (Back to Prop 56 Menu) Developmental Screening Services Proposition 56 Developmental Screening Services (PDF) Published: March 19, 2020 FAQs on Proposition 56 - Developmental Screening Services (PDF) Published: October 14, 2021 (Back to Prop 56 Menu) Family Planning Services Proposition 56 - Family Planning Services (PDF) Published: June 1, 2022 FAQs on Proposition 56 - Family Planning Screening Services (PDF) Published: October 13, 2022 (Back to Prop 56 Menu) Ground Emergency Medical Transport (GEMT) Payment The Department of Health Care Services (DHCS) has established a Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) program. In accordance with 42 USC Section 1396u-2(b)(2)(D), Title 42 of the Code of Federal Regulations part 438.114(c), and WIC Sections 14129-14129.7, Medi-Cal Managed Care Health Plans must provide increased reimbursement rates for specified GEMT services to non-contracted GEMT providers. SPA 18-004 implements a one-year QAF program and reimbursement add-on for GEMT provided by emergency medical transportation providers effective for State Fiscal Year (SFY) 2018-19 from July 1, 2018, to June 30, 2019. GEMT Program Overview (PDF) FAQs on GEMT (PDF) GEMT Dispute Request Form (PDF) Please email completed forms to Prop56Inquiry@iehp.org or fax to (909) 296-3550. (Back to Prop 56 Menu) HYDE Proposition 56 HYDE Services (PDF) Published: May 15, 2020 FAQs on Proposition 56 - HYDE Services (PDF) Published: October 14, 2021 (Back to Prop 56 Menu) Proposition 56 and GEMT Payment Schedule Proposition 56 and GEMT Supplemental Payment Schedule CY2023 Updated: January 6, 2023 (Back to Prop 56 Menu) Proposition 56 Payment Dispute Process Proposition 56 - Paid Claims Dispute Request Form (PDF) Proposition 56 - Encounter Dispute Request Form (PDF) Please email completed forms to Prop56Inquiry@iehp.org or fax to (909) 296-3550. (Back to Prop 56 Menu) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.