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Latest News - IEHP Expands Healthcare Services to Entire Inland Empire
are services for more than 11,000 residents in Needles, Big River, Red Mountain, Blythe, Trona and surrounding areas in California. The expanded coverage, directed through the CalAIM initiative, will transition traditional services to managed care plans like IEHP and provide a new coordinated care service offering supporting all 27,408 miles of the Inland Empire. Prior to the expansion, residents in these rural areas received health coverage through Medi-Cal’s traditional fee-for-service model but did not have access to services like health education programs, telephone advice nurses, and coordinated care support. IEHP is currently in the process of contracting and credentialing available Providers in these areas to ensure Members are assigned to the Primary Care Providers nearest to their areas. “Just like the rest of our Membership, these new Members deserve the best care possible and should have access to a solid network of Providers and community supports,” said Susie White, IEHP Chief Operating Officer. “We’re thrilled some of our trusted Provider partners have made their way into our new service area and opened clinics to welcome our new Members. Teams across our organization continue to work on building a sustainable network for our entire community.” To help new Members become familiar with the health plan and the resources they now have access to, IEHP’s Community Health Teams have attended and hosted various events in the community, with the commitment to continue the support efforts moving forward. Earlier this year, IEHP joined community partners Young Visionaries, the Family & Kids Foundation, and Food Forward, to provide food, toys, household items, fresh produce, and vaccine opportunities for more than 300 residents in Trona. “As an IEHP Member, you can absolutely trust that we will do the right thing for you and your family and get you connected to the care you need,” said Jarrod McNaughton, IEHP Chief Executive Officer. “We are so excited to welcome our neighbors in these rural areas and support them in a way that complements and enhances their quality of life for years to come.”
Latest News - SAC Health Receives IEHP’s Mission INSPIRE AWARD
C), received Inland Empire Health Plan’s (IEHP) Mission INSPIRE Award this month at the health plan’s second Annual Mission Conference. The award recognized SAC Health’s ongoing support and service to residents in Riverside and San Bernardino counties. SAC Health’s roots reach back as far as the 1960s, which have led to 35 specialties offered today at 10 locations, including a mobile unit that supports more than 144,000 patient visits each year. SAC Health is also one of IEHP’s most prominent partners, providing care to more than 50,000 of the Inland Empire’s most vulnerable residents and educating future physicians in the region. In collaboration with SAC Health, new health care clinics were developed in brand new service areas, supporting thousands of residents in Blythe and Barstow. “You can’t do this kind of work and truly impact the community and those that need the care without really strong partnerships. It takes a whole community to do that,” said Dr. Jason Lohr, CEO of SAC Health. “We are overwhelmed with gratitude and humility to be honored with this award.” SAC Health is one of the first recipients of the IEHP Mission INSPIRE Award. The award honors providers, community organizations and partners for their commitment to the health plan’s mission to “heal and inspire the human spirit.” “We are thrilled to honor SAC Health’s dedication and determination to consistently do the right thing for our communities and Members,” said Jarrod McNaughton, IEHP Chief Executive Officer. To learn more about the IEHP Mission Conference and how the health plan is charting a collaborative path forward, visit iehp.org.
Latest News - IEHP Earns Industry CORE Certification for Data Security
Operating Rules for Information Exchange (CORE®) Eligibility, Claim Status, and Payment & Remittance Certification Seals. This means IEHP successfully completed an extensive testing process and review of national operating standards, enabling health plans and providers to electronically share large quantities of administrative data quickly and accurately. These rules and guidelines aim to improve the efficiency and improve national health care system costs. “Exceeding these standards is critical to ensuring our providers have the necessary information to provide the very best care to our members,” said Vinil Devabhaktuni, IEHP’s Chief Information Officer. “Our teams work tirelessly to build sustainable systems and processes to support this effort and will continue to find innovative solutions to support the ongoing needs of our members and providers.” Widely viewed as the industry “gold standard,” the CORE Certification illustrates IEHP’s commitment to the secure exchange of member data and timely provisions of health care services. The certification also demonstrates IEHP’s ongoing work effort adhering to the operating rules and their underlying standards, plus going above and beyond what is required. “Inland Empire Health Plan is demonstrating industry leadership,” said Robin J. Thomashauer, CAQH president. “Operating rules are most effective when everyone follows them, and today, thanks to IEHP, our nation’s health care system has taken another important step forward.” CAQH CORE is a collaboration of more than 130 participating organizations that work together to develop operating rules. Participants represent health care providers, health plans, vendors, associations, government entities and the organizations that set standards for health care and data exchange. CORE Certification is currently available for all currently published Operating Rule Sets. To learn more about IEHP visit iehp.org. For more information about CAQH CORE, visit www.caqhcore.org.
Latest News - Team IEHP sparks end-of-year cheer with community giving in the Inland Empire
will not rest until our communities enjoy Optimal Care and Vibrant Health. So year after year, #TeamIEHP does what they do best – heal and inspire the human spirit by giving back to the Inland Empire community. Between turkey distributions, vaccine clinics and senior citizen holiday gift drives, 2022 is no different. Over the Thanksgiving holiday, IEHP distributed 200 free turkeys through its community resource centers, while the remaining holiday season of giving will include a company toy drive for the city of Trona, handwritten cards to local children in the foster system, and community vaccine clinics at holiday events, including Motivating Action Leadership Opportunity’s (MALO) Christmas Extravaganza. IEHP is also hosting an internal holiday gift drive to support senior citizens who have been identified as isolated, neglected or abused. Last year, IEHP team members provided cash donations and filled several boxes with items like blankets, socks, home décor, hygiene products and slippers. All donations were given to the Office on Aging. This year, IEHP team members are looking forward to exceeding last year’s contributions. “It’s the right thing to do,” said IEHP Behavioral Health and Care Management Support Services Manager Ben Jauregui. “Each year, our teams look forward to giving back in this way and reminding our local seniors they are cared for and loved.” For seniors who are isolated, vulnerable or medically at-risk, the holiday season can be challenging – even lonely – according to Jewel Lee, director of the Riverside County Office on Aging. “This is an opportunity for us to highlight to everyone that even short moments of joy are very valuable to those who have no family or live alone,” Lee added. “We are fortunate to have community partners – like IEHP – who help us touch the lives of people in need of hope and positivity at this time of year.”
Latest News - IEHP supports new moms with mental health events
ew moms and moms-to-be are invited to visit IEHP’s Community Resource Centers in December for free maternal mental health events, which will offer health and wellness resources and connections to prenatal and postpartum care. Events will be hosted by IEHP’s Maternal Mental Health Team at all three of the health plan’s Community Resource Centers: Thursday, Dec. 1, 9 a.m.- 1 p.m. at IEHP’s Victorville center, 12353 Mariposa Road, Suites C-2 & C-3, Victorville, Calif., 92395 Saturday, Dec. 3, 9 a.m.- noon at IEHP’s San Bernardino center, 805 W. Second St., Suite C, San Bernardino, Calif., 92410 Friday, Dec. 9, 2- 5 p.m. at IEHP’s Riverside center, 3590 Tyler St., Suite 101, Riverside, Calif., 92503 Registration is encouraged by visiting Connect I.E. or IEHP’s Events page on Facebook. In addition to information on community resources for prenatal and postpartum care, attendees will receive baby items and will be eligible for raffle prizes. Members will also learn more about their maternal health benefits and the services they can access. “The pregnancy process doesn’t end once the baby is born,” said IEHP Manager Heather Waters, LCSW. “Postpartum care is just as important as prenatal care. Our team at IEHP can assist you with linkage to your postpartum appointment and any additional services, such as transportation and behavioral health.” A recent report from the CDC also highlights this need, citing that more than 80% of pregnancy-related deaths between 2017-2019 were preventable and 53% of deaths occurred between seven days and one year after delivery. The report also notes the leading underlying causes of pregnancy-related deaths include mental health conditions. “Our Maternal Mental Health team at IEHP is serious about improving maternal health outcomes in our communities, and we look forward to equipping our members with the necessary tools, benefit information and resources they need to deliver healthy babies and remain well after delivery,” added Waters.
Latest News - Celebrity Chef Provides Healthy Cooking Demos to I.E. Residents
althy cooking to the Inland Empire (I.E.) by showing Members and community residents how to cook delicious, traditional meals with a healthy and spicy twist at the health plan’s Victorville Community Resource Center. A 2018 MasterChef Latino judge, Chef Mario is a Boyle Heights native and has expertise elevating the culinary experience of residents in and around the Los Angeles area. Chef Mario’s demonstrations highlight cooking with both new and familiar ingredients that are proven to address common health issues in the region, including diabetes and hypertension. “Healthy eating doesn’t need to mean bland or boring food and Chef Mario knows how to make that possible,” said IEHP’s Community Health Senior Director Cesar Armendariz. “We’re thrilled to connect Chef Mario to our Members and communities to learn how to better utilize spices and well-known ingredients to better manage our health and wellness in a vibrant, delicious manner.” Chef Mario’s cooking demonstrations are open to the community and take place in July every Tuesday from 12:30 p.m. - 1:30 p.m. Classes in August will be every Thursday from 10:30 a.m. - 11:30 a.m. at the health plan’s Victorville center, located at 12353 Mariposa Road, Suites C-2 & C-3. IEHP also plans to record demonstrations for public use in the coming months. “This partnership means so much to me on a personal level. A healthy way of life should be available to all – it’s such an important component of health care that is often ignored,” said Chef Mario. “Food is the connection to everything, from our physical well-being to our mental well-being. There has been no greater time than now to embrace healthy eating but not sacrifice the flavor. I'm so excited to partner with IEHP and have so many fun demos, recipes and other surprises coming.” In addition, IEHP will connect Chef Mario to community partners for additional cooking demonstrations and civic events. “IEHP is proud to provide education and resources to Members and community residents who want to learn how to better manage their health through cooking. We’re excited to have Chef Mario’s help as we continue to look for ways to serve our community,” said IEHP Chief Executive Officer Jarrod McNaughton. To learn more about IEHP’s Community Resource Centers or to find a nutrition class, visit the community resource page. alt=" "="" src="-/media/dc4dca59a6f446009bdb09836af76cc9.ashx?h=400&w=300" class="" />
Latest News - Statewide Initiative Supports Behavioral Health of I.E. Youth
h Molina Healthcare, County Behavioral Health, the Offices of Education in Riverside and San Bernardino counties, and select local school districts and charter schools to implement the Student Behavioral Health Incentive Program (SBHIP). The three-year program is in accordance with the California Department of Health Care Services’ (DHCS) goal to expand prevention and early intervention behavioral health services in schools and provides financial incentives to partnering school districts and charter schools. A total of $389 million has been allocated for California. Between both IEHP and Molina Healthcare, up to $50,845,334 can be utilized to support this program. According to the American Psychological Association, one in five young women and one in ten young men experience a major depressive episode before the age of 25. The COVID Collaborative also notes one in 330 California children have lost either a parent or caregiver in the last two years, adding significant stress and trauma to the lives of California’s youth, along with stay-at-home orders and remote learning. “If the past few years have taught us anything, it’s that we need to be proactive in addressing mental health and wellness needs early on, before traumas have a chance to manifest later in life,” said Amrita Rai, IEHP’s clinical director of community behavioral health. Through SBHIP efforts, existing mental health initiatives will be bolstered, and coordination between schools, managed care plans, county behavioral health and community partners aim to address the equity gap and improve access to mental health prevention and treatment for students. Resources will be directed to fill gaps in these areas throughout the participating schools and their respective communities. Services will be limited to schools who are participating in SBHIP and who receive funding. “We are well into a crisis when it comes to the mental health and wellness of our youth. Now is the time to be bold and work tirelessly for our children because what we do now will affect generations to come,” said Rai. “Why not focus our resources, our passion, and our commitment back into the community and schools? Our children spend most of their lives in school, which makes this multi-organizational partnership so worthwhile.” Partnerships with local education agencies and school sites include San Bernardino County Superintendent of Schools (SBCSS); Riverside County of Education; Palm Springs Unified School District; Hemet Unified School District; San Bernardino City Unified School District; Rialto Unified School District; Victor Valley Union High School; Ontario-Montclair School District; Leadership Military Academy; Nuview Union School District; Provisional Accelerated Learning Academy; and Riverside County Office of Education Alternative Education Program. While the initiative will begin at these partner sites, it is anticipated that learnings would benefit other schools and districts interested in implementing similar programs in the future. “San Bernardino County Superintendent of Schools recognizes the growing mental health crisis among our youth and supports this joint effort to address this critical issue,” said County Superintendent Ted Alejandre. “SBCSS seeks to build capacity within countywide systems and increase access to much needed support to ensure every child receives the services they need when they need them.” “Educators at the Riverside County Office of Education and within all Local Educational Agencies (LEA) in Riverside County, are vitally interested in addressing the needs of the whole student beyond the classroom. Linking arms with partners across the county via the Student Behavioral Health Incentive Program (SBHIP) will equitably provide mental health services to those who might not otherwise have access to this level of support,” said Riverside County Superintendent of Schools, Dr. Edwin Gomez. Selection of school districts and charter schools was dependent on DHCS guidelines and considered specific criteria, such as the number of students who received Medi-Cal, were foster youth or English learners, received free or reduced priced meals, were interested in participating in the program and other factors. “It’s the right thing to do. This program gives us a great opportunity to extend both heart and hand to children in our community,” said Dr. Takashi Wada, IEHP’s chief medical officer. “Working together, we can equip them with necessary skills, habits and care they can use today and through adulthood, setting them up for a healthier and happier tomorrow.” “The COVID-19 pandemic has exacerbated and elevated behavioral health needs in our communities, including in young people. Mental and emotional wellbeing make up a significant portion of overall health and healthy youth lead to improved community wellness. We are proud to partner with IEHP, local offices of education and mental health professionals to address the youth behavioral health crisis in tangible, preventative ways.” said Dr. Sayeed Khan, chief medical officer at Molina Healthcare. Program preparation began this year and will support a January 2023 launch at all 10 participating local education agencies. Through careful planning and implementation, the program will aim to build and support a sustainable system beyond the life of the program, which will end in December 2024. alt=" "="" src="-/media/7c6d40e217094fb1be8ec6cec9473878.ashx?h=233&w=350" class="" />
Latest News - IEHP Leaders Honored with LLU Alumnus of the Year Awards
ommunity Behavioral Health Amrita Rai were each named Alumnus of the Year by their respective departments at Loma Linda University (LLU) for their promotion of the vision and purposes of their alma mater along with their contributions to the community. Pham earned his master’s degree with an emphasis in healthcare administration from LLU’s School of Public Health. At IEHP, Pham develops and executes IEHP’s strategy system to advance the health plan’s mission and achieve its bold 2030 vision: we will not rest until our communities enjoy optimal care and vibrant health. In this work, Pham constantly seeks new ways for IEHP to better serve the community and its most vulnerable residents. “We were pleased to honor Mr. Thomas Pham with the SPH Alumnus of the Year Award at our 2022 commencement ceremony. His notable contributions as part of IEHP to the health and well-being of the Inland Empire communities reflect our vision for healthy people living in resilient communities supported by equitable systems of health,” said Dr. Helen Hopp Marshak, LLU Dean, School of Public Health. Honored by LLU’s School of Behavioral Health, Rai graduated with a master’s degree in social work. In her current role at IEHP, Rai actively leads both community and statewide initiatives in improving access to mental health services, including the Student Behavioral Health Incentive Program. “Amrita Rai received the 2022 Alumni of the Year award at the graduation services of the Loma Linda University School of Behavioral Health for her unwavering commitment to servant leadership and the delivery of equitable behavioral health services for the most vulnerable populations throughout the Inland Empire,” said Dr. Beverly Buckles, LLU Dean, School of Behavioral Health. Rai also shares her expertise and passion at various speaking engagements throughout the year, inspiring awareness and continued improvement of the development and delivery of behavioral health services. “The transformational work Thomas and Amrita have done in their respective areas is a true testament to their love for the Inland Empire community. Active contributions and engagement from team members like Thomas and Amrita make IEHP’s commitment to heal and inspire the human spirit possible, and we are grateful for their service,” said Jarrod McNaughton, IEHP Chief Executive Officer.
Senior Health - Senior Health
This includes making a plan to improve safety and taking routine tests and health screenings to detect health problems and treat them early. Advanced Care Directive What’s an Advanced Care Directive and why do I need someone else to help me? Advanced Care Directive is a specific type of power of attorney or health care proxy, in which the person authorizes someone (an agent) to make decisions on their behalf when they are unable to do so. Decisions can be large and small. For example, “Who will be responsible for communicating with your family?” or “In the final stages of living, do you want to be at home?” IEHP offers free Advanced Care Directive Workshops to help you. Call IEHP Health Education Department at 1-866-224-IEHP (4347) or 1-800-718-4347 for TTY users to see if a workshop is coming up near you! See also: Advanced Care Directive Guide (PDF) Advanced Care Directive Form (PDF) PREPARE: A California program to help you make medical decisions for yourself and others. National Library of Medicine: Seniors' Health You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader.
COVID-19 - Coronavirus
VID-19? The Coronavirus, also known as COVID-19, is a virus that causes breathing problems in people. What is the Delta Variant? According to the CDC, Delta variant is more than 2x as contagious as previous COVID-19 variants. Some data suggest the Delta variant might cause more severe illness than previous variants in unvaccinated people. What is the Omicron Variant? According to the CDC, the Omicron variant will likely spread more easily than the first SARS-CoV-2 virus, even those who are vaccinated or don’t have symptoms. While, COVID vaccines help to protect against severe illness, hospitalizations, and deaths due to infection with the Omicron variant, breakthrough infections in fully vaccinated people are likely to happen. Though Omicron is a new variant, the same tools used to fight COVID-19 can protect yourself and others against Omicron. How can I get COVID-19? The virus passes from person to person through close contact and droplets in the air from coughing or sneezing (like the common cold or flu). You may be more at risk if you’ve traveled to infected regions or were around people who recently came back from those areas. Visit reliable online sources like the Centers for Disease Control and Prevention (www.cdc.gov) regularly to find out f you may be at risk. What are the symptoms? Most people who get COVID-19 feel like they have the flu. Older people, especially those who are already sick or have another disease like, COPD, heart conditions, and/or diabetes, are in danger of getting the most severe forms of this virus. Symptoms can range from mild to severe. They include fever, cough, breathing problems, and more. How can I protect myself and my family? The best protection is getting your COVID vaccines and booster shots. In addition, to lower your risk, follow these steps: Wash your hands with soap and water for at least 20 seconds to prevent the spread of the virus. Alcohol-based hand sanitizers are your next best choice. Cover your mouth and nose with a tissue when you cough or sneeze. If you do not have a tissue, cough or sneeze into your upper sleeve and not into your hands. Keep your hands away from your nose, mouth and eyes as much as you can. Get a flu shot! It’s not too late! as well. The flu shot doesn’t directly protect you from COVID-19, but it will can help ease the impact of the flu.' Stay home if you are feeling sick until you feel better or are cleared by a Doctor. Most people who get COVID-19 get better with good self-care and rest. Use over-the-counter cold and flu medicines to control fever and ease your symptoms. Keep at least 6 feet away from others whenever possible. When should I call my Doctor? If you think you might have COVID-19, call your Doctor’s office. Tell them your symptoms and if you’ve traveled to the infected regions or were around people who recently came back from those areas. Your Doctor will tell you what to do next so you can get the care you need and not risk passing the virus to your friends and family. What if I can't get a hold of my Doctor or the office is closed? If you can’t reach your Doctor or if it’s after-hours, you can call IEHP’s 24-Hour Nurse Advice Line at 1-888-244-4347 or 711 for TTY users, 24 hours a day, seven days a week. Our trained Nurses offer medical advice and, if needed, will connect you with a Doctor via phone or video chat. How much will I have to pay to get tested? IEHP covers standard* COVID-19 testing and provider-ordered tests. Members will not be charged for either of these tests. IEHP will pay for provider-ordered tests, regardless of whether it’s PCR, rapid, at-home rapid, etc. If your doctor orders the test for you, IEHP will cover the cost of the test. Your provider is required to bill IEHP directly for these tests. IEHP does NOT reimburse Members who choose to pay for COVID tests. This includes rapid COVID-19 tests with same-day results. Click here for more information about COVID‐19 tests and testing locations. *Test results for standard COVID-19 testing are often ready within two days.
Plan Updates - Updates
l Notes for DY 2 to 8 (PDF) Core Quality Withhold Technical Notes for DY 2 to 10 (PDF) Riverside University Health System - Health Advisory Influenza (PDF) A Message From IEHP Medical Director, Dr. Takashi Wada The 2022-2023 influenza season continues to coincide with circulation of COVID-19 virus (SARS-CoV-2). As of August 2022, approximately 94.2 million cases of COVID-19 had been reported in the United States. Influenza vaccination remains an important tool for the prevention of potentially severe respiratory illness, which helps decrease the stress on the U.S. health care system. IEHP DualChoice members who are 18 years of age or older may obtain flu vaccines through the IEHP Pharmacy Vaccine Network. Flu Vaccine Notice: Access to Pharmacy Vaccine Network (PDF) Frequently Asked Influenza (Flu) Questions: 2022-2023 Season (CDC Recommendations) What’s New for 2022-2023 By clicking on these links, you will be leaving the IEHP website. The composition of flu vaccines has been updated. For the 2022-2023 flu season, there are three flu vaccines that are preferentially recommended for people 65 years and older. These are Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine and Fluad Quadrivalent adjuvanted flu vaccine. The recommended timing of vaccination is similar to last season. For most people who need only one dose for the season, September and October are generally good times to get vaccinated. Vaccination in July and August is not recommended for most adults but can be considered for some groups. While ideally it’s recommended to get vaccinated by the end of October, it’s important to know that vaccination after October can still provide protection during the peak of flu season. The age indication for the cell culture-based inactivated flu vaccine, Flucelvax Quadrivalent (ccIIV4), changed from 2 years and older to 6 months and older. Pre-filled Afluria Quadrivalent flu shots for children are not expected to be available this season. However, children can receive this vaccine from a multidose vial at the recommended dose. Preventive Services Immunizations By clicking on these links, you will be leaving the IEHP website. CDC ACIP Vaccine Recommendations and Guidelines: https://www.cdc.gov/vaccines/hcp/acip-recs/index.html CDC ACIP Immunization Schedule for Children: https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html CDC ACIP Immunization Schedule for Adults: https://www.cdc.gov/vaccines/schedules/hcp/adult.html USPSTF Task Force's Immunization Recommendations: https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=immunization California Immunization Registry Portal (CAIR): https://cair.cdph.ca.gov/CAPRD/portalInfoManager.do Immunization Timing 2022 (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.
Plan Updates - Coronavirus (COVID-19) Advisory
e Control and Prevention (CDC) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus that was first detected in China and which has now been detected in almost 70 locations internationally, including in the United States. The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19"). IEHP will continually update you on the latest recommendations, news, and resources on COVID-19 as it becomes available. COVID-19 Therapeutics Available for Members In an effort to provide the most up-to-date treatments against COVID-19, IEHP continues to maintain a list of providers, including but not limited to infusion clinics, ancillary, hospital and non-hospital based infusion centers offering COVID-19 infusion therapy treatment. Under all Member coverage, outpatient COVID therapeutics will be offered immediately after a Member is determined to be clinically eligible under and Emergency Use Authorization (EUA). List of Infusion Sites COVID-19 Infusion Treatments by Organization (PDF) Test-To-Treat COVID-19 Vaccine Reimbursement for Medi-Cal Providers DHCS has carved out the COVID-19 vaccine from Medi-Cal managed care health plans and will reimburse providers under the Fee-for-Service (FFS) delivery system for both medical and pharmacy claims. Medi-Cal will reimburse the associated COVID-19 vaccine administration fee at the allowable Medicare rate for all claims (medical, outpatient, and pharmacy), based on the number of required doses for all Medi-Cal beneficiaries. For further information: June 13, 2022 - DHCS COVID-19 Vaccine Administration Provider FAQs 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. FIND A TESTING AND VACCINATION SITE NEAR YOU TODAY! RIVERSIDE Riverside County Public Health COVID Testing Site Vaccine Information Vaccine Locations & Registration Registrations encouraged but not required for: The CDC recommends everyone ages 6 months and older get vaccinated against COVID-19 as well as a booster for everyone 5 years and older, if eligible. For more information, visit the Riverside Country Vaccine webpage. Teenagers 5 to 17 years old must register for a vaccination clinic that offers the Pfizer vaccine and be accompanied by a parent/legal guardian or present a signed written consent from a parent/legal guardian and be accompanied by an adult. Pfizer Minor Consent Form (PDF) | Spanish The Moderna and Johnson & Johnson vaccines can only be given to individuals age 18 years and older. Johnson & Johnson Fact Sheet (PDF) | Spanish - Published April 26, 2021 SAN BERNARDINO San Bernardino County Public Health COVID Testing Site Vaccine Locations & Registration Additional Dose and Boosters Information COVID-19 Vaccine Consent Form (PDF) | Spanish The CDC recommends everyone ages 6 months and older get vaccinated against COVID-19 as well as a booster for everyone 5 years and older, if eligible. For more information, visit the San Bernardino County Pediatric COVID-19 Vaccination web page Walk-ins are now available at County-operated vaccination sites. Walk-in individuals will not need to bring any additional information to the site, however be prepared to register on site, which will include answering health screening questions. Walk-ins may experience longer wait times and availability may vary based on site demand. Centers for Disease Control and Prevention (CDC) Clinical Care Guidance Vaccines Vaccination Plans January 10, 2022 - Continued Coverage of COVID-19 Diagnostic Testing (PDF) CalVax CalVax is a state-wide centralized system for health care Providers enrolled or interested in participating in the California COVID-19 Vaccination Program, developed by the California Department of Public Health (CDPH). The new CalVax platform will provide a system to manage vaccine enrollment, ordering, inventory, administration, reporting and data analytics. Training materials such as job aids, videos, and recorded demos will be available to support all system users as they navigate through the new CalVax platform (mycavax.cdph.ca.gov). CA Notify • CA Notify Flyer in English (PDF) and Spanish(PDF) • CA Notify Shareable Tools for web and social media • CA Notify Website Financial Assistance Resources Riverside County Medical Association - COVID-19 Financial Toolkit for Medical Practice U.S. Department of Health & Human Services (HHS) CARES Provider Relief Fund Learn more about the Provider Relief Fund (PRF) Provider Relief Fund (PRF) Portal U.S. Small Business Administration. Borrowers may be eligible for Paycheck Protection Program (PPP) loan forgiveness. See if you're eligible here. Guidance Regarding Monoclonal Antibody Treatment for COVID-19 Even with decreasing cases and hospitalizations, those with high-risk conditions who have tested positive for COVID-19 are encouraged to get monoclonal antibody treatment at Riverside University Health System (RUHS) – Medical Center. In January, the U.S. Food and Drug Administration (FDA) limited the use of certain monoclonal antibody therapies that were ineffective against the omicron variant. In response, RUHS – Medical Center is administering sotrovimab, an IV infusion shown to be effective against omicron and other variants. January 14, 2022 - RUHS-Medical Center Offers Monoclonal Antibodies Treatment Quest Diagnostic For more information, please visit Quest Diagnostics FAQs COVID-19 Specimen Collection Instructions (Watch Video Here) Fact Sheet for Healthcare Providers for COVID-19 Testing (View PDF Here) LabCorp For more information, please visit LabCorp's COVID-19 page. Which COVID-19 Test is Right For You? COVID-19 FAQs If you do not have the ability to collect specimens for COVID-19, please refer to your County Public Health resources for guidance on directing Members for testing. Telehealth IEHP is strongly encouraging the utilization of telehealth for visits that can be conducted over the phone or via other audiovisual telecommunications. IEHP has published a telehealth FAQ which is available here: Telehealth Services Due to Limiting Exposure to COVID-19 (PDF)- October 17, 2022 Remember: IEHP Provider Telehealth Information (PDF) IEHP expects that Providers will offer telehealth services and support to their Members during their published business hours. Existing authorizations are valid and do not need to be changed even if services are being provided via telehealth You can request a POS 02 or POS 10 on your authorization however if you do not, you can still utilize the authorization for telehealth services even if a different POS was approved. When billing the claim for the service, you will utilize a POS 02 or POS 10. ONLY Services that are deemed clinically appropriate to provide via telehealth should be provided via telehealth. If there are treatments, exams, procedures or other services that cannot be provided via telehealth, those are not eligible to be provided via telehealth. Provider Resources for Combatting COVID-19 Fatigue ACEs Aware - Support for those on the front lines as California addresses stress and anxiety related to COVID-19 Department of Health Care Services (DHCS) and California Department of Public Health (CDPH) COVID 19 Response Department of Health Care Services (DHCS) California Department of Public Health (CDPH) The California Department of HealthCare Services (DHCS) has published a COVID-19 response page with guidance for Providers and Partners, Home and Community Based Services and Behavioral Health. Found Here: DHCS COVID‑19 Response | DHCS COVID-19 Medi-Cal FAQs The California Department of Public Health (CDPH) also has a page with new guidance documents and additional resources and news releases. Found Here: CDHP COVID-19 Updates Centers for Medicare & Medicaid Services (CMS) CMS Health Care Provider Toolkit - Help link to COVID-19 related questions San Bernardino Medical Society The San Bernardino County Medical Society promotes the science and art of medicine, the care and well-being of patients, the protection of the public health and to promote the betterment of the medical profession. The latest news, research and developments on the COVID-19 outbreak for physicians can be found here: SBCMS COVID-19. January 07, 2021 - COVID-19 Vaccines For All Practicing Physicians and Staff – San Bernardino County (PDF) 2-1-1 San Bernardino County Resource & Information Guide 2-1-1 San Bernardino County has curated a COVID-19 Resource & Information Guide and will update this page regularly as the situation changes. For more information, please click here. Correspondences May 2, 2022 - Webinar - IWIN COVID and the Community April 13, 2022 - COVID-19 “Test to Treat” Initiative April 8, 2022 - 2nd Round of Free At-Home COVID-19 Test Kits Available February 23, 2022 - COVID-19 Oral Antiviral Drugs – Coverage and Dispensing Pharmacies January 28, 2022 - Free OTC COVID-19 Antigen Kits Available January 26, 2022 - Free At-Home COVID-19 Tests Available by Request January 5, 2022 - Extending SNF COVID-19 Per Diem Rate December 22, 2021 - COVID-19 Vaccine Billing for Medicare Advantage Enrollees Effective DOS January 1, 2022 December 16, 2021- COVID-19 Vaccine Incentive Program – Program Guide December 16, 2021 - REMINDER: COVID Vaccine Enrollment Survey - Your Response is Requested December 10, 2021 - REMINDER: COVID Vaccine Enrollment Survey - Your Response is Requested December 10, 2021 - COVID-19 Vaccine Billing for Medicare Advantage Enrollees December 3, 2021- COVID-19 Vaccine Enrollment Survey December 1, 2021- CDC Encourages COVID Booster Due to Omicron Variant November 17, 2021- UPDATE! COVID-19 Vaccine FQHC, RHC and IHF Incentive Program November 9, 2021- Three Upcoming Webinars on Building COVID-19 Vaccine Trust October 22, 2021- 2021 COVID-19 Vaccination Member Incentive October 22, 2021- NEW!!! COVID-19 Vaccine FQHC and RHC Incentive Program October 19, 2021- COVID-19 Treatment – RUHS Monoclonal Antibody Treatment Center October 12, 2021- Reminder - NEW COVID-19 Vaccine PCP Incentive Program - Kickoff Meeting October 6, 2021- NEW COVID-19 Vaccine PCP Incentive Program- Kickoff Meetings October 4, 2021- New COVID-19 Vaccine PCP Incentive Program September 8, 2021- CDPH Webinar: How to Have Crucial Conversations About COVID-19 Vaccines – Thursday, September 9th August 18, 2021 - Riverside County Public Townhall on COVID-19 Vaccines For additional resources regarding COVID-19, please visit: Centers for Disease Control and Prevention (CDC) Riverside County Public Health San Bernardino Public Health You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Pharmacy Pain Management - Pharmacy Pain Management
ively manage members on multiple opioid therapies to prevent overutilization, identify unsafe and inappropriate opioid use, and address potential fraud, waste, and abuse. Identified members at risk of opioid overutilization will be evaluation through our Pharmacy Pain Management Program (PPM). A clinical team will be reviewing member therapy and reaching out to the primary provider to discuss the existence of multiple prescribing providers, member's total opioid utilization, appropriate level of opioid use for the member, and considerations for implementation of a member-level claim edit. After review and consultation with the prescribing provider, if the member's therapy is determined to be appropriate and medically necessary, no further action will be taken. Results of consultation with provider and findings will be documented. After review and consultation with the prescribing provider, if the member's therapy is determined to be inappropriate, and the provider recommends member-level point of sale claim edit, the member will be mailed a notification letter-that entrails the provider's recommendation. Medicare members will receive the notice 30 days in advance of the point of sale claim edit implementation. Member may also be referred for evaluation and monitoring by a pain management specialist. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website. Resources and Tools: Pain Management CPG (PDF) Pain Quick Reference Guide (PDF) For convenience, the URL link to the State of California Department of Justice's Controlled Substance Utilization Review and Evaluation Systems (CURES), California Prescription Drug Monitoring Program (PDMP) site. By clicking on this link, you will be leaving the IEHP website. http://oag.ca.gov/cures-pdmp Information on this page is current as of January 1, 2022
Special Programs - Community Supports
e alternatives that MCPs may offer in place of services or settings covered under the California Medicaid State Plan. Beginning January 1, 2022, IEHP will be offering 11 of the 14 DHCS Preapproved Community Supports services. Please click on the service for additional details. 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 (Riverside County) 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. IEHP Direct and Delegated Providers can submit referrals for Community Supports via the Provider Portal. For questions on how to submit a referral or more information relating to the above services, Providers can call the Provider Call Center at (909) 890-2054 or (866) 223-4347. Please continue to direct IEHP Members needing additional information on Community Supports Services to IEHP Member Services at (800) 440-4347, Monday - Friday, 8am - 5pm. TTY users should call (800) 718-4347. If you have programmatic questions, please email DGCommunitySupportTeam@iehp.org Community Supports Provider Brochure - English (PDF) | Spanish (PDF) | Chinese (PDF) | Vietnamese (PDF) Community Supports FAQs (PDF) Medi-Cal Community Supports or In Lieu of Services (ILOS) Policy Guide (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.
Clinical Information - Medication Therapy Management
MTM is a term to describe a broad range of services offered by Pharmacists on our health care team. The IEHP Clinical Pharmacy Team reviews the Members’ medicines, making sure they’re taking the right ones for their health conditions. If you are a Provider for IEHP Members who qualify for the MTM Program, you can let them know to look out for a letter from us. They will be enrolled automatically—unless they opt-out. MTM is offered to Members at no additional cost. IEHP's MTM services include these core elements: Medication therapy reviews Medication education Disease management A team of Pharmacists and Doctors developed these MTM services to help provide better prescription drug coverage for our Members. For example, MTM also helps identify possible medication errors. Medicare MTM Program This is a free program under Medicare Part D for IEHP DualChoice Members who have multiple medical conditions, take many prescription drugs, and have high drug costs to assist with better medication management and overall health. IEHP DualChoice Members’ enrollment includes a yearly comprehensive medication review (CMR) and regular targeted medication review (TMR) services throughout the year. MTM services include: Comprehensive Medication Review (CMR) An IEHP Clinical Pharmacist will provide an annual comprehensive review of the IEHP DualChoice Member’s medications over the phone. The Pharmacist will review IEHP DualChoice Member’s medications and make clinical recommendations to IEHP DualChoice Members and Providers. Targeted Medication Review (TMR) The IEHP Clinical Pharmacy Team will also offer TMRs through the year by reviewing issues with the participating IEHP DualChoice Member’s medicines. The team will perform TMRs for all enrolled beneficiaries every three months. The beneficiary may get TMR recommendations by mail and their Primary Care Provider may receive recommendations by fax—if the IEHP Clinical Pharmacy Team deems it necessary. For more information, IEHP DualChoice Members eligible for CMR or TMR services can call 1-877-273-IEHP (4347), 8am-5pm (PST), 7 days a week, including holidays. TTY users should call 1-800-718-4347. Click here for a blank personal medication list. Medicare MTM Program services may have limited eligibility criteria. They are available for the following conditions: 1. The IEHP DualChoice Member has a minimum of three (3) disease states: Bone Disease-Arthritis-Osteoporosis Bone Disease-Arthritis-Rheumatoid Arthritis Chronic Heart Failure (CHF) Diabetes Dyslipidemia End-Stage Renal Disease (ESRD) Hypertension Mental Health Chronic/ Disabling Mental Health Conditions Respiratory Disease – Asthma Respiratory Disease – Chronic Obstructive Pulmonary Disease (COPD) 2. The IEHP DualChoice Member is prescribed a minimum of five (5) different medications to treat those disease states: ACE-Inhibitors Angiotensin II Receptor Blockers (ARBs) Antidepressants Antihyperlipidemic Antihypertensives Antipsychotics Beta Blockers Bronchodilators Calcium Channel Blockers Disease-Modifying Anti-Rheumatic Drugs (DMARDs) Diuretics Insulins Oral Hypoglycemics Selective Serotonin Reuptake Inhibitors (SSRIs) Tumor Necrosis Factors (TNFs) Inhaled Corticosteroids Calcimimetic Cardiac Glycoside Colony Stimulating Factors Glucagon-Like Peptide-1 Glucocorticosteroids Neprilysin Inhibitor NSAIDs Phosphate Binders Vitamin D Analogs 3. Drug costs of $1,174 (one-fourth of $4,696) for the previous three months are likely to be incurred. For answers to frequently asked questions, please download the FAQ document below: MTM FAQs (PDF) For details, contact the IEHP Pharmaceutical Services Department at (909) 890-2049, Monday-Friday, 8am-5pm. IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Information on this page is current as of October 2022. H5355_CMC_20_1900233_Accepted
Join Our Network - Community Supports
ffer in place of services or settings covered under the Medicaid State Plan. These services should be medically appropriate and cost-effective alternatives. Beginning January 1, 2022, Inland Empire Health Plan (IEHP) is offering 11 of the 14 DHCS Preapproved Community Supports services: Asthma Remediation Community Transition Services/Nursing Facility Transition to a Home Home Modifications Housing Deposits Housing Tenancy and Sustaining Services Housing Transition Navigation Services Medically Supportive Food/Meals/Medically Tailored Meals Nursing Facility Transition/Diversion to Assisted Living Facilities, such as Residential Care Recuperative Care (Medical Respite) Short-Term Post-Hospitalization Housing Sobering Centers (Riverside County) Tentative Upcoming Services Day Habilitation (Date TBD) Personal Care and Homemaker Services (Date TBD) Respite Services (Date TBD) Community Supports FAQs (PDF) Please return the completed Community Supports Service Provider Assessment (PDF) via email at DGCommunitySupportTeam@iehp.org. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Provider Resources - Additional Resources & Tools
ols Menu Click on the following links to jump to that specific section: After Hours Care After Hours Phone Numbers IEHP Access Standards IEHP Direct Adult Hospitalists LabCorp Locations Urgent Care Clinics After Hours Care IEHP Providers can direct Members to access care after hours. After hour care includes the 24-Hour Nurse Advice Line, DocOnline and Urgent Care Clinics. Fever? Pain? Cold? Call our 24-Hour Nurse Advice Line --> Your Members can call the IEHP 24-Hour Nurse Advice Line for medical advice anytime, day or night: 1-888-244-IEHP (4347) DocOnline, an extension to the Nurse Advice Line, allows Members to speak with a board-certified Physician for advice after hours using telephonic and/or video devices. DocOnline Physicians will triage, assess, and provide diagnoses for minor acute conditions. Physicians may also give treatment advice, refill select prescriptions and refer Members for in-person care. DocOnline FAQs (PDF) Prescription Medication Refill List (PDF) (Back to Additional Resources Menu) After Hours Phone Numbers for Coverage Determination and Expedited Appeals IEHP DualChoice (HMO D-SNP) Members The following numbers are to be used for after hour requests: Coverage Determinations: Phone: (888) 860-1297 Expedited Appeals: Phone: (866) 223-4347 Fax: (909) 890-5748 (Back to Additional Resources Menu) IEHP Access Standards On an annual basis, IEHP conducts the Appointment Availability Access Study. All Members must receive access to all covered services without regard to sex, race, color, religion, ancestry, national origin, creed, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, sexual orientation, or identification with any other persons or groups defined in Penal Code Section 422.56, except as needed to provide equal access to Limited English Proficiency (LEP) Members or Members with disabilities, or as medically indicated. Appointment Standards for All Provider Types (PDF)| Last Revised: 12/12/2022 Appointment Standards for Behavioral Health (PDF)| Last Revised: 01/11/2023 (Back to Additional Resources Menu) IEHP Direct Adult Hospitalists Direct Adult Hospitalist (PDF) | Last Revised: 02/01/2021 (Back to Additional Resources Menu) LabCorp Locations A listing of LabCorp Patient Service Centers around the Inland Empire can be found below: LabCorp Patient Service Centers (PDF) LabCorp Patient Service Centers at Walgreens (PDF) (Back to Additional Resources Menu) Urgent Care Clinics --> Any of your IEHP Members needing medical attention may visit an Urgent Care Clinic after regular business office hours and on weekends. A listing of all Urgent Care Clinics is found on the IEHP Doctor Search. (Back to Additional Resources Menu) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Provider Resources - IEHP DualChoice - Model of Care
als who are dual eligible for both Medicare and Medi-Cal in Riverside and San Bernardino counties, including the most vulnerable population. This also includes members transitioning from IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan). IEHP has identified the most vulnerable as the following: Age 21-70 Identified as High and Rising Risk Diagnosed with Cardiovascular Disease AND/OR Diabetes RUB Score of 4 & 5. *RUB is Resource Utilization Band which is a predictor of using acute or costly services. IEHP will identify the most vulnerable members assigned to IPAs IEHP and its IPAs must design care management specific interventions to demonstrate how they support these member's health and wellness goals. Examples of Specially Tailored Services for the Most Vulnerable Population Remote Patient Monitoring Medically Tailored Meals and Other Community Supports Nutrition Education Pharmacy Services (medication reconciliation and other programs) Long-Term Services and Supports (LTSS) Telehealth Behavioral Health Services Transportaion More frequent care management contact IEHP DualChoice (HMO D-SNP) Model of Care Training The Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) and the National Committee for Quality Assurance (NCQA) require that IEHP staff and contracted consultants/vendors, our Medicare IPAs, Hospitals/SNFs, and Providers, receive training on the Plan’s Model of Care for our D-SNP Members: Interdisciplinary Care Team (ICT) Fact Sheet (PDF) IEHP DualChoice (HMO D-SNP) Model of Care Training (PDF) IEHP DualChoice (HMO D-SNP) Model of Care Training (HTML) *We recommend opening file in: Mozilla Firefox, MS Edge, Chrome or MS Internet Explorer You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.