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Helpful Information and Resources - Emergency Safety
y when there is a power shutoff or fire. We want to ensure you get the needed care and services to help you during these events. If you are impacted by these events and need help with your durable medical equipment (such as wheelchairs, ventilators, oxygen monitors, etc.) 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. If you need a medicine refill, go to your pharmacy and request a refill. For medical advice after-hours, please call the IEHP 24-Hour Nurse Advice Line at 1-888-244-4347 or 711 (TTY). How to prepare for an emergency. Public Safety Power Shutoff Alerts A Public Safety Power Shutoff, also called a PSPS, occurs in response to severe weather. Power is turned off to help prevent wildfire and keep communities safe. We encourage you to sign up for alerts so you know when a Public Safety Power Shutoff may occur and when your power is restored. Click here to sign up. Medicine Safety Some medicines may need to be stored in a refrigerator to keep their strength, including many liquid medicines. When the power is out for a day or more, throw away any medicines that should be refrigerated, unless the medicines label says otherwise. If a life depends on the refrigerated medicines (for example, insulin), use them only until a new supply is available. Replace all refrigerated medicines as soon as you can. Resources Refrigerated Medicine Storage (PDF) Insulin Storage and Product Switching in an Emergency (PDF) Comparison of Insulins (PDF) Durable Medical Equipment Safety Use the checklist below to prepare for a power outage. Check your backup power equipment frequently to ensure it will function during an emergency. Call your power and water companies about your needs for life-support devices (home dialysis, suction, breathing machines, etc.) in advance of a disaster. Many utility companies keep a “priority reconnection service” list and map of the locations of power-dependent customers for use in an emergency. Ask the customer service department of your utility companies if this service is available. Keep the shut-off switch for oxygen equipment near you so you can get to it quickly in case of emergency. Generator users should operate generators in open areas to ensure good air circulation. Test generators once a month, and take your generator to be serviced at least once a year, to make sure it will work when needed. Create a plan for how to recharge batteries when the power is out. Reference resources below. When power is restored, make sure the settings on your medical device have not changed. Resources Emergency Power Planning for a Durable Medical Equipment Checklist (PDF): this booklet helps you establish a plan to obtain and organize your medical device information. How to Prepare for and Handle Power Outages for Medical Devices that Require Electricity - FDA Emergency Power Planning for People Who Use Electricity and Battery Dependent Assistive Technology and Medical Devices: this checklist will help you create a plan for your electric and battery-dependent devices. Mental Health If you have been impacted by a fire and need mental health, related to stress or grief, call IEHP Member Services at 1-800-440-IEHP (4347), 8am-5pm (PST), Monday-Friday. TTY users should call 1-800-718-4347. For medical advice after-hours, please call the IEHP 24-Hour Nurse Advice Line at 1-888-244-4347 or 711 (TTY). Additional Tips Build or restock your emergency supply kit, including food, water, flashlights, a radio, fresh batteries, first aid supplies and cash. Click here to find local resources that help you build an emergency supply kit. Identify backup charging methods for phones such as a battery power pack, a car charger and solar battery charger. Learn how to manually open your garage door. Create a plan based off what you can do by yourself and what you will need help with. Create an emergency contact list. If you own a backup generator, ensure it is ready to safely operate. Create an emergency action plan that includes evacuation planning for your home, family and pets. Resources https://www.sce.com/wildfire: how to safety prepare for a wildfire https://www.sce.com/wildfire/psps: Power Safety Power Shutoff resources https://prepareforpowerdown.com/: how to prepare for a power shutoff http://www.jik.com: emergency preparedness information prepared by Jule Kiles https://www.readyforwildfire.org/prepare-for-wildfire/get-set/: how to prepare for a wildfire Emergency Supplies Kits for People with Disabilities and Activity Limitations: checklist suggests emergency kit contents including no cost supplies, that you can tailor to your needs and abilities. Emergency Evacuation Preparedness: Taking Responsibility For Your Safety, A Guide For People with Disabilities and Other Activity Limitation: how to develop plans that integrates people with disabilities and others with access and functional needs. Emergency Health Information: Savvy Health Care Consumer Series: a guide to develop your emergency health information. Emergency Travel Safety Tips for Overnight Stays: a guide for people with disabilities. Tips for Emergency Use of Mobile Devices: preparing your device for an emergency.
Senior Health - Advanced Care Planning
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.
Care After Hours - Emergency Room vs. Urgent Care Clinic
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.
Urgent Care and Medi-Cal
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.
Medi-Cal Evidence of Coverage Updates
book for the benefit year of January 1, 2022 – December 31, 2022. How to get care Sensitive care Minor consent services You may only get the following services without your parent or guardian’s permission if you are 12 years old or older: Outpatient mental health care for (minors age 12 or older): Sexual assault (no lower age limit) Incest Physical assault Child abuse When you have thoughts of hurting yourself or others (minors age 12 or older) HIV/AIDS prevention/testing/treatment Sexually transmitted infections prevention/testing/treatment Substance use disorder treatment services (minors age 12 or older). For more information see “Substance use disorder treatment services” in this handbook. If you are under 18 years old, you can go to a doctor without permission from your parents or guardian for these types of care: Pregnancy Family planning/birth control Abortion services For pregnancy testing, family planning services, birth control, or sexually transmitted infection services, the doctor or clinic does not have to be part of the IEHP network. You can choose any Medi-Cal provider and go to them for these services without a referral or pre-approval (prior authorization). Services from an out-of-network provider not related to sensitive care may not be covered. For help finding a doctor or clinic giving these services, or for help getting to these services (including transportation), you can call IEHP Member Services at 1-800-440-IEHP (4347) (TTY 1-800-718-4347 or 711). Minors can talk to a representative in private about their health concerns by calling the 24/7 at 1-888-244-IEHP (4347) (TTY 711). Benefits and services What your health plan covers This chapter explains your covered services as a member of IEHP. Your covered services are free as long as they are medically necessary and provided by an in-network provider. You must ask us for pre-approval (prior authorization) if the care is out-of-network except for sensitive services, emergencies and some urgent care services. Your health plan may cover medically necessary services from an out-of-network provider. But you must ask IEHP for pre-approval (prior authorization) for this. Medically necessary services are reasonable and necessary to protect your life, keep you from becoming seriously ill or disabled, or reduces severe pain from a diagnosed disease, illness or injury. For Members under the age of 21, Medi-Cal services include care that is medically necessary to fix or help relieve a physical or mental illness or condition. For more details on your covered services, call IEHP Member Services at 1-800-440-IEHP (4347) (TTY 1-800-718-4347 or 711). Members under 21 years old get extra benefits and services. Read Chapter 5: Child and youth well care for more information. Some of the basic health benefits IEHP offers are listed below. Benefits with a star ( * ) may need pre-approval. Acupuncture* Acute (short-term treatment) home health therapies and services Adult immunizations (shots) Allergy testing and injections Ambulance services for an emergency Anesthesiologist services Asthma prevention Audiology* Behavioral health treatments* Cardiac rehabilitation Chiropractic services* Chemotherapy & Radiation therapy Cognitive health assessment Dialysis/hemodialysis services Durable medical equipment (DME)* Emergency room visits Enteral and parenteral nutrition* Family planning office visits and counseling (you can go to a non-participating provider) Habilitative services and devices* Hearing aids Home health care* Hospice care* Inpatient medical and surgical care* Lab and radiology* Long-term home health therapies and services* Maternity and newborn care Major organ transplant* Occupational therapy* Orthotics/prostheses* Ostomy and urological supplies Outpatient hospital services Outpatient mental health services Outpatient surgery* Palliative care* PCP visits Pediatric services Physical therapy* Podiatry services* Pulmonary rehabilitation Rapid Whole Genome Sequencing Rehabilitation services and devices* Skilled nursing services Specialist visits Speech therapy* Surgical services Telemedicine/Telehealth Transgender services* Urgent care Vision services* Women’s health services
MediCal Open Access Program - Open Access Program
a better life, and a better future. Many children enter foster care with a list of physical or behavioral health concerns. Due to changing placements, these concerns often go untreated. By speeding up the process to see a Doctor, the Open Access Program makes it simple for your child to get ongoing medical care. No matter where you live in the Inland Empire, your child can see any Doctor in the network. Plus, our program gives your child many services you won’t find with the Regular Medi-Cal system. How Open Access makes it simpler for your child to get healthcare: Your child can see any PCP in our large network. You can switch Doctors any time, for any reason. IEHP will help you find one. Call 1-800-440-IEHP (4347) / TTY (800) 718-4347. The Program gives your Doctor a record of your child’s health history (shots, medicines, checkups) so there’s no guesswork. If you misplaced your IEHP Member ID Card or Beneficiary Identification Card (BIC), an Open Access Doctor can go online and quickly confirm your child’s eligibility. You and your child get extra services at no cost: Keep your child feeling well with no-cost Wellness Programs like asthma or diabetes. Keep your child safe and healthy and get extras a parent enjoy like an infant car seat, children’s vitamins, and a bicycle helmet. A team helps you care for your child with a chronic illness. Working with your child’s Doctor, we call you, making sure your child gets the right care. We even lend a hand if things like Doctor visits, lab tests or medicine pile up. Important Resources Open Access Provider Directory (PDF) To get more information about the Open Access Program call an IEHP Foster Care Specialist at (800) 706-4347, Monday–Friday, 8am-5pm. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download a free copy. Click Adobe Acrobat Reader.
Complex Care Management
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.
Helpful Information and Resources - Personal Injuries and Accidents
l eligible, Please contact the Department of Health Care Services at (916) 445-9891 or visit DHCS.ca.gov/PI. Operating hours: 8am – 12pm and 1pm – 5pm, Monday through Friday. Closed on weekends and holidays. Mailing address: Department of Health Care Services Third Party Liability and Recovery Division Casualty Insurance Section – MS 4720 P.O. Box 997425 Sacramento, CA 95899-7425 IEHP DualChoice (HMO D-SNP) Medicare-Medicaid Plan Members If you are a Medicare Member and would like to report a potential liability settlement, judgment, award or other payment you have received, or to request your Protected Health Information, please click here for Authorization of Release (PDF).
Report an Issue - Report a problem with your care
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.
Helpful Information and Resources - Holiday Schedule
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
Member Advisory Committee - Public Policy Participation Committee
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
IEHP DualChoice - How to Access Care
ited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when you are out of the area), out-of-area dialysis services, and cases in which IEHP DualChoice (HMO D-SNP) authorizes use of out-of-network providers. What are Network providers? Network providers are the doctors and other health care professionals, medical groups, hospitals, and other health care facilities that have an agreement with us to accept our payment as payment in full. We have arranged for these providers to deliver covered services to members in our plan. All of our plan participating providers also contract us to provide covered Medi-Cal benefits. Find a Doctor Use the IEHP DualChoice Provider and Pharmacy Directory below to find a network provider: 2023 IEHP DualChoice Provider and Pharmacy Directory (PDF) What is a Primary Care Provider (PCP) and their role in your Plan? A PCP is your Primary Care Provider. You will usually see your PCP first for most of your routine health care needs. Your PCP will also help you arrange or coordinate the rest of the covered services you get as a member of our Plan. "Coordinating" your services includes checking or consulting with other Plan providers about your care and how it is going. This includes: your X-rays laboratory tests, therapies care from doctors who are specialists hospital admissions, and follow-up care Primary Care Providers (PCPs) are usually linked to certain hospitals. When you choose your PCP, remember the following: You must choose your PCP from your Provider and Pharmacy Directory. Call IEHP DualChoice Member Services if you need help in choosing a PCP or changing your PCP. Choose a PCP that is within 10 miles or 15 minutes of your home. The PCP you choose can only admit you to certain hospitals. Try to choose a PCP that can admit you to the hospital you want within 30 miles or 45 minutes of your home. Some hospitals have “hospitalists” who specialize in care for people during their hospital stay. If you are admitted to one of these hospitals, a “hospitalist” may serve as your caregiver as long as you remain in the hospital. When you are discharged from the hospital, you will return to your PCP for your health care needs. If you need to change your PCP for any reason, your hospital and specialist may also change. Your PCP should speak your language. However, your PCP can always use Language Line Services to get help from an interpreter, if needed. If you do not choose a PCP when you join IEHP DualChoice, we will choose one for you. We will send you your ID Card with your PCP’s information. Remember, you can request to change your PCP at any time. You can switch your Doctor (and hospital) for any reason (once per month). If your change request is received by IEHP by the 25th of the month, the change will be effective the first of the following month; if your change request is received by IEHP after the 25th of the month, the change will be effective the first day of the subsequent month (for some providers, you may need a referral from your PCP). How to Get Care from a Specialist You will usually see your Primary Care Provider (PCP) first for most of your routine healthcare needs such as physical check-ups, immunization, etc. When your PCP thinks that you need specialized treatment or supplies, your PCP will need to get prior authorization (i.e., prior approval) from your Plan and/or medical group. This is called a referral. Your PCP will send a referral to your plan or medical group. It is very important to get a referral (approval in advance) from your PCP before you see a Plan specialist or certain other providers. If you don't have a referral (approval in advance) before you get services from a specialist, you may have to pay for these services yourself. What if you are outside the plan’s service area when you have an urgent need for care? Suppose that you are temporarily outside our plan’s service area, but still in the United States. If you have an urgent need for care, you probably will not be able to find or get to one of the providers in our plan’s network. In this situation (when you are outside the service area and cannot get care from a network provider), our plan will cover urgently needed care that you get from any provider. Our plan does not cover urgently needed care or any other care if you receive the care outside of the United States. Changing your Primary Care Provider (PCP) You may change your PCP for any reason, at any time. Also, it’s possible that your PCP might leave our plan’s network of providers and you would have to find a new PCP. If this happens, you will have to switch to another provider who is part of our Plan. If your PCP leaves our Plan, we will let you know and help you choose another PCP so that you can keep getting covered services. IEHP DualChoice Member Services can assist you in finding and selecting another provider. You can change your Doctor by calling IEHP DualChoice Member Services. Please call IEHP DualChoice Member Services at (877) 273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY users should call (800) 718-4347. For more information on network providers refer to Chapter 1 of the IEHP DualChoice Member Handbook. IEHP DualChoice (HMO D-SNP) is a HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) is dependent on contract renewal. This is not a complete list. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Click here to download a free copy by clicking Adobe Acrobat Reader. Information on this page is current as of October 01, 2022 H8894_DSNP_23_3241532_M
Healthy Living - Flu
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.
Helpful Information and Resources - Texting Program
Rx Prior Authorization Drug Treatment Criteria - Prior Authorization Drug Treatment
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. Medicare: For IEHP DualChoice (HMO D-SNP) - Medicare-Medicaid Plan - Formulary and Criteria information, please click here IEHP DualChoice (HMO D-SNP). Medicaid: On January 7, 2019, Governor Gavin Newsom issued Executive Order N-01-19 (EO-N-01-19) for achieving cost-savings for drug purchases made by the state. A key component of EO N-01-19 requires the Department of Health Care Services (DHCS) transition all Medi-Cal pharmacy services from managed care (MC) to fee for service (FFS). Click here to go to the “DHCS Medi-Cal Rx” page on IEHP website Click here to go to “Medi-Cal Rx: Transition” page on DHCS website Updated April 7, 2021, this document describes DHCS’ multi-faceted pharmacy transition policy, inclusive of “grandfathering” previously approved PAs from managed care and fee-for-service, as well as a 180-day period with no PA requirements for existing prescriptions, to help support the Medi-Cal Rx transition. During this transition period, Magellan will provide system messaging, reporting and outreach to provide for a smooth transition to Medi-Cal Rx. Click here to view “Medi-Cal Rx Pharmacy Transition Policy” from DHCS website To view Drug Criteria Referenced in Summary Table - Click Links Below: Clinical Practice Guidelines - CPGs Drug Prior Authorization Criteria HP Acthar (repository corticotropin injection) (PDF) Nucala (PDF) Spinraza (nusinersen) (PDF) Synagis (PDF) Xolair (omalizumab) (PDF) Drug Class Prior Authorization Criteria Adult Enteral Nutritional Supplement (PDF) Antineoplastic Agents (PDF) Erythorpoieses-Stimulating Agents (PDF) Growth Hormones (PDF) Hepatitis C (PDF) Hereditary Angioedema (PDF) Immuno Globulins (PDF) Nutritional Supplement Infant Formula (PDF) Opioid Analgesics (PDF) Pediatric Enteral Nutritional Supplement (PDF) Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitor (PDF) Testosterone Hormone Replacement (PDF) Therapeutic Agents in Rheumatic And Inflammatory Diseases (PDF) Pharmacy Policies Discharge Policy (PDF) Drug Trial and Failure (PDF) High Daily Morphine Milligram Equivalent (PDF) IEHP Drug Prior Authorization Policy (PDF) Intradialytic Parenteral Nutrition (IDPN) Policy (PDF) Non-Formulary Drug (PDF) Non-Sterile Compounded Medication (PDF) Off-Label Indication Policy (PDF) Pharmacy Drug Management Program for Pain (PDF) Quantity Limit Policy (PDF) Information on this page is current as of January 1, 2022.
Latest News - Public Notice for the Regular Meeting of the Joint Powers Agencies
AN AND IEHP HEALTH ACCESS. Date of Meeting: November 8, 2021 Time of Meeting: 9:00 AM Location of Meeting: Inland Empire Health Plan Headquarters 10801 Sixth Street, Suite 120 Rancho Cucamonga, California 91730 This Notice shall confirm the REGULAR MEETING of the Joint Powers Agencies - INLAND EMPIRE HEALTH PLAN AND IEHP HEALTH ACCESS. If disability-related accommodations are needed to participate in this meeting, please contact Annette Taylor, Secretary to the IEHP Governing Board at (909) 296-3584 during regular business hours of IEHP (M-F 8:00 a.m. – 5:00 p.m.) Agenda Copies of the Packet may be obtained here.
Latest News - University of La Verne Names IEHP’s Chief Executive Officer its Leopard of the Year
eve Morgan Leopard of the Year award, University of La Verne’s (ULV) most prestigious alumni recognition. “We consider this our Lifetime Achievement award, given to an alumnx who not only has achieved extraordinary career success, but maybe more importantly, has also greatly impacted and improved lives in their community,” shared University of La Verne President Dr. Devorah Lieberman. Selected by a committee comprised of leaders from ULV’s Alumni Advisory Board, the Office of Alumni Engagement and University Administration, recipients of the award are alumni who demonstrate a deep-seated commitment to their community and support the university with their time, talent and resources. “Jarrod has been a transformational partner with us over the past several years in the creation of our new College of Health and Community Well-Being,” added Lieberman. “His intimate knowledge of the health care needs of the Inland Empire and his personal passion to help guide our students – many of them first-generation college graduates, like himself – into productive, worthwhile career paths was a visionary contribution to help guide our planning. As our programs grow and our students succeed, we will forever credit his foresight and support in helping form this college.” McNaughton, who earned a Master of Business Administration at ULV, has remained engaged with the university since graduation, serving students through guest lectures, commencement speeches and more. “Maintaining a strong connection with your alma mater is an important part in supporting the next generation, especially those living in the Inland Empire,” said McNaughton. “I am incredibly humbled by this recognition and look forward to my continued collaboration with ULV in bridging gaps for current and future students.”
Latest News - Inland Empire Health Plan Promotes Autism Awareness
rents of Members to feel confident in advocating for themselves, their children, and family members to access the behavioral healthcare they need. The health plan supports more than 7,500 Members who are utilizing behavioral health treatment services for autism spectrum disorder (ASD) and related conditions. Such services may include: applied behavioral analysis, speech therapy, physical therapy, occupational therapy, psychiatry services and more. “Having Autism or being on the spectrum is nothing to be afraid of,” said Heather Waters, IEHP’s Manager of Behavioral Health and Care Management. “As a health plan, we want to take the stigma out of asking or seeking behavioral healthcare and encourage our Members or parents of Members to trust their gut and ask for support as soon as they spot any signs or symptoms of possible developmental delays.” Waters shared that early treatment and recognition of symptoms, as early as one year of age and before a child enters school, can result in better health outcomes, especially for children. Signs and symptoms vary and can range from obsessive or compulsive behaviors to poor social skills, delayed milestones, and more. IEHP Medi-Cal Members can be referred to services and treatment for ASD symptoms by a Medical Doctor or a Licensed Psychologist. This allows Members under 21 years of age to access critically important behavioral and developmental therapies immediately, while they undergo the autism evaluation process. IEHP’s Internal Behavioral Health Team helps Members and their families navigate an ASD diagnosis through actively coordinating services and additional resources through partnerships with several provider groups and local agencies across the region. Recently, IEHP collaborated with the Inland Empire Autism Assessment Center of Excellence (AAC) to provide a Member in Indio with a complete Autism Diagnostic Evaluation through telehealth appointments. “Even with care coordination challenges like location and Member condition, the situation wasn’t impossible,” said Waters. “As the Member and their family connected with the AAC, our team checked in regularly to make sure the services were effective and to remind the family and Member that they were not alone in this journey.” To receive an evaluation or additional services, Members are encouraged to call IEHP’s Member Services at 1-800-440-4347 and ask for the Behavioral Health Department.
Latest News - UC Riverside Athletics and IEHP Partner for Community Wellness
forces this season to bring health and wellness resources, including COVID-19 education and vaccine information, to the campus community and broader audiences. Utilizing a multi-channel approach, the organizations will serve as an access point to timely and accurate health information for students, staff and the community during the ongoing pandemic. “We are excited to welcome IEHP as a partner to help us continue our mission of preparing our student-athletes for opportunities in life through sport,” said Wesley Mallette, Director of Intercollegiate Athletics. “In partnership with IEHP, we hope to educate and inform all Highlanders about the amazing resources IEHP provides and their positive impact on lives.” As a corporate sponsor, IEHP will be cheering for UCR’s basketball, baseball and softball home games, and will be sponsoring a basketball game on February 17, celebrating Black History Month. At this event, Michael Deering, IEHP’s Vice President of Innovation, Acceleration and Diversity, will be announcing the UCR Highlanders’ starting lineup. Also featured in the partnership is the health plan’s collaborative work with UCR’s Center for Healthy Communities and School of Medicine and will be aired on videoboard screens before games—appearing on ESPN+ when Highlander games are televised. “UCR’s commitment to public health is incredibly evident in all they do,” said Jarrod McNaughton, IEHP’s Chief Executive Officer. “We’re grateful to partner with them on multiple levels and look forward to sharing resources and accurate COVID-19 information so we can put our best foot forward in living healthy lives and defeating this virus, together.” For upcoming UCR game schedules and events, visit gohighlanders.com.
Latest News - New IEHP Program Combats Loneliness and Depression
xperiencing loneliness, anxiety or depression. The partnership connects 70,000 Members to support services for mental health screenings. The program began in March and will run through the fall of 2022. Members who elected to participate were invited to download the Pyx App on their smart phones or tablets, which immediately connects to Pyx-ir, an interactive robot. Pyx-ir will regularly converse, ask wellness questions and connect Members to IEHP services and call centers, depending on need. The program’s services rolled out to English and Spanish speaking Members who receive both Medicare and Medi-Cal benefits (Cal MediConnect Members), as well as Medi-Cal Members who are seniors with a disability or have been identified as unable to leave their homes and are at a greater risk for loneliness. “Isolation and stay-at-home orders have tremendously impacted these populations in the last two years,” said Anna Edwards, IEHP’s Care Management Clinical Director. “Our partnership with Pyx Health will extend care beyond the health plan’s usual business hours and truly meet the Members where they are.” For continuity of care, Pyx Health will provide the health plan with comprehensive reports based on Member screenings to connect Members with additional resources at the plan level. If needed, Members will also have the option to connect with Pyx Health’s Compassionate Call Center representatives who will be able to route information and reports to IEHP’s Care Management Team. “In addition to usual health plan services, we believe our partnership with Pyx Health will provide Members a unique aspect of personalized care,” said Dr. Takashi Wada, IEHP’s Chief Medical Officer. “We’re eager to learn how this pilot program and type of service can engage Members in their own health and how it will positively impact their overall wellness.”