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Latest News - IEHP Supports New Moms with Maternal Health Events

IEHP) will host a series of maternal health events at all three of their Community Resource Centers throughout the month of May.  The events will celebrate new moms and moms-to-be and will provide resources including postpartum care and access to community partner support including CalFresh. Medi-Cal enrollment support and guidance on how and when to access care will also be offered. In addition, events will focus on the behavioral health of pregnant and postpartum members. According to California Department of Public Health’s latest Maternal and Infant Health Assessment, 21% of pregnant and postpartum Californians report depressive symptoms which negatively impact the health and wellness outcomes of newborns and their parents. “We know these statistics heavily impact our members in the Inland Empire. Some studies have found troubling racial and ethnic disparities in receiving mental health care for postpartum depression,” said Ruth Villalpando Albarran, IEHP Licensed Behavioral Health Care Manager. “These events are designed to guide and assist members at every stage of their pregnancy and postpartum journey. Working together, we can help ensure optimal care and inspire vibrant health for them and their little ones.” The health plan hosted its first event on May 18 at its Riverside Community Resource Center. Additional events will be hosted at IEHP’s San Bernardino and Victorville Community Resource Centers at 805 West 2nd Street, suite C in San Bernardino on Wednesday, May 25 and at 12353 Mariposa Road, Suites C-2 & C-3 in Victorville on Thursday, May 26. Both events will be held from 9 a.m. to 1 p.m. Members can register by visiting  

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 - 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.

Leadership Team - Jarrod McNaughton, MBA, FACHE

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

Leadership Team - Keenan Freeman, MBA

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

Leadership Team - Edward Juhn, MD, MBA, MPH

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

Leadership Team - Michelle Rai, MS

2020. She oversees IEHP’s communications and marketing programs and guides the development of long-term communication and marketing strategies.  In this role, Ms. Rai oversees the strategic execution of IEHP’s branding, advertising, media relations, internal communications, digital and social media initiatives to align with IEHP’s Mission, Vision and Values.  

Leadership Team - Takashi Wada, MD, MPH

clinical strategic leadership for IEHP in partnership with the Chief Quality Officer through collaborative, accountable processes to improve the quality-of-care delivery and drive improved health outcomes for IEHP Members.  He is responsible for the health services division, including utilization management, behavioral health and care management, pharmacy, community health and health education, population health, health services special initiatives and health equity.   

Leadership Team - Susie White, MBA

ork sphere and was appointed Chief Operating Officer (COO) in July 2019. As COO, Susie is responsible for IEHP’s overall day-to-day operations. She is highly regarded for her commitment to driving IEHP’s team culture, serving the plan’s 1.6 million Members and advancing the plan’s Provider experience through the implementation of strategic initiatives that support the plan’s Mission, Vision and Core Values.    

Member Advisory Committee - Persons with Disabilities Workgroup

uide our services. As a result, we are able to improve how we deliver care and services. If you are an IEHP Member with a disability, you can request to be a Member of our PDW.  The PDW meets every three months at IEHP. 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 any communication needs and access issues that Members may have. To apply for membership in this workgroup, 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. 2023 Meeting Schedule March 22, 2023 May 10, 2023 August 30, 2023 November 8, 2023 Time: 12pm - 2pm

Leadership Team - Vinil Devabhaktuni, MBA

e, Mr. Devabhaktuni provides leadership for the overall information technology architecture, as well as the design, development, implementation and support of IEHP’s systems.  His focus includes maintaining the organization’s connection to Providers, collaborating closely with IT leadership, and aligning initiatives with IEHP’s overall strategic plan.  

Governing Board Meetings - 2023 Meeting Schedule and Locations

n to the public. We invite you to join us at the next board meeting. You can also download a copy of our most current monthly board report. Dr. Bradley P. Gilbert Center for Learning and Innovation 9500 Cleveland Avenue Rancho Cucamonga, CA 91730 Click here to view the meeting room map.  Inland Empire Health Plan Dates & Times Monday, January 30, 2023 9:00 a.m. February - NO MEETING Monday,  March 6, 2023 9:00 a.m. Monday, April 10, 2023 9:00 a.m. Monday, May 8, 2023 9:00 a.m.  Monday, June 5, 2023 9:00 a.m.  Monday, July 10, 2023 9:00 a.m.  Monday, August 14, 2023 9:00 a.m.  Monday, September 11, 2023 9:00 a.m.  Tuesday, October 10, 2023 9:00 a.m. Monday, November 13, 2023 9:00 a.m.  Monday, December 11, 2023 9:00 a.m. 

IEHP DualChoice - Rights and Responsibilities

, you have the right to: Receive information about your rights and responsibilities as an IEHP DualChoice Member. Be treated with respect and courtesy. IEHP DualChoice recognizes your dignity and right   to privacy. Receive services without regard to race, ethnicity, national origin, religion, sex, age, mental or physical disability or medical condition, sexual orientation, claims experience, medical history, evidence of insurability (including conditions arising out of acts of domestic violence), disability, genetic information, or source of payment.  Receive information about IEHP DualChoice, its programs and services, its Doctors, Providers, health care facilities, and your drug coverage and costs, which you can understand. Have a Primary Care Provider who is responsible for coordination of your care. If your Primary Care Provider changes, your IEHP DualChoice benefits and required co-payments will stay the same. Your IEHP DualChoice Doctor cannot charge you for covered health care services, except for required co-payments. Request a second opinion about a medical condition. Receive emergency care whenever and wherever you need it. See plan Providers, get covered services, and get your prescription filled timely. Receive information about clinical programs, including staff qualifications, request a change of treatment choices, participate in decisions about your health care, and be informed of health care issues that require self-management. If you have been receiving care from a health care provider, you may have a right to keep your provider for a designated time period. If you are under a Doctor’s care for an acute condition, serious chronic condition, pregnancy, terminal illness, newborn care, or a scheduled surgery, you may ask to continue seeing your current Doctor. To make this request, or if you have any concerns about your continuity of care, please call IEHP DualChoice Member Services at 1-877-273-IEHP (4347). Receive Member informing materials in alternative formats, including Braille, large print, and audio. Information on procedures for obtaining prior authorization of services, Quality Assurance, disenrollment, and other procedures affecting IEHP DualChoice Members. IEHP DualChoice will honor authorizations for services already approved for you. If you have any authorizations pending approval, if you are in them idle of treatment, or if specialty care has been scheduled for you by your current Doctor, contact IEHP to help you coordinate your care during this transition time. Call IEHP DualChoice at 1-877-273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY users should call 1-800-718-4347. Review, request changes to, and receive a copy of your medical records in a timely fashion. Receive interpreter services at no cost. Notify IEHP if your language needs are not met. Make recommendations about IEHP DualChoice Members’ rights and responsibilities policies. Be informed regarding Advance Directives, Living Wills, and Power of Attorney, and to receive information regarding changes related to existing laws. Decide in advance how you want to be cared for in case you have a life-threatening illness or injury. Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation Complain about IEHP DualChoice, its Providers, or your care. IEHP DualChoice will help you with the process. You have the right to choose someone to represent you during your appeal or grievance process and for your grievances and appeals to be reviewed as quickly as possible and be told how long it will take. Have grievances heard and resolved in accordance with Medicare guidelines; Request quality of care grievances data from IEHP DualChoice. Appeal any decision IEHP DualChoice makes regarding, but not limited to, a denial, termination, payment, or reduction of services. This includes denial of payment for a service after the service has been rendered (post-service) or denial of service prior to the service being rendered (pre-service). Request fast reconsideration; Request and receive appeal data from IEHP DualChoice; Receive notice when an appeal is forwarded to the Independent Review Entity (IRE); Automatic reconsideration by the IRE when IEHP DualChoice upholds its original adverse determination in whole or in part; Administrative Law Judge (ALJ) hearing if the independent review entity upholds the original adverse determination in whole or in part and the remaining amount in controversy is $100 or more; Request Departmental Appeals Board (DAB) review if the ALJ hearing is unfavorable to the Member in whole or in part; Judicial review of the hearing decision if the ALJ hearing and/or DAB review is unfavorable to the Member in whole or in part and the amount remaining in controversy is $1,000 or more; Make a quality of care complaint under the QIO process; Request QIO review of a determination of noncoverage of inpatient hospital care; Request QIO review of a determination of noncoverage in skilled nursing facilities, home health agencies and comprehensive outpatient rehabilitation facilities; Request a timely copy of your case file, subject to federal and state law regarding confidentiality of patient information; Challenge local and national Medicare coverage determination. As an IEHP DualChoice Member, you have the responsibility to: Review your Member Handbook, and call IEHP DualChoice Member Services if you do not understand something about your coverage and benefits Inform your Doctor about your medical condition, and concerns. Follow the plan of treatment your Doctor feels is necessary Make necessary appointments for routine and sick care, and inform your Doctor when you are unable to make a scheduled appointment. Learn about your health needs and leading a healthy lifestyle. Make every effort to participate in the health care programs IEHP DualChoice offers you. For more information on Member Rights and Responsibilities refer to Chapter 8 of your IEHP DualChoice Member Handbook. Rights and Responsibilities Upon Disenrollment Ending your membership in IEHP DualChoice (HMO D-SNP) may be voluntary (your own choice) or involuntary (not your own choice) You might leave our plan because you have decided that you want to leave. There are also limited situations where you do not choose to leave, but we are required to end your membership.Chapter 10 of your IEHP DualChoice Member Handbook tells you about situations when we must end your membership. When can you end your membership in our plan? Because you get assistance from Medi-Cal, you can end your membership in IEHP DualChoice at any time. Your membership will usually end on the first day of the month after we receive your request to change plans. Your enrollment in your new plan will also begin on this day. How to voluntarily end your membership in our plan? If you would like to switch from our plan to another Medicare Advantage plan simply enroll in the new Medicare Advantage plan. You will be automatically disenrolled from IEHP DualChoice, when your new plan’s coverage begins. If you would like to switch from our plan to Original Medicare but you have not selected a separate Medicare prescription drug plan. You must ask to be disenrolled from IEHP DualChoice. There are two ways you can asked to be disenrolled: To disenroll, please call Health Care Options (HCO) at 1-844-580-7272, 8am - 6pm (PST), Monday - Friday. TTY/TDD users should call 1-800-430-7077. For more information visit the DHCS website. By clicking on this link, you will be leaving the IEHP DualChoice website. Or you can contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. Until your membership ends, you are still a member of our plan. If you leave IEHP DualChoice, it may take time before your membership ends and your new Medicare coverage goes into effect. (See Chapter 10 of the IEHP DualChoice Member Handbook for information on when your new coverage begins.) During this time, you must continue to get your medical care and prescription drugs through our plan. You should continue to use our network pharmacies to get your prescriptions filled until your membership in our plan ends. Usually, your prescription drugs are only covered if they are filled at a network pharmacy including through our mail-order pharmacy services. If you are hospitalized on the day that your membership ends, you will usually be covered by our plan until you are discharged (even if you are discharged after your new health coverage begins). If you no longer qualify for Medi-Cal or your circumstances have changed that make you no longer eligible for Dual Special Needs Plan, you may continue to get your benefits from IEHP DualChoice for an additional two-month period. This additional time will allow you to correct your eligibility information if you believe that you are still eligible. You will get a letter from us about the change in your eligibility with instructions to correct your eligibility information. To stay a member of IEHP DualChoice, you must qualify again by the last day of the two-month period. If you do not qualify by the end of the two-month period, you’ll de disenrolled by IEHP DualChoice. Involuntarily ending your membership IEHP DualChoice must end your membership in the plan if any of the following happen: If you do not stay continuously enrolled in Medicare Part A and Part B. If you move out of our service area for more than six months.        If you become incarcerated. If you lie about or withhold information about other insurance you have that provides prescription drug coverage. If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan. If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan. If you let someone else use your membership card to get medical care. To be a Member of IEHP DualChoice, you must keep your eligibility with Medi-Cal and Medicare. If you lose your zero share-of-cost, full scope Medi-Cal, you will be disenrolled from our plan (for your Medicare benefits) the first day of the following month and will be covered by the Original Medicare. The State or Medicare may disenroll you if you are determined no longer eligible to the program. IEHP DualChoice (HMO D-SNP) is a HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) depends on contract renewal. Information on this page is current as of October 01, 2022. H8894_DSNP_23_3241532_M

Healthy Living - Monkey Pox

amily of viruses that cause smallpox. Is monkeypox very dangerous?  The Centers for Disease Control and Prevention (CDC) stated that most of those infected recover from monkeypox in two to four weeks. Those who caught the virus said the rash (that looks like pimples or blisters) can be painful.    Those with weakened immune systems, children under age 8, people who are pregnant or breastfeeding, and those with a history of eczema may be more likely to get seriously ill or pass away.  What are the symptoms? The most common symptoms are:  Fever and headache Muscle aches and backache Swollen lymph nodes Exhaustion and chills Sore throat, stuffy nose or cough Rash (i.e., pimples or blisters that show up on the face, inside the mouth and on other body parts) If you have monkeypox symptoms, please call your Doctor’s office. How does monkeypox spread? It is spread through direct contact with someone who has an infected rash, scabs or body fluids. It could also spread through face-to-face contact. Or it can be spread by touching items that had been touched by those with the infection. People who don’t have monkeypox symptoms can’t spread this virus to others. How can I protect myself and my family? Take these precautions:  Avoid skin-to-skin contact with those who have a rash that looks like monkeypox. This rash can look like small blisters or pimples and may be itchy or painful. Avoid contact with surfaces or materials that a person with monkeypox has used or touched. Wash your hands with soap and water for 20 seconds often or use an alcohol-based hand sanitizer. Is there a monkey pox vaccine? JYNNEOS is a 2-dose vaccine developed to protect against monkeypox. The second dose should be given 4 weeks after the first dose. Consult with your health care provider if you are at high risk of exposure or if you were in contact with a person who has monkeypox within the last 2 weeks.  Antiviral drugs used for treatment of smallpox may be considered some instances to treat monkeypox viral infections. Consult with your health care provider for more information.  Who should get this vaccine? The Centers for Disease Control and Prevention (CDC) recommends it for those who have been in close contact with those with monkeypox. While anyone exposed to this monkeypox can become infected, 98% of current infections have been found in men who have sex with men. Talk with your Doctor if you believe you have been exposed to monkeypox. If you have monkeypox symptoms, please call your Doctor’s office. Click here to learn more.  What are the side effects of the vaccine? The most common side effects are pain, redness, and itching at the spot where the vaccine is given. You may also experience fever, headache, tiredness, nausea, chills, and muscle aches; however, these are signs that the vaccine is working, not getting sick. These side effects may last for several weeks. Is the vaccine safe? The vaccine is safe to get. However, you should not get the vaccine if you have a severe allergic reaction (anaphylaxis) after getting your first dose of the JYNNEOS vaccine. Make sure to let your health care provider know if you have a severe allergic reaction from any vaccinations. Do I have to pay for the vaccine? Monkeypox vaccines are FREE. Your health care provider must give you the vaccine regardless of your ability to pay the administration fee.   

IEHP DualChoice - 2023 Plan Benefits

ou will pay: Benefits Doctor Visit: $0 Vision Care: $350 limit every year for contact lenses and eyeglasses (frames and lenses) Inpatient Hospital Care: $0 Home Health Agency Care: $0 Ambulance Services: $0 Transportation: $0. Including bus pass. Call our transportation vendor Call the Car (CTC) at (866) 880-3654, for TTY users, call your relay service or California Relay Service at 711. For reservations call Monday-Friday, 7am-6pm (PST). Call at least 5 days before your appointment. Diagnostic Tests, X-Rays & Lab Services: $0 Durable Medical Equipment: $0 Home and Community Based Services (HCBS): $0 Community Based Adult Services (CBAS): $0 Long Term Care that includes custodial care and facility: $0 Utilities allowance of $40 for covered utilities. You must qualify for this benefit. You pay nothing for a one-month or long term-supply of drugs With IEHP DualChoice, you pay nothing for covered drugs as long as you follow the plan’s rules. Tier 1 drugs are: generic, brand and biosimilar drugs. They have a copay of $0. After your coverage begins with IEHP DualChoice, you must receive medical services and prescription drug services in the IEHP DualChoice network. To learn more about the plan’s benefits, cost-sharing, applicable conditions and limitations, refer to the IEHP DualChoice Member Handbook. 2023 Summary of Benefits (PDF) 2023 Annual Notice of Changes (PDF) 2023 IEHP DualChoice Member Handbook (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Click here to download a free copy of Adobe Acrobat Reader.By clicking on this link, you will be leaving the IEHP DualChoice website.  Plan Premium With "Extra Help," there is no plan premium for IEHP DualChoice. Plan Deductible There is no deductible for IEHP DualChoice. Because you are eligible for Medi-Cal, you qualify for and are getting “Extra Help” from Medicare to pay for your prescription drug plan costs. You do not need to do anything further to get this Extra Help.  You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, you can contact: 1-800-MEDICARE (1-800-633-4227). , TTY users should call (877) 486-2048, 24 hours a day/7days a week The Social Security Office at (800) 772-1213 between 7 a.m. and 7 p.m., Monday through Friday, TTY users should call (800) 325-0778; or Your State Medicaid Office How to get care coordination Do you need help getting the care you need? A care team can help you. A care team may include your doctor, a care coordinator, or other health person that you choose. A care coordinator is a person who is trained to help you manage the care you need. You will get a care coordinator when you enroll in IEHP DualChoice. This person will also refer you to community resources, if IEHP DualChoice does not provide the services that you need. To speak with a care coordinator, please call IEHP DualChoice Member Services at (877) 273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY users should call 1-800-718-4347. Prior Authorization and Out of Network Coverage  What kinds of medical care and other services can you get without getting approval in advance from your Primary Care Provider (PCP) in IEHP DualChoice (HMO D-SNP)? You can get services such as those listed below without getting approval in advance from your Primary Care Provider (PCP). Routine women’s health care, which includes breast exams, screening mammograms (X-rays of the breast), Pap tests, and pelvic exams as long as you get them from a network provider. Flu shots as long as you get them from a network provider. Emergency services from network providers or from out-of-network providers. Urgently needed care from in-network providers or from out-of-network providers when network providers are temporarily unavailable or inaccessible, e.g., when you are temporarily outside of the plan’s service area. Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area. (If possible, please call IEHP DualChoice Member Services before you leave the service area so we can help arrange for you to have maintenance dialysis while you are away.) How to get care from specialists and other network providers A specialist is a doctor who provides health care services for a specific disease or part of the body. There are many kinds of specialists. Here are a few examples: Oncologists care for patients with cancer. Cardiologists care for patients with heart conditions. Orthopedists care for patients with certain bone, joint, or muscle conditions. You will usually see your PCP first for most of your routine healthcare needs such as physical checkups, immunization, etc. When your PCP thinks that you need specialized treatment or supplies, your PCP will need to get prior authorization (i.e., prior approval) from your Plan and/or medical group. This is called a referral. Your PCP will send a referral to your plan or medical group. It is very important to get a referral (approval in advance) from your PCP before you see a Plan specialist or certain other providers. If you don’t have a referral (approval in advance) before you get services from a specialist, you may have to pay for these services yourself. PCPs are usually linked to certain hospitals and specialists. When you choose a PCP, it also determines what hospital and specialist you can use.  What if a specialist or another network provider leaves our plan? Sometimes a specialist, clinic, hospital or other network provider you are using might leave the plan. When a provider leaves a network, we will mail you a letter informing you about your new provider. If you prefer a different one, please call IEHP DualChoice Member Services and we can assist you in finding and selecting another provider. How to get care from out-of-network providers When your doctor recommends services that are not available in our network, you can receive these services by an out-of-network provider. In order to receive out-of-network services, your Primary Care Provider (PCP) or Specialist must submit a referral request to your plan or medical group. All requests for out-of-network services must be approved by your medical group prior to receiving services. IEHP DualChoice (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.  Information on this page is current as of October 1, 2022. H8894_DSNP_23_3241532_M

IEHP DualChoice - Important Resources

rm (PDF) Medicare Complaint Form (by clicking this link, you will be leaving the IEHP DualChoice website) The IEHP DualChoice Privacy Notice describes how medical information about you may be used and disclosed, and how you can get access to this information. IEHP DualChoice Privacy Notice (PDF) Centers for Medicare and Medicaid Services The following link will take you to the Centers for Medicaid and Medicare Services website, where you can look through the CMS Best Available Evidence Policy using the following link: CMS Best Available Evidence Policy. By clicking on this link, you will be leaving the IEHP DualChoice website. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here. By clicking on this link, you will be leaving the IEHP DualChoice website. IEHP DualChoice (HMO D-SNP) is a HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) depends on contact renewal. Information on this page is current as of October 01, 2022. H8894_DSNP_23_3241532_M

Special Programs - Alcohol and Drug (SABIRT)

ant to the Department of Health Care Services (DHCS) APL 21-014 (PDF), “Alcohol and Drug SABIRT,” IEHP has updated its requirements for alcohol and substance use screening in the primary care setting. Helpful resources: Correspondence - June 2022 - Alcohol and Drug SABIRT Training Guide (PDF) Screening Tools Alcohol Use Disorders Identification Test (AUDIT-C) Brief Addiction Monitor (BAM) (PDF) Cut Down-Annoyed-Guilty-Eye-Opener Adapted to Include Drugs (CAGE-AID) (PDF) Tobacco Alcohol, Prescription Medications and other Substances (TAPS) (PDF) National Institute on Drug Abuse (NIDA) Quick Screen for Adults (PDF) Drug Abuse Screening Test (DAST-10) (PDF) Parents, Partner, Past, and Present (4Ps) for pregnant women and adolescents (PDF) Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) for non-pregnant adolescents (PDF) Michigan Alcoholism Screening Test Geriatric (MAST-G) alcohol screening for geriatric population (PDF) Assessment Tools Alcohol Use Disorders Identification Test (AUDIT) (PDF) Brief Addiction Monitor (BAM) (PDF) NIDA-Modified Alcohol, Smoking and Substance Involvement Screening Test (NM-ASSIST) (PDF) Drug Abuse Screening Test (DAST-20) (PDF) Pamphlets Riverside Brochure (English) (PDF) Riverside Brochure (Spanish) (PDF) San Bernardino Brochure (English) (PDF) San Bernardino Brochure (Spanish) (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Innovations and Quality Performance - Quality Performance

rting our providers. We are committed to quality, driving us to create programs and services to meet the needs of our members and providers. In fact, IEHP is one of the top-rated Medicaid plans in California. Determined by both the Healthcare Effectiveness Data and Information Set (HEDIS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS), NCQA has awarded IEHP an Accreditation status for Medi-Cal. This status is only given to health plans that have clinical and service programs that meet or exceed NCQA standards. Learn more about how IEHP delivers quality services and care below.  Quality Report Inside the 2023 Quality Report, we take you through our quality journey by looking at our performance over the past year with critical measures. We show you how that data translates into tangible outcomes for our Members, Providers and Team Members. While there were many areas where we excelled, there were also places where we found opportunities for improvement. The goal of this Quality Report is to be transparent—with you and with ourselves. This journey is ongoing, and we hope to learn from it so we can do better and be better for those who rely on us the most. 2023 Annual Quality Report (PDF) 2022 Annual Quality Report 2020 Annual Quality Report (PDF) Quality Management IEHP supports an active, ongoing, and comprehensive quality management program with the primary goal of continuously monitoring and improving the quality of care, access to care, patient safety, and quality of services delivered to IEHP Members. The Quality Management (QM) Program provides a formal process to systematically monitor and objectively evaluate, track and trend the health plan’s quality, efficiency and effectiveness. Quality Management Evaluation 2021 Quality Management Annual Evaluation (PDF) Quality Management Program Description 2022 Quality Management Program Description (PDF) HEDIS Every year, IEHP assesses the overall quality of health care experienced by IEHP members. To achieve this IEHP uses  NCQA, a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS® which provides: a set of standardized performance measures based on statistically valid samples of members the public with information to compare health plan performance HEDIS Rate: 2021 Medi-Cal HEDIS Rates (PDF) 2021 Medicare HEDIS Rates (PDF) Physician Satisfaction IEHP values a strong partnership with our providers. To support them we offer many services from online support, to a call center, to a dedicated service representative. That's why doctors think highly of IEHP. In fact, according to the 2021 Provider Satisfaction Survey conducted by SPH Analytics, 98.1% of physicians would recommend IEHP to other physicians. See the full results of the 2021 Provider Satisfaction Survey (PDF). Population Needs Assessment Every year, IEHP sends out a Population Assessment Survey to IEHP Members to learn more about their needs. View the results below.  2020 Population Needs Assessment Results  You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader. 

Health Navigator Program - Health Navigator Program

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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. Breaking Maternal Mental Health Stigma - One Mom at a Time   Immediately after childbirth, most women experience “baby blues,” which can include mood swings, crying spells, anxiety and difficulty sleeping – all very normal, but short-lived symptoms. However, postpartum depression is more severe and long-lasting, usually requiring treatment from a mental health professional. For millions of new moms, like Inland Empire Health Plan (IEHP) Member Gerti, motherhood – and all the challenges it brings – can be overwhelming. After the birth of her daughter, Gerti struggled with her mental health and recognized she needed help.  Thankfully, she knew exactly where to turn.    Additional Resources The ABC's of Safe Sleep (Video) Centers for Disease Control and Prevention: Pregnancy Depression During and After Pregnancy