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Special Programs - Total Fracture Care
ticipating Orthopedist for global fracture care without a prior authorization. This Program ensures that Members in need of fracture care by an Orthopedist, as determined by an Emergency Department Physician, Urgent Care Physician or Primary Care Provider, will receive timely access to care. Policy Reference: 10 - Medical Care Standards Total Fracture Care Providers Arrowhead Orthopaedics For more information and locations, please visit: https://www.arrowheadortho.com/ Orthopaedic Medical Group of Riverside Inc. For more information and location, please visit: https://omgnet.com/ You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Pregnancy and Postpartum
al care as early as possible improves the chances of a healthy pregnancy and childbirth. Receiving postpartum care after childbirth is just as crucial for a woman to make sure she is healing properly and gets the help she needs to care for herself and her baby. IEHP has programs that offer support for our pregnant Members throughout their pregnancy and after. Baby-N-Me App This is a free app for IEHP Members who are pregnant or have a baby under 2 years old. On this app pregnant Members can get up-to-date information about their growing baby like ultrasound videos, get handy tools like a weight gain calculator, complete a survey that screens for postpartum depression, set appointment reminders, and much more! Parents of a baby under 2 years old can get parenting tips and advice, age-adapted information about their baby’s growth, feeding patterns, and tools to track diaper changes, growth, and vaccines. You can download this app for free through iTunes or Google Play Loving Support Loving Support is committed to helping mothers achieve their breastfeeding goals. The Helpline offers advice, referrals to mom support groups and support and encouragement to get breastfeeding off to a good start. International Board Certified Lactation Consultants (IBCLCs) also offer guidance, pumping strategies and tips for returning to work/school or are pumping for their premature babies. Call Loving Support with any questions or concerns you may have throughout the first year and beyond. You can contact the Loving Support 24/7 Helpline at 888-451-2499/951-358-7212. The staff speaks English and Spanish. Additional Resources The ABC's of Safe Sleep (Video) Centers for Disease Control and Prevention: Pregnancy Depression During and After Pregnancy
COVID-19 - Jaime Camil Video Series
much of California is returning to some sense of normalcy after more than a year and a half of battling COVID-19, it’s important to recognize that the pandemic is not over. In fact, the number of cases and hospitalizations have been rising since the state reopened in mid-June, with the contagious Delta variant of the coronavirus spreading quickly. Many Californians have put off annual check-ups, vaccinations, and preventive medicine during the pandemic to avoid the virus. In an effort to ensure our combined 3.8 million members and communities are getting vaccinated and resuming their routine wellness care, we've teamed up with L.A. Care Health Plan to launch a multi-pronged educational campaign with the help of award-winning actor Jaime Camil. Check out clips from the series below! Actor Jaime Camil and Ernesto Campos debunk COVID-19 myths. Jaime Camil discusses with Dr. Ernesto Campos where YOU can get vaccinated. Jaime Camil and Dr. Ernesto Campos talk about how COVID-19 affects the unvaccinated. Jaime Camil and Dr. Ernesto Campos discuss how COVID-19 is still a contagious disease. Debunking COVID-19 myths such as magnetism. Debunking COVID-19 myths Jaime Camil and Dr. Ernesto Campos talk about the efficacy of the COVID vaccine. Jaime Camil and Dr. Ernesto Campos talk about the importance of the COVID vaccines.
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.
Governing Board - Curt Hagman
ed in the California State Assembly from 2008 to 2014 and represented communities in San Bernardino, Orange, and Los Angeles counties. In January 2015 he was appointed to the IEHP Governing Board, becoming Vice-chair in February 2017 and Chair from 2018-2020. In January 2021, Supervisor Hangman served as Vice-chair. Supervisor Hagman has an extensive resume of public service prior to his state office election. His local government experience started as a Parks/Recreation Commissioner in Chino Hills, which sparked a growing passion for public service. Supervisor Hagman was elected to the City Council in 2004, and served as Mayor in 2008. During this time he worked on a multitude of regional committees, which has given him exposure to numerous issues facing his constituency. In early 2011, he was also appointed by the Assembly Speaker to the State Allocation Board, which works with the Office of Public School Construction in funding allocation for applicable school districts ensuring appropriate school construction.
Governing Board - Jeff Hewitt
more than 2.4 million residents of six incorporated cities (Moreno Valley, Calimesa, Beaumont, Banning, Perris, and Menifee) and more than 25 unincorporated communities. He was appointed to the IEHP Governing Board in January 2020 and appointed as Vice-chair in January 2022. Supervisor Hewitt began his career in public service as a member, and then chairman, of the Calimesa Planning Commission. He was later elected to the Calimesa City Council in 2010 and served as mayor for three consecutive terms. During this time, he spearheaded a bold project that transferred fire services from the county to the city, saving Calimesa almost $3 million in the first two years while doubling the number of crew members on each dispatch. Most importantly, he was able to achieve this without increasing taxes or fees. An Inland Empire native, Supervisor Hewitt is dedicated to improving the quality of life for all residents of the region.
Governing Board - Karen Spiegel
sworn into office on January 8, 2019. The Second District includes the unincorporated communities of Coronita, El Cerrito, Home Gardens and Highgrove, and the cities of Corona, Eastvale, Jurupa Valley, Norco, and the western half of the City of Riverside. In February 2019 she was appointed to the IEHP Governing Board, appointed Vice-chair in 2020, and served as Chair in 2021. Karen Spiegel began her political career as the elected City Treasurer for the City of Corona in 1996. After six years as Treasurer, she embraced the City Council elections in 2002 and served the City of Corona as Council Member for 16 years, serving as Mayor four terms. Her actions speak volumes and her unique passion for service truly sets her apart. She encourages community participation with City and County government and has introduced many new programs. Karen has been credited for her leadership in regional transportation issues, collaboration and regional partnerships. In addition to the service in her District, Karen represents Riverside County on the Regional and State level in many organizations and has served in a leadership role on several. She is an energetic member of the community and her "roll-up your sleeves" attitude has led her to immerse herself in many civic, business and community activities. She has been honored for her service with numerous awards and recognitions over the years.
San Bernardino County Medi-Cal
of Americans. About nine percent of San Bernardino County residents under the age of 65 were uninsured based on the last count of the US Census. That is why Inland Empire Health Plan (IEHP) provides coverage to millions of Members in San Bernardino and Riverside counties. Discover the health plan that puts its members at the center of their universe. IEHP will not rest until our communities enjoy optimal care and vibrant health. Keep reading to learn more about IEHP and the benefits offered to Medi-Cal recipients. IEHP Provides Coverage for San Bernardino County Medi-Cal Recipients Medi-Cal is a no-cost or low-cost health coverage program. It provides health, dental and vision coverage to qualified low-income California residents. IEHP is the health plan for Medi-Cal recipients in San Bernardino County. We are dedicated to providing our Members and local communities with optimal care and vibrant health. Top-Class Medi-Cal Services Medi-Cal is a no-cost or low-cost health coverage program. It provides health, dental and vision coverage to qualified low-income California residents. IEHP is the health plan for Medi-Cal recipients in San Bernardino County. We are dedicated to providing our Members and local communities with optimal care and vibrant health. With IEHP and Medi-Cal coverage, Members not only have access to general health care but also advanced and specialized care such as: Transgender services Laboratory services Radiology services Pediatric care Mental health services Addiction rehabilitation care These are just a few examples of how IEHP’s network of Providers gives Members and their families in San Bernardino County a wide range of medical care. To apply for Medi-Cal in San Bernardino County call the IEHP Enrollment Advisors at (866) 294-4347, Monday – Friday, 8am – 5pm. TTY users should call (800) 720-4347. You may 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. Vision Services IEHP provides vision coverage and has a wide network of vision specialists. IEHP Members get a free vision exam every 24 months, additional or more frequent eye exams are covered if medically necessary, such as those with diabetes. You also get a pair of eyeglasses, with both frames and lenses every 24 months, when you have a valid prescription. Contact lens testing and contact lenses may be covered if the use of eyeglasses is not possible due to eye disease or condition. Medi-Cal San Bernardino Dental Services Through Medi-Cal, you and your family get professional dental services. This benefit is included with your Medi-Cal coverage at little to no cost to you. Some of the types of dental care offered include: Diagnostic and preventive dental hygiene (such as examinations, X-rays, and teeth cleanings) Emergency services for pain control Tooth extractions Root canal treatments (anterior/posterior) Scaling and root planning Crowns (prefabricated/laboratory) Orthodontics for children who quality Complete and partial dentures Topical fluoride 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. Medical Trip Transportation 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. IEHP covers: Visits to your Primary Care Doctor, Specialists and urgent care clinics. Visit for dental, mental health, substance abuse and other services. Click here to learn more about transportation services offered by IEHP. San Bernardino County: How to Apply for Medi-Cal IEHP’s mission to heal and inspire the human spirit is made possible through its Vision—to not rest until our communities enjoy optimal care and vibrant health. This is why we continue to serve all communities throughout San Bernardino County. You have many options to apply for Medi-Cal, these include: Call IEHP Call 1-866-294-4347, 8am-5pm Monday-Friday. TTY users should call 1-800-720-4347. You’ll speak to one of IEHP’s friendly bilingual Enrollment Advisors. By Mail You can mail your completed and signed application to: Covered California P.O. Box 989725 West Sacramento, CA 95798-9725 Or mail it to the Riverside County Medi-Cal Office. Apply in Person Click here to find the Riverside County Medi-Cal Office. Apply Online Click here to apply online. Get Health Coverage Now Become a member of the IEHP family and get access to the top-rated California state medical insurance. For more than 25 years, IEHP has proudly served Inland Empire residents and their families. Join IEHP now and make your health our top priority.
Governing Board - Andrew Williams
Medicaid Manged Care Explained
to know during this guide. What is Managed Care? Managed care is a healthcare delivery system used to manage quality, utilization, and cost. Managed care refers to a group of activities that helps lower the cost of offering for-profit healthcare services and health insurance while boosting the quality of healthcare services. IEHP is a managed health care plan that organizes care for their member. IEHP works with doctors, hospitals, and other health care Providers to give improved health care coordination and quality of care to the Members they serve. Medicaid Managed Care Medicaid managed care helps to provide Medicaid health benefits and other services through managed care organizations, also known as MCOs, and state Medicaid agencies. Managed care organizations accept a specific payment per member per month for their services. The main goals of Medicaid-managed care are to improve healthcare outcomes, healthcare quality, and health plan performance. How Does Managed Care Work? Managed-care plans tend to ask for less paperwork and offer a lower premium payment. The choice of treatment, drugs, and Doctors are limited. Healthcare providers, hospitals, and Doctors make plans with managed care plans to serve members at a lower rate. When you have a managed care plan, you are need to choose a primary care Doctor or PCP, who is part of the network, the doctor you choose will take care of all your medical needs, including annual exams, preventive care, and treatment for common illnesses. Your PCP will decide whether you need to be referred to a specialist like an oncologist. With a managed care plan, you cannot get coverage for specialist services without getting referred by your PCP. The cost for a managed care plan is typically less than a fee-for-service plan. You will typically pay a copayment every time you visit your doctor, as long as they are part of the plan network. This cost will depend on the type of managed health plan you choose. Choosing a Medicaid Health Plan MCO Medicaid can offer members the chance to select a health plan under Medicaid. Here is what you should look for in a Medicaid health plan: Excellent plan coverage. When you are looking for a Medicaid health plan, you should look for something that covers everything you could possibly need, including hospital stays, pregnancy, and newborn care, hospice and palliative care, emergency services, outpatient or ambulatory services, transgender services, mental health services, rehabilitative services, prescription drugs, lab services, preventative and wellness services, sensitive services, chronic illness management, substance use treatment services, dental services, vision services, pediatric services, telehealth services, non-medical transportation or NMT, non-emergency medical transportation or NEMT, and long-term services and supports or LTSS. Low premiums. Look for a Medicaid health plan that offers low to no premium payments. Some Medicaid plans offer a $0 monthly premium. Accessibility. You should also look for a Medicaid health plan accessible to you and others who need it, including children, adults, seniors, and those with disabilities who live in your area. What does IEHP offer? With IEHP, you also get access to: A network of more than 8,000 Doctors, Specialists and other health care Providers Care coordination 24-Hour Nurse Advice Line Vision services Urgent Care centers Healthy lifestyle classes and programs And so much more! If you need healthcare coverage, or have questions about what IEHP offers, call 1-866-294-4347, 8am-5pm Monday-Friday. TTY users should call 1-800-720-4347. You’ll speak to one of our friendly bilingual Enrollment Advisors.
Healthcare Scholarship Fund - Our Scholars
group of students from the Inland Empire. More than 30 recipient students grew up in the Inland Empire and more than 50% are first generation medical students and grew up in low-income households. Through the scholarship fund, aspiring healthcare professionals will be guided through the system and connected to the health plan’s provider network. This allows students to pursue successful careers in healthcare immediately after graduation to help support the region’s growing population. Loma Linda University School of Medicine Inland Empire Medical Community Service Awardees Class of 2022 Ye Jin Jeon Ye Jin's Why: “I applied for the Inland Empire Medical Community Service Award because the goal and priority to expand access to care and healthcare provider options for the Southern California region aligns with my calling. As a child growing up in the San Bernardino County, I saw the economic disproportion within my own neighborhood, and this compelled me…God has led me pursue my medical career” Class of 2024 Edwin Choque Edwin's Why: “Simply put, my heart lies in the Inland Empire. This community of individuals have fostered me and loved me since I was a child and all I can hope is to pay that love and care forward. . . . My dream is to be on the front lines as a representative for these individuals who frequently become marginalized…” University of California, Riverside Dean's Mission Recipients Four Year Award Elizabeth Celaya-Ojeda Elizabeth's Why: “I want to work particularly with the underserved in this area because I truly believe that being a physician is a privilege and with that there is a responsibility to be an advocate for those who are facing health disparities. I am particularly interested in providing care to underserved Native American and Hispanic communities. Not many healthcare providers are aware of the disparities these two communities face and I want to be an advocate for them, especially in the Inland Empire.” Alfonso Parocua Alfonso's Why: “Growing up, my family lacked meaningful access to healthcare and relied on a local free clinic as our only means of interacting with a physician. Through my personal experience with the free clinic, I developed a passion for service to the underserved communities who lack meaningful access to basic healthcare amenities due to low socioeconomic status. I sought opportunities that would allow me to pay my gratitude forward by becoming part of the solution to healthcare disparities in Inland Southern California. Through my volunteer efforts in free clinics and other community involvement programs, I witnessed the passion and dedication that health care providers and volunteers in the area have towards the underserved community. This realization deepened my connection to Inland Southern California because I was reminded so much of the health care professionals that helped my family when they couldn't help themselves.” Two Year Award Cesar Fortuna Cesar's Why: “A San Bernardino native, I have had the opportunity to volunteer in my community as a Spanish language translator for free clinics. Most patients I have spoken with fell into the category of uninsured, underinsured, or undocumented. It became clear the extent of need in this region when I would translate to the providers that this was the first-time dozens of our patients had ever seen a medical professional; however, this wasn’t uncommon. To these patients and their stories, I thank them because they inspire me to pursue Emergency Medicine where I can become a valuable player in providing care, providing resources, or providing comfort.” Lavinia Mitroi Lavinia's Why: “My goal of pursuing a career at the intersection of medicine and public health is driven by a desire to put patients and communities at the center of our health care system in the U.S. This desire was sparked most poignantly by my own experiences as an IEHP patient growing up in the Inland Empire. As I prepare for a future career as a pediatrician in this region, I hope to serve as an advocate for children and families, providing direct health services but also creating systems change.” Armando Navarro Armando's Why: “The earliest memory of my grandfather is him telling me, “Mijo, tienes que aprender Español para ayudar tu comunidad, you have to learn how to speak Spanish to help your community”. These words were often repeated to me by my grandfather who lamented the fact that he only spoke Spanish. I witnessed the health disparities affecting my community; doctors who did not speak Spanish, parents who could not afford a trip to the doctors’ office, and a healthcare system that was not inclusive of my community’s culture. I have a duty to give back to a school, a community, that has given me so much.” Christ Ordookhanian Christ's Why: “I see the medical profession through the lens of an individual who had lived through challenging times and witnessed how one individual provider can make such and impact when their heart is in the right place. My dedication to our underserved community stems from that of a lifelong mission I have set for myself which is to ensure I give back to a community that I am deeply associated with, they are my founding roots in the United States, and I vow to be at the forefront of the next generation of physicians that care and give the underserved hope.” University of California, Riverside Dean's Mission Recipients Daphne Du Daphne's Why: “I spent most of my life in underprivileged areas and saw firsthand how difficult healthcare access could be through inadequate financial resources, transportation, or translation services. Thanks to this investment in my studies, there is less stress in my life. I can focus on my studies and eventually give back to the community by becoming a physician who will advocate for patients without meaningful access to health care.” Judith Gonzales Judith's Why: “As a first-generation college student, there have always been many barriers in my path to higher education. I am the eldest daughter of an immigrant family, and it is truly an honor to be able to reach this point in my education and in my career, and to give back to my parents who have sacrificed so much for me and my sisters. Growing up in an underserved community showed me the long-lasting impacts of health inequities and strengthened my resolve to pursue a career in medicine. Working in the Inland Empire, I hope to not only address, but actively work towards combating the health inequity present in our communities.” Jordan Hough Jordan's Why: “Despite disadvantages encountered when living in a low-income community, I am grateful for the privilege I had in meeting physicians dedicated to their practice and willing to share that love through mentorship. These individuals have served as exemplary medical professionals and have encouraged me to follow in their footsteps. As a future physician, I aspire to empathetically care for patients by allowing my past experiences to enhance my understanding of their needs. I also plan to incorporate teaching into patient care by presenting opportunities for students to shadow and be mentored for a career in medicine.” Diana Martinez Diana's Why: “I am the daughter of Mexican Immigrants and grew up in Compton, California where I unfortunately was quickly desensitized to violence and was able to tell the difference between a firework and a gun shot. My mother had to travel a significant distance to ensure we had adequate healthcare. Despite these conditions, my parents always stressed education and did their best to give me what I needed. These life circumstances ignited my passion to serve those in disadvantaged communities, which I interacted with throughout my educational career. The Inland Empire Health Program Scholarship means I can achieve my dream –by practicing medicine in a community that deserves adequate, equitable, and accessible healthcare. I will serve as a bilingual physician in the Inland Empire that can serve families like my own and many more.”
Healthcare Scholarship Fund - About the Healthcare Scholarship Fund
p Fund is the health plan’s partnership with local academic institutions to help remove the barrier of debt for medical students and develop a growing workforce for healthcare professionals to care for the Inland Empire’s growing Medi-Cal population. Why is the Healthcare Scholarship Fund needed? According to the California Healthcare Foundation, the Inland Empire has one of the lowest ratios of Primary Care Physicians (PCPs) and specialty physicians per 100,000 people in California. In addition, the Inland Empire lacks adequate Specialty and Behavioral Health practitioner capacity to serve the current growing population. With the average cost of a four-year medical degree standing firm at $276,800, pursuing a career in the medical field is out of reach for more and more each year. The HSF will aid students by helping to remove the financial burden of medical school that often restricts the choices of many aspiring healthcare professionals and allow recipients to immediately pursue careers in healthcare. I am a student and am interested in becoming a Doctor, what should I do? Students interested in the IEHP Healthcare Scholarship Fund are encouraged to contact the academic institutions below for more information on how apply. While each institution may have differing eligibility requirements, all Healthcare Scholarship Fund scholarships require students commit to practicing in the Inland Empire for 5 years after graduation. Participating schools and programs include: Loma Linda University Medical School University of California Riverside California University of Science and Medicine
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.
Gender Health - Gender Health
rse population of the Inland Empire has been estimated at almost 27,000 people. At Inland Empire Health Plan (IEHP), we want you to get all the care you need with the respect you deserve. IEHP covers all medically necessary Medi-Cal covered Gender Health services. IEHP has Doctors and Specialist who have experience in gender health services. To find out more information, 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 Get Started See your IEHP PCP on a regular basis. If you have not seen your Doctor yet or in a long time, set up a visit today. Your Doctor, the key to your overall health care, knows your health history and helps make sure you get the care you need. Your Doctor can refer you to Specialists, if needed. This includes any gender health options that meet your medical needs, so share your treatment goals with your Doctor. You can change your IEHP Doctor at any time. Benefits Talk to your Doctor about these Gender Health Benefits: Behavioral Health Services Hormone Replacement Therapy Surgeries and Procedures IEHP has a dedicated team of Care Managers who are familiar with Gender Health services and are ready to help with: Referrals to see a specialist Getting medical supplies Getting medicines Connecting you to community resources IEHP also provides non-clinical resources such as: Care Coordination Community and Legal Resources Demographic updates Family Support Groups Resources For education and training on gender health care, please access the following resources: Gender Health Brochure for Adults (PDF) Gender Health Brochure for Children (For Parents and Children under 18) (PDF) Clinical Guidelines (PDF) LGBTQ Resources (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download a free copy. Click Adobe Acrobat Reader.
Medi-Cal Behavioral Health Treatment
ed benefit solely for Members Diagnosed with Autism Spectrum Disorder. The coverage criteria have been expanded to include IEHP Members who meet ALL the below: Under 21 years of age Have a recommendation from a licensed physician and surgeon or a licensed psychologist that evidence based BHT services are medically necessary. Be medically stable Not need 24-hour medical/nursing monitoring or procedures provided in a hospital or intermediate care facility for persons with intellectual disabilities. Behavioral Health Treatment (BHT) is the design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the direct observation, measurement and functional analysis of the relations between environment and behavior. BHT services teach skills using behavioral observation and reinforcement, or through prompting to teach each step of targeted behavior. BHT services are based on reliable evidence and are not experimental. Treatment may or may not include Applied Behavioral Analysis (ABA). BHT is medically necessary after the Provider has completed a comprehensive developmental surveillance and screening, and have recommended BHT services is clinically warranted to treat persistent developmentally inappropriate behavior and/or diagnoses that may be able to be corrected or ameliorated with BHT services. Aberrant behaviors include but are not limited to self-injury, aggression, and deficits in language skills, daily living skills, and social skills. PCPs will continue to referral a Member directly to IEHP Behavioral Health for any BHT services and/or diagnostic needs regardless of IPA. If you have any questions or ask your PCP for screening, diagnosis and treatment, you can 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. Cost to Member There is no cost to the Member for these services. Visit IEHP's Mental Health page for general mental health information.
How to Get Care
network is a group of Doctors, hospitals and other providers who work with IEHP. You must choose a PCP within 30 days from the time you become an IEHP Member. If you do not choose a PCP, IEHP will choose one for you. You may choose the same PCP or other PCPs for all family members in IEHP. If you have a Doctor you want to keep, or you want to find a new PCP, you can look in the IEHP Provider Directory. To help you choose the right one for you, PCPs listed in the IEHP network include their name, address, phone number, specialty, etc. If you change PCPs, you will get a new IEHP Member ID card in the mail. It will have the name of your new PCP. To change your PCP, 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 Get Care - How to Get Care
l care, like: Routine checkups Sick visits, such as colds, flu and fever Chronic illnesses, like asthma and diabetes Order medical tests Your Doctor also handles your preventive care, such as vaccines, shots, health screenings and other tests. Preventive care is about preventing disease. Regular checkups, even when you are not sick, can help your Doctor spot a health problem early, and treat it before it gets worse. 2. Getting care from a Specialist When you need specialty care, your Doctor will refer you to a Specialist. This is how referrals work: When the request is received by IEHP, a decision will be made within 5 business days for a regular referral. For an urgent referral, this is done within 72 business hours. For a regular referral, expect a letter from your medical group or IEHP within 2 days after a decision has been made. When the request is approved, call your Specialist to make an appointment. If the request is denied, talk to your Doctor or call IEHP Member Services at (800) 440-4347 or (800) 718-4347 (TTY) to learn more. 3. Getting your medicine You can fill your prescription at any IEHP contracted pharmacy. There are more than 760 pharmacies in our network. From major chains, like Walgreens, CVS, Rite Aid, Walmart and many others. To find one close to you, check your IEHP Doctor Directory or click the Provider Search link. Helpful tips to help your treatment: Be sure to call the pharmacy five days before you run out of medicine. Take your medicine the way your Doctor tells you to. 4. Find a Doctor To find more information on Primary Care Physician's (PCPs), Specialists, Pharmacies, etc., click here to visit the Doctor search. 5. Getting help from Member Services If you need 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. The call is toll free. If you reach IEHP Member Services after hours, you will be able to leave a secure voice message. Calls will be returned the next working day. If you call after midnight and leave a secure voice message, we will return your call the same working day. Resources Barriers to Care: We all have our own cultural, religious or health beliefs. This document includes some common beliefs that may keep you from getting the care you need—along with some facts to help you make informed decisions about your health.
Community Supports - Flexible Care Choices: Community Supports
e options. These may be offered (instead of state plan-covered services) to qualified Members at medium to high levels of risk. Community Supports can help you remain healthy, reduce complications from illnesses, and avoid unnecessary stays in the hospital, nursing facilities, and emergency departments You may find that Community Supports with IEHP can help during a transition in housing or care. If you need help managing your health, IEHP’s Community Supports might be the right choice. When you need extra care IEHP’s Community Supports are open to any Medi-Cal or IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) Member who needs supportive care. Community Supports may nurture your whole health—to care for your body and mind. Members who could benefit from Community Supports may be: Facing times without housing Struggling to get food for their loved ones Having asthma issues and need changes to their living space How your Care Team can help you If you can be helped by Community Supports, you may get a care team that can assist in identifying your needs. Then, they will coordinate no-cost services. This includes finding resources for housing, care after leaving the hospital, and dealing with asthma at home. Who may be on your care team: Nurse Care Manager Behavioral Health Care Manager Care Coordinator Community Health Worker Support when you need it Your care team can assist you by phone or in person, and they can even meet you at your location. You are not alone with IEHP’s Community Supports. What community supports are offered? Asthma Remediation: Environmental Asthma Trigger Remediations are physical modifications to a home environment that are necessary to ensure the health, welfare, and safety of the individual, or enable the individual to function in the home and without which acute asthma episodes could result in the need for emergency services and hospitalization. Community Transition Services/Nursing Facility Transition to a Home: Assist members to live in the community and avoid further institutionalization.These services are non-recurring set-up expenses for individuals who are transitioning from a licensed facility to a living arrangement in a private residence where the person is directly responsible for his or her own living expenses. Environmental Accessibility Adaptations (Home Modifications): Environmental Accessibility Adaptations (EAAs also known as Home Modifications) are physical adaptations to a home that are necessary to ensure the health, welfare, and safety of the individual, or enable the individual to function with greater independence in the home: without which the Member would require institutionalization. Housing Deposits: Housing Deposits assist with identifying, coordinating, securing, or funding one-time services and modifications necessary to enable a person to establish a basic household that do not constitute room and board. Housing Tenancy & Sustaining Services: This service provides tenancy and sustaining services, with a goal of maintaining safe and stable tenancy once housing is secured. Housing Transition Navigation Services: Housing transition services assist Members with obtaining housing. Medically Supportive Food/Meals/Medically Tailored Meals: Malnutrition and poor nutrition can lead to devastating health outcomes, higher utilization, and increased costs, particularly among Members with chronic conditions. Meals help individuals achieve their nutrition goals at critical times to help them regain and maintain their health. Results include improved Member health outcomes, lower hospital readmission rates, a well-maintained nutritional health status, and increased Member satisfaction. Nursing Facility Transition/Diversion to Assisted Living Facilities: Nursing Facility Transition/Diversion services assist individuals to live in the community and/or avoid institutionalization when possible. The goal is to both facilitate nursing facility transition back into a home-like, community setting and/or prevent skilled nursing admissions for Members with an imminent need for nursing facility level of care (LOC). Individuals have a choice of residing in an assisted living setting as an alternative to long-term placement in a nursing facility when they meet eligibility requirements. Recuperative Care (Medical Respite): Recuperative care, also referred to as medical respite care, is short-term residential care for individuals who no longer require hospitalization, but still need to heal from an injury or illness (including behavioral health conditions) and whose condition would be exacerbated by an unstable living environment. An extended stay in a recovery care setting allows individuals to continue their recovery and receive post-discharge treatment while obtaining access to primary care, behavioral health services, case management and other supportive social services, such as transportation, food, and housing. Short-Term Post-Hospitalization Housing: Short-Term Post-Hospitalization housing provides Members who do not have a residence and who have high medical or behavioral health needs with the opportunity to continue their medical/psychiatric/substance use disorder recovery immediately after exiting an inpatient hospital (either acute or psychiatric or Chemical Dependency and Recovery hospital), residential substance use disorder treatment or recovery facility, residential mental health treatment facility, correctional facility, nursing facility, or recuperative care and avoid further utilization of State plan services. Sobering Centers: Sobering centers are alternative destinations for individuals who are found to be publicly intoxicated (due to alcohol and/or other drugs) and would otherwise be transported to the emergency department or jail. Sobering centers provide these individuals, primarily those who are homeless or those with unstable living situations, with a safe, supportive environment to become sober. To learn more about Community Supports, 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.
COVID-19 - Mental Health
otions and how that balance (or imbalance) affects behavior and thoughts. What is stigma? There is still too much stigma surrounding behavioral and mental health. Historically, “crazy” or “mad” folks have been ostracized from society. This has been due to ignorance about mental health. Unfortunately, there is still too much fear and mis-understanding in our communities about mental health. Many people suffer from mental disorders. And given the current COVID-19 crisis, many more people will suffer from mental illness. Too many people suffer in silence with mental illness The statistics before COVID were about 1 in 5 people were diagnosed with a mental illness in America Those numbers will increase now during the COVID-19 crisis Mental Health includes wellness, self-care, emotional regulations, relationship issues, and parenting among other facets of everyday life Mental well-being is important to everyone Mental illness can happen to anyone Tips for staying mentally well during COVID-19 Self-care is critical: listen to your warning signs of struggling with your emotions and doing the basic things like showering, eating, sleeping, and exercise Do something that brings you enjoyment every day: play with your children or spouse, take walks, read a book, do something creative Connect with someone outside your home every day via telephone or other video technology Eat nutritiously, do not binge or eat too many sweets Avoid alcohol Continue to see your therapist via tele-health Continue to take care of your physical, financial, and spiritual needs Be patient with yourself and others Readily forgive yourself Exercise, do yoga, go for a walk. Stay active, but do not overdue it Remember that you are not alone. Many people are struggling or will struggle with mood and anxiety issues during this time . Reach out for help. Mental health help is available and we want you to seek help. Resources Psychiatry Walk-in Clinic (Montclair) Psychiatry Walk-in Clinic (Palm Desert) Teen Mental Health Guide A simple guide to manage stress