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} .uenroll-hero-wrapper{ } .uenroll-hero-column-left { background: #1e95d3; padding: 2em; padding-right: 56px; } .uenroll-hero-headline { color: #ffffff !important; font-size: 1.953rem; font-weight: bold; } .uenroll-hero-subheadline { color: #fdb913 !important; font-size: 1.563rem; } .uenroll-hero-body-text { color: #ffffff; font-size: 1.25rem; padding-top: 1em; padding-bottom: 1em; width: 80%; } .uenroll-cta-btn{ background: #fdb913 !important; padding-right: 2em; padding-left: 2em; padding-bottom: 0.6em; padding-top: 0.6em; border-radius: 8px; font-weight: bold; font-size: 1.25rem; } .uenroll-hero-img { height: 100% !important; object-fit: cover !important; } .uenroll-sidebar-img { height: 90% !important; object-fit: cover !important; text-align: right; } /** BEGIN MOBILE STYLES - Screens less than 769px **/ @media only screen and (max-width: 769px) { .uenroll-hero-column-left { background: #1e95d3; padding: 2em; padding-right: 2em; } .uenroll-hero-headline { color: #ffffff !important; font-size: 1.653rem; font-weight: bold; } .uenroll-hero-subheadline { color: #fdb913 !important; font-size: 1.263rem; } .uenroll-hero-body-text { color: #ffffff; font-size: 1.1rem; padding-top: 1em; padding-bottom: 1em; width: 100%; } .uenroll-cta-btn{ background: #fdb913 !important; padding-right: 0em; padding-left: 0em; padding-bottom: 0.6em; padding-top: 0.6em; border-radius: 8px; font-weight: bold; font-size: 1.1rem; } .uenroll-hero-img { height: auto !important; } .uenroll-sidebar-img { height: auto !important; } } Your Health Matters. Not your Immigration Status. Apply for no-cost health coverage right over the phone. Call Today! 1-866-294-4347 State Law Expands Medi-Cal Services to More Adults For the first time in history, low-income Californians aged 50 and up are eligible for full-scope Medi-Cal benefits, regardless of their immigration status.  Under the law (California Assembly Bill 133), health plans like Inland Empire Health Plan (IEHP) are now able to provide these adults access to preventive health care, behavioral health services, vision care and more. In 2019, in a historic move toward health equity, the state expanded full-scope Medi-Cal services to all California residents 0-26 years old. Now, in 2022, this new law provides the most inclusive health care policy for low-income persons in the nation. Nearly 185,000 people across the state could benefit.   “When more residents have access to coordinated care and preventive services, health and wellness improves, and communities thrive,” said IEHP Chief Medical Officer Dr. Takashi Wada. “All communities, regardless of immigration status, deserve the opportunity to achieve vibrant health.” IEHP understands the fears involved when an undocumented resident applies for Medi-Cal. That is why we are making every effort to connect residents to trusted resources and support. This includes community events, partnerships with legal help like TODEC and more. “IEHP is eager to do all we can to support these adults so that they can get the care and benefits they need,” said IEHP Chief Executive Officer Jarrod McNaughton. To apply for Medi-Cal, call IEHP’s helpful Enrollment Advisors at 1-866-294-IEHP (4347), Monday-Friday, 8 a.m.-5 p.m. TTY users should call 1-800-718-4347. Call Today! 1-866-294-4347

e questions, call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347. You can also email MemberServices@iehp.org. Medicare/Medi-Cal Members:  If you have questions, 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. You can also email MemberServices@iehp.org. If you are a PROVIDER: If you need information, call the Provider Relations Team at (909) 890-2054, 8am-5pm, Monday-Friday. You can also email ProviderServices@iehp.org. To enroll with IEHP: If you need healthcare coverage, call 1-866-294-4347, 8am-5pm Monday-Friday. TTY users should call 1-800-720-4347. You’ll speak to one of our friendly bilingual Enrollment Advisors. To verify the employment status of an IEHP employee  Please submit your request to the IEHP Human Resources Department:  Email: Human_Resources@iehp.org. Fax: 909-477-8544 Phone: 909-890-2000 (and ask for Human Resources) Our Communities For general inquiries please call (909) 890-2000, 8am-5pm, Monday-Friday. TTY users should call (909) 890-0731. Prospective Vendors  If you are interested in becoming a vendor for IEHP, please visit our Procurement page. For all records processing Please contact the IEHP Legal Department. The Legal Department processes inquiries related to Protected Health Information (“PHI”), Subpoena, Guardianship, Public Records Act (“PRA”), and California Government Claims requests. The Legal Department is also IEHP’s designated Agent for Service of Process. Inland Empire Health Plan Attn: Legal Department 10801 Sixth Street Rancho Cucamonga, CA 91730 E-mail: legal@iehp.org Fax: (909) 477-8578 Authorization of Release (PDF) - This form authorizes IEHP to use and disclose Protected Health Information. If you are a reporter of the Media/Press  Please call our media contact: Chelsea Galvez Communications Strategist (909) 727-5263 press@iehp.org Our Location 10801 Sixth Street Rancho Cucamonga, CA 91730  Mailing Address P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 Fax: (909) 890-2003 Claims Mailing Address for IEHP Direct Members Inland Empire Health Plan - Claims P.O. Box 4349 Rancho Cucamonga, CA 91729-4349 Claims Appeals and Disputes Mailing Address for IEHP Direct Members Inland Empire Health Plan - Claims Appeals and Disputes P.O. Box 4319 Rancho Cucamonga, CA 91729-4319

tioning of the brain and emotions and how that balance (or imbalance) affects behavior and thoughts.  What is the stigma around Mental Health? There is still too much stigma surrounding behavioral and mental health. Historically, “crazy” or “mad” folks have been ostracized from society. This has been due to ignorance about mental health.  Unfortunately, there is still too much fear and mis-understanding in our communities about mental health. Many people suffer from mental health disorders. And given the current COVID-19 crisis, many more people will suffer from mental illness. Too many people suffer in silence with mental illness The latest statistics before COVID stated that about 1 in 5 people were diagnosed with a mental illness in America Those numbers will increase now during the COVID-19 crisis Mental Health includes wellness, self-care, emotional regulations, relationship issues, and parenting among other facets of everyday life Mental well-being is important to everyone Mental illness can happen to anyone Everyone deserves access to mental health treatment. Things you can do to learn more or to get help Understand the importance of mental health wellness and what is a mental illness. Click here to learn more. Take a quick check up from the neck up. Click here to take an online screening.  Tips for staying mentally well during COVID-19 Self-care is critical: listen to your warning signs of struggling with your emotions and doing the basic things like showering, eating, sleeping, and exercise Do something that brings you enjoyment every day: play with your children or spouse, take walks, read a book, do something creative Connect with someone outside your home every day via telephone or other video technology Eat nutritiously, do not binge or eat too many sweets Avoid alcohol Continue to see your therapist via tele-health Continue to take care of your physical, financial, and spiritual needs Be patient with yourself and others Readily forgive yourself Exercise, do yoga, go for a walk.  Stay active, but do not overdo it Seek treatment for your mental health whenever needed At IEHP Behavioral Health, we put just as much importance on your mental health as on your physical health. Your mental health includes a balance of emotional, psychological and social well-being.  It affects how you think, what you feel, and how you act.  Your mind and body are connected and therefore, one can affect the other. When your mind suffers, your body suffers as well. At IEHP Behavioral Health, our goal is to help you live your best and healthiest life, both mentally and physically.   Mental illness is more common than you might think and IEHP is here to help and support. Did you know that one in five adults in the United States suffers from a mental illness that can be treated? These people are battling mental illnesses such as depression, anxiety, and even drug or alcohol abuse.   If you think you may be experiencing a behavioral or mental health challenge and want to seek treatment, schedule an appointment with your Doctor. If you don’t have a Doctor, you can find a behavioral health specialist in your area, 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 and ask to speak to the Behavioral Health Department. If you are experiencing thoughts of hurting yourself or someone else, please go to your closest emergency room, call 911, or reach out to the National Suicide Prevention Lifeline at 1-800-273-8255. Remember that you are not alone.   Many people are struggling or will struggle with mood and anxiety issues during this time. Reach out for help.   Mental health help is available and we want you to get help. Available Resources San Bernardino County Behavioral Health Riverside County Behavioral Health San Bernardino County Substance Use Riverside County Substance Use Psychiatry Walk-in Clinic (Montclair) Psychiatry Walk-in Clinic (Palm Desert) Psychiatry Walk-in Clinic (Victorville) Teen Mental Health Guide COVID-19 Maternal Mental Health FAQ Substance Abuse and Mental Health Services Administration Find a provider Maternal Mental Health & Wellness Resources  National Postpartum Support International Local Inland Empire Maternal Mental Health Collaborative Resources

oncerns without the support and care they need. But there is hope. The 988 Lifeline offers the opportunity to help a countless number of people struggling with suicidal thoughts and health-related distress each day.  What is 988? This is an easy-to-remember number that people in crisis can call. It will route them to the National Suicide Prevention Lifeline (now known as the 988 Suicide & Crisis Lifeline). It is a life-saving resource for people in crisis. It is a number to call to get in touch with trained crisis counselors, not police. When people call or text 988, they will be connected to trained counselors who are part of the existing Lifeline network. These counselors will listen, understand how problems are affecting the callers, provide support, and connect them to resources if necessary. How is 988 different than 911? 988 is not a new service, just a new number. The 988 code was set up to improve access to crisis services in a way that meets our country’s growing suicide and mental health-related crisis care needs. It provides easier access to the Lifeline network and related crisis resources, which are distinct from the public safety purposes of 911 (where the focus is on dispatching Emergency Medical Services, fire and police as needed). Is 988 available for substance use crisis? The Lifeline accepts calls from anyone who needs support for a suicidal, mental health and/or substance use crisis. Is the 988 Lifeline a free service? Yes, the Lifeline answers calls 24/7 in multiple languages. The 988 service also answers texts or chats (English only). Standard data rates from mobile carriers may apply to those who text to the Lifeline. If monetary help is needed for communications needs, please see www.fcc.gov/lifeline-consumers for details. Calls, texts, and chats are available to anyone who needs mental health-related or suicide crisis support.  Is Lifeline available for everyone?  It is offered to everyone in the United States, providing 24/7, free and confidential support to people in suicidal crisis or emotional distress. The 988 Lifeline offers the opportunity to help a countless number of people struggling with suicidal thoughts and health-related distress each day. If you or someone you know is in crisis, call your local crisis number below. 988 services nationwide continue to be in development, utilize your local resources as needed.  Riverside 1-800-273-TALK (951) 686-HELP (4357) 1-877-727-4747 and Crisis text line: 741-741. San Bernardino 24-Hour Crisis Line: (760) 365-6558 East Valley: (909) 421-9233 West Valley: (909) 458-9628 High Desert: (760) 956-2345 Mental Health Urgent Care Clinics Riverside Urgent Care Clinics Riverside (Adults ages 18 and over) 9990 County Farm Rd. Bldg. 2, Riverside, CA 92503 (951) 509-2499 Perris (Youth and Adults ages 13 and older) 85 Ramona Expressway, Suites 1-3, Perris, CA 92571 (951) 349-4195 San Bernardino Urgent Care Clinics Victorville (Crisis Walk-in Center) 12240 Hesperia Rd., Ste. A, Victorville, CA 92395 (760) 245-8837 Yucca Valley (Crisis Walk-in Center) 7293 Dumosa Ave., Ste. 2, Yucca Valley, CA 92284 (760) 365-2233 Merrill Center - Fontana (Crisis Stabilization Units) 14677 Merrill Ave., Fontana, CA 92335 (951) 643-2340 Windsor Center - San Bernardino (Crisis Stabilization Units) 1481 N. Windsor Dr., San Bernardino, CA 92404 (909) 361-6470 Additional Resources Take My Hand, a Mental Health Peer Support Chat Line Medi-Cal Mental Health Services CARES LINE 1-800-499-3008.

(the “Services”) is governed by the terms and conditions below.  Use of the Services means that you have agreed to accept these terms, which are effective on the date you agree to participate. When you opt-in, you can expect to receive different healthcare notifications, such as, how to access care with IEHP, important health reminders, and we will inform you about health education and wellness program. Message frequency varies.  These terms and conditions may be subject to change.  IEHP reserves the right to update or amend these Terms and Conditions at any time. IEHP or its service provider may, at its sole discretion, terminate, adjust, or suspend the Services or any portion thereof, for any user for any reason.  You can also terminate or suspend the Services at any time by texting the word “STOP” to 90902 or by email at texthelp@iehp.org to unsubscribe. For Help text HELP to 90902 or you can also call 1-800-440-4347 to reach IEHP Member Services. You must be at least 13 years old to be eligible to use the Services. However, if you are at least 13 years old but not yet 18, you may use the Services if, and only if, you have your parents' or guardians' prior permission. No one under age 13 may use the Services under any circumstances.  IEHP does not charge for the Services, however, message and data rates may apply. For example, your pager or cellular phone service provider may charge you to receive Wireless Text Messages. Neither IEHP, nor its contractors, will be held responsible for any charges related to the use of the Services.  You agree that you are responsible for paying your carrier’s charges to use the Services, or if you are under 18, you have permission to use the Services from the adult responsible for paying the carrier’s charges. Carriers are not liable for delayed or undelivered messages. IEHP PROVIDES THE SERVICES "AS IS" WITH NO WARRANTIES OF ANY KIND. IEHP EXPRESSLY DISCLAIMS ANY WARRANTY, EXPRESS OR IMPLIED, REGARDING THE SERVICES, INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, OR THAT THE SERVICES WILL BE SECURE, UNINTERRUPTED OR FREE OF ERRORS, VIRUSES OR OTHER HARMFUL COMPONENTS. * Some states do not allow the disclaimer of implied warranties, so the foregoing disclaimer may not apply to you. UNDER NO CIRCUMSTANCES WILL IEHP OR ITS EMPLOYEES, OFFICERS, OR DIRECTORS BE LIABLE TO YOU FOR ANY INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL OR EXEMPLARY DAMAGES ARISING OUT OF OR IN CONNECTION WITH USE OF THE SERVICES WHETHER OR NOT IEHP HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. If you are dissatisfied with the Services or any content on any of IEHP website properties, or with these Terms and Conditions, your sole and exclusive remedy is to discontinue using the Services. You acknowledge, by your use of the Services, that your use of the Services is at your sole risk. You agree to indemnify, defend and hold harmless IEHP, its partners, clients, employees, officers and directors, from and against any and all claims, liabilities, penalties, settlements, judgments, fees (including reasonable attorneys' fees) arising from (i) any content that you or anyone using your account may submit, post or transmit to the web site; (ii) your use of the Services; (iii) your violation of the terms of these Terms and Conditions; and (iv) any violation or failure by you to comply with all laws and regulations in connection with the Services. You may not assign any of your rights or delegate any obligations hereunder, in whole or in part, whether voluntarily or by operation of law, without the prior written consent of IEHP. Any such purported assignment or delegation by you without the appropriate prior written consent of IEHP will be null and void and of no force or effect. IEHP is committed to your privacy. Our Privacy Policy can be found here. Contact Info 10801 Sixth Street, Rancho Cucamonga, CA 91730 1-800-440-IEHP (4347) 1-800-718-IEHP (4347) for TTY Users 8AM-5PM PST    

d by APL 19-004, all Providers currently in IEHP's network and those looking to join the network are mandated to enroll in the Medi-Cal Program. This requirement to enroll in the Medi-Cal Program applies to all IEHP Providers, including those participating through an IPA. If a Provider currently active with IEHP fails or declines to complete their enrollment in the Medi-Cal Program, IEHP will be required to terminate their participation from the network.  How to Enroll The Provider Enrollment Division (PED), a unit within the Department of Health Care Services (DHCS), is responsible for the timely enrollment of Providers into the Medi-Cal Program. PED now offers an improved web-based application via their Provider Application and Validation Enrollment (PAVE) portal. Please note the current PAVE release may not support specific Provider types or submissions from new out-of-state Providers. PAVE is being implemented in a series of releases to include Provider types and enrollment actions. Here is a current list of Provider types supported in PAVE. Provider Resources All Plan Letter 19-004 This APL supersedes 17-019, the APL mandating Providers to enroll in the Medi-Cal Program. All Plan Letter 17-019 Access the APL on DHCS's website regarding the screening and enrollment of all Providers rendering services to Medi-Cal beneficiaries.  California Health & Human Services (CHHS) Agency Open Data Portal Utilize the Open Data Portal to identify Providers who have successfully enrolled in the Medi-Cal Program through DHCS. The portal is maintained and updated by PED monthly. Frequently Asked Questions (FAQ) The document contains responses from DHCS to frequently asked questions regarding screening and enrollment requirements. Provider Resources from DHCS Access to PAVE Provider Types, PAVE 101 Training Slides, Provider Job Aides, FAQs, PAVE Support Resources Contact Information Department of Healthcare Services Attn:  Provider Enrollment Division MS4704 PO BOX 997412 Sacramento, CA 95899-7412 PED Message Center (916) 323-1945 After reaching the welcome message, please select Option 4, then Option 1 to speak with a live agent. PAVE Technical Assistance (866) 252-1949 PAVE@dhcs.ca.gov PED Policy Assistance PEDCORR@dhcs.ca.gov IEHP Provider Assistance ProviderNetwork@iehp.org

Member Services at (877) 273-IEHP (4347) and ask for a Member Complaint Form. If you need help to fill out the form, IEHP Member Services can assist you. You can complete the Member Complaint Form online. You can give the completed form to any IEHP Provider or mail it to: P.O Box 1800, Rancho Cucamonga, CA 91729-1800 You can fax the completed form to (909) 890-5877. You can file a grievance online. This form is for IEHP DualChoice as well as other IEHP programs.  For some types of problems, you need to use the process for coverage decisions and making appeals. For other types of problems you need to use the process for making complaints. Both of these processes have been approved by Medicare. To ensure fairness and prompt handling of your problems, each process has a set of rules, procedures, and deadlines that must be followed by us and by you. Long-Term Services and Supports: If you are having a problem with your care, you can call the Office of Ombudsman at 1-888-452-8609 for help. For problems and concerns regarding eligibility determinations, assessments, and care delivered by our contracted Community Based Adult Services (CBAS) centers,  or Nursing Facilities/Sub-Acute Care Facilities, you should follow the process outlined below. Community Based Adult Services (CBAS) You can call IEHP Member Services at (877) 273-IEHP (4347) and ask for a Member Complaint Form. If you need help to fill out the form, IEHP Member Services can assist you. You can give the completed form to any IEHP Provider or mail it to: P.O Box 1800 Rancho Cucamonga, CA 91729-1800 You can fax the completed form to (909) 890-5877. You can file a grievance online. This form is for IEHP DualChoice as well as other IEHP programs. Help in Handling a Problem You can contact Medicare. Here are two ways to get information directly from Medicare: You can call (800) MEDICARE (800) 633-4227, 24 hours a day, 7 days a week, TTY (877) 486-2048. You can visit the Medicare website By clicking on this link, you will be leaving the IEHP DualChoice website. Get Help from an Independent Government Organization We are always available to help you. But in some situations, you may also want help or guidance from someone who is not connected with us. You can always contact your State Health Insurance Assistance Program (SHIP). This government program has trained counselors in every state. The program is not connected with us or with any insurance company or health plan. The counselors at this program can help you understand which process you should use to handle a problem you are having. They can also answer your questions, give you more information, and offer guidance on what to do. The services of SHIP counselors are free. You can call SHIP at 1-800-434-0222. Get Help and Information from DHCS Call: (916) 445-4171 MCI from TDD at (800) 735-2929 MCI from Voice Telephone: (800) 735-2922 Sprint from TDD at (800) 877-5378 Sprint from Voice Telephone: (800) 877-5379 Write to: Department of Health Care Services 1501 Capitol Ave., P.O. Box 997413 Sacramento, CA 95899-7413 Website:www.dhcs.ca.gov By clicking on this link, you will be leaving the IEHP DualChoice website. Get Help and Information from Medi-Cal The Office of the Ombudsman Program can answer your questions and help you understand what to do to handle your problem. The Office of the Ombudsman is not connected with us or with any insurance company or health plan. They can help you understand which process to use. Call: 1-888-452-8609 (TTY 711) Monday through Friday, 9 a.m. to 5 p.m. Visit their website at: www.healthconsumer.org/ By clicking on this link, you will be leaving the IEHP DualChoice website. Get Help and Information from Livanta Our state has an organization called Livanta Beneficiary & Family Centered Care (BFCC) Quality Improvement Organization (QIO). This is a group of doctors and other health care professionals who help improve the quality of care for people with Medicare. Livanta is not connect with our plan. Call: (877) 588-1123, TTY (855) 887-6668 For appeals: (855) 694-2929 For all other reviews: (844) 420-6672 Write to: Livanta BFCC-QIO Program 10820 Guilford Road, Suite 202 Annapolis Junction, Maryland 20701 Website: www.livanta.com By clicking on this link, you will be leaving the IEHP DualChoice website. How to obtain an aggregate number of grievances, appeals, and exceptions filed with IEHP DualChoice (HMO D-SNP)? Please call or write to IEHP DualChoice Member Services. Call: (877) 273-IEHP (4347). Calls to this number are free. 8am - 8pm (PST), 7 days a week, including holidays, TTY: (800) 718-4347. This number requires special telephone equipment. Calls to this number are free. Fax: (909) 890-5877 Write: IEHP DualChoice, P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 Email: memberservices@iehp.org Visit: 10801 Sixth Street, Suite 120, Rancho Cucamonga, CA 91730 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 01, 2022. H8894_DSNP_23_3241532_M

h Plan by searching for the exact name of the medication or by browsing our formulary database. You can also view the IEHP Medicare Formulary (PDF)  Additional resources to help you understand drug coverage information are available via your desktop at https://www.formularylookup.com or download the free mobile app from http://ios.formularylookup.com or http://android.formularylookup.com, If the prescription is not in IEHP's Formulary, providers may print and submit a new Prescription Drug Prior Authorization (Rx PA) Request Form or submit the Prescription Drug Prior Authorization Online.

ated to help IEHP Members to find high-quality local pharmacies for your pharmacy services. This searchable system will display the rating of each participating pharmacy. The ratings range from 1 to 5 stars (with 1 being the lowest and 5 being the highest). What does the rating scale mean? The rating is on a scale of 1 to 5 stars (with 1 being the lowest and 5 being the highest).    Star Ratings Performance Description 1 Star Well below average 2 Stars Below average 3 Stars Average 4 Stars Good 5 Stars Exceptional No Star No information is available for this pharmacy Please keep in mind that Pharmacy Quality Star Rating is currently under development and may not reflect the most recent ratings of your Pharmacy at this time. IEHP Pharmacy Quality Rating is visible with IEHP "Find a Doctor, Urgent Care, or Pharmacy" webpage (select “Pharmacies” and put in your zip code or city, then hit “Find”). The quality rating information is displayed on the right side of each pharmacy. Information on this page is current as of January 1, 2022      

e Health Plan by searching for the exact name of the medication or by browsing our formulary database. You can also view the IEHP Medicare Formulary (PDF)  Additional resources to help you understand drug coverage information are available via your desktop at https://www.formularylookup.com or download the free mobile app from http://ios.formularylookup.com or http://android.formularylookup.com, If the prescription is not in IEHP's Formulary, providers may print and submit a new Prescription Drug Prior Authorization (Rx PA) Request Form or submit the Prescription Drug Prior Authorization Online.

addresses the clinical and non-clinical needs of high-need, high-cost IEHP Members through systematic coordination of services and comprehensive care management. ECM is a collaborative and interdisciplinary approach to providing intensive and comprehensive care management services to individuals. It serves to build on the Health Homes Program (HHP) and Whole Person Care (WPC) pilots and transitions those pilots to one larger program to provide a broader platform to build on positive outcomes from each program. ECM provides these vulnerable Members an additional care team to help coordinate and manage their care. The care team consists of a Nurse Care Manager, a Behavioral Health Care Manager, a Care Coordinator, and a Community Health Worker. These specially trained professionals collaborate with IEHP Members' Primary Care Physicians, Specialists, and family support systems to create a personalized plan of care. Beginning January 1, 2022, please direct eligible IEHP Members who need the ECM services to call IEHP Member Services at (800) 440-4347, Monday - Friday, 8am - 5pm. TTY users should call (800) 718-4347. If you have programmatic questions, please submit them to ECM@iehp.org. IEHP Enhanced Care Management Member Brochure (PDF) CalAIM Enhanced Care Management 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.

page. What is CCS? CCS is a statewide program that enables children with qualifying conditions to receive specialized services related to that condition independent from IEHP. The CCS program provides diagnostic and treatment services, and medical case management for those who have qualifying conditions. CCS also provides occupational and physical therapy services through the Medical Therapy Program (MTP). The Medical Therapy Program (MTP) is a special program that provides physical therapy (PT), occupational therapy (OT), for children who have disabling conditions, generally due to neurological or musculoskeletal disorders Who Qualifies? The CCS program services children and young adults under the age of 21 who have eligible medical conditions. Examples of CCS-eligible conditions include, but are not limited to, chronic and acute medical conditions such as cystic fibrosis, hemophilia, cerebral palsy, heart disease, cancer, traumatic injuries, and infectious diseases producing major sequelae. For a more inclusive list of diagnoses and medical criteria of qualifying conditions please reference the below links: https://www.dhcs.ca.gov/services/ccs https://www.dhcs.ca.gov/services/ccs/Documents/CCSMedicalEligibility.pdf Provider Responsibilities Primary Care Physicians (PCPs), Specialty Providers, and IPA/Medical Groups are responsible for performing appropriate baseline health assessments and diagnostic evaluations sufficient to identify children and young adults with potential CCS-qualifying conditions and refer to CCS as needed. PCPs are responsible for all well child and pediatric preventative services as these services are not a covered benefit of CCS. PCPs are also responsible in assisting CCS members with transition from CCS to IEHP authorizations at the age of 21 when members age out of the CCS program. Benefits of CCS Enrollment CCS Clients are not restricted to in area providers but have access to any CCS paneled provider within the state of California when a need for the specialty care has been determined to be CCS eligible. Once a client is determined to be eligible for CCS, the client will continue to be medically eligible for CCS until treatment is complete or age 21 when the CCS program ends. Additional Resources To assist our valued Providers, every Member active with CCS has a distinct red “CCS” widget in the Provider Portal. Opening that widget enables you to view the diagnosis being treated and any Specialists and their treatment authorization range. For any questions about your Member’s CCS care or management, please do not hesitate to contact IEHP’s CCS Team at: (800) 706-4347 or by email at CCSCareManagement@iehp.org . (By clicking on the links below, you will be leaving the IEHP site) For additional CCS resources please reference the below links: CCS Program Overview: https://www.dhcs.ca.gov/services/ccs CCS Program Application: https://www.dhcs.ca.gov/formsandpubs/forms CCS Brochure (English/Spanish): https://www.dhcs.ca.gov/services/ccs/Pages/CCSBrochure.aspx How to become a CCS Provider: https://www.dhcs.ca.gov/services/ccs/Pages/ProviderEnroll.aspx You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

assist primary care providers in delivering care in accordance with IEHP standards. Resources are reviewed regularly and updated to reflect changes from a regulatory and clinical standpoint. Preventive Care Guidelines American College of Obstetricians and Gynecologists (ACOG) American Academy of Pediatricians (AAP) / Bright Futures Comprehensive Perinatal Services Program (CPSP) Clinical Practice Guidelines Library The guidelines contained on this page are recommended by IEHP with the intent to enhance Member care. IEHP’s Clinical Practice Guidelines topics are organized using the following categories: United States Preventive Services Task Force (USPSTF); IEHP Internal Library; Healthcare Effectiveness Data Information Set (HEDIS); and Managed Care Accountability Set (MCAS) Links or documents embedded within the Internal Library category indicate literature that has been published by leading, formal organizations and have been endorsed/approved by IEHP’s Medical Directors and Quality Committee. IEHP produced information relevant to the topic will also be listed in this category. We have also indicated any HEDIS/ MCAS measures that are pertinent to the topic. Additionally, IEHP accepts USPSTF guidelines to help primary care clinicians identify clinical preventive services that are appropriate for their patients. IF there is a USPSTF guideline relevant to the topic, we have identified it below.  Library Catalog Click on a letter to jump to that specific section: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z A Asthma USPSTF N/A IEHP Internal Library Global Strategy for Asthma Management and Prevention (PDF) HEDIS Asthma Medication Ratio (AMR) Medication Management for People with Asthma (MMA) MCAS Asthma Medication Ratio (AMR) (Back to Library Catalog) B Breast Cancer USPSTF Breast Cancer Screening Use of Medications to Prevent Breast Cancer BRCA Testing IEHP Internal Library N/A HEDIS Breast Cancer Screening (BCS) MCAS Breast Cancer Screening (BCS) (Back to Library Catalog) C Cervical Cancer USPSTF Cervical Cancer Screening IEHP Internal Library N/A HEDIS Cervical Cancer Screening (CCS) MCAS Cervical Cancer Screening (CCS) (Back to Library Catalog) Chlamydia USPSTF Chlamydia and Gonorrhea Screening IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS Chlamydia Screening in Women (CHL) MCAS Chlamydia Screening in women (CHL) (Back to Library Catalog) Cholesterol USPSTF Statin Therapy for Primary Prevention of CVD Healthful Diet and Physical Activity for CVD Prevention in Adults with CVD Risks IEHP Internal Library American Heart Association – Blood Cholesterol Management (PDF) American Heart Association – Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (PDF) HEDIS Statin Therapy for Patients with Cardiovascular Disease-Adherence (SPC) Statin Therapy for Patients with Cardiovascular Disease – Statin Therapy (SPC) MCAS N/A (Back to Library Catalog) Chronic Obstructive Pulmonary Disorder USPSTF N/A IEHP Internal Library Global Initiative for Chronic Obstructive Lung Disease – COPD (PDF) HEDIS Pharmacology Management of COPD Exacerbation – Systemic Corticosteroids (PCE) Pharmacology Management of COPD Exacerbations – Bronchodilators (PCE) Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR) MCAS N/A (Back to Library Catalog) Colorectal Cancer USPSTF Colorectal Cancer Screening IEHP Internal Library N/A HEDIS Colorectal Cancer Screening (COL) MCAS N/A (Back to Library Catalog) D Depression USPSTF Screening for Depression in Adolescents Screening for Depression in Adults including Pregnant Women Screening for Perinatal Depression IEHP Internal Library American Academy of Pediatrics – Adolescent Depression in Primary Care (PDF) American Psychiatric Association – Major Depressive Disorder (PDF) HEDIS Antidepressant Medication Management Acute Phase (AMM) Antidepressant Medication Management Continuation Phase (AMM) MCAS Antidepressant Medication Management Acute (AMM-Acute) Antidepressant Medication Management Continuation (AMM-Cont) (Back to Library Catalog) Diabetes USPSTF Gestational Diabetes Screening Prediabetes and Type 2 Diabetes: Screening IEHP Internal Library American Diabetes Association – Diabetes Care (PDF) National Kidney Foundation – Diabetes and Chronic Kidney Disease (PDF) HEDIS Statin Therapy for Patients with Diabetes – Adherence (SPD) Statin Therapy for Patients with Diabetes – Statin Therapy (SPD) Comprehensive Diabetes Care – HbA1C Testing (CDC) Comprehensive Diabetes Care - HbA1C Control (<=9) (CDC) Comprehensive Diabetes Care (<8) (CDC) Comprehensive Diabetes Care - Eye Exam (CDC) Comprehensive Diabetes Care – Monitoring for Nephropathy (CDC) Comprehensive Diabetes Care – Blood Pressure Control (<140/90) (CDC) MCAS Comprehensive Diabetes Care HbA1C Testing (CDC HT) Comprehensive Diabetes Care HbA1C Testing >9%) (CDC H9) (Back to Library Catalog) E (Back to Library Catalog)   F (Back to Library Catalog)   G Gonorrhea USPSTF Chlamydia and Gonorrhea Screening IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS N/A MCAS N/A (Back to Library Catalog) H Hepatitis C USPSTF Hepatitis C Virus Infection in Adolescents and Adults: Screening IEHP Internal Library American Association for the Study of Liver Diseases – Hepatitis C (PDF) HEDIS N/A MCAS N/A (Back to Library Catalog) Human Immunodeficiency Virus (HIV) USPSTF HIV Screening in Pregnant Persons HIV Screening in Adults and Adolescents HIV Prevention – Preexposure Prophylaxis IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS N/A MCAS N/A (Back to Library Catalog) Hypertension USPSTF Screening for Hypertension in Adults IEHP Internal Library Joint National Committee – Hypertension Guidelines (PDF) HEDIS Controlling high blood pressure (CBP) MCAS Controlling high blood pressure (CBP) (Back to Library Catalog) I (Back to Library Catalog)   J (Back to Library Catalog)   K (Back to Library Catalog) L (Back to Library Catalog)   M (Back to Library Catalog)   N (Back to Library Catalog)   O Obesity USPSTF Weight Loss to Prevent Obesity Related Morbidity and Mortality in Adults - Counseling Screening for Obesity in Children and Adolescents Behavioral Health Counseling for Adults that are Overweight or Obese and Have Other CVD Risk Factors IEHP Internal Library N/A HEDIS Weight Assessment and Counseling (WCC-BMI) Adult Body Mass Index (ABA) MCAS Weight Assessment and Counseling (WCC-BMI) Adult Body Mass Index (ABA) (Back to Library Catalog) Osteoporosis USPSTF Osteoporosis to Prevent Fractures: Screening IEHP Internal Library N/A HEDIS Osteoporosis management in women who have had a fracture (OMW) MCAS N/A (Back to Library Catalog) P (Back to Library Catalog) Q (Back to Library Catalog) R (Back to Library Catalog) S Sexually Transmitted Infections USPSTF Syphilis Screening in Pregnant Women Syphilis Screening for those at Increased Risk for Infection Chlamydia and Gonorrhea Screening HIV Screening in Pregnant Persons HIV Screening in Adults and Adolescents HIV Prevention – Preexposure Prophylaxis IEHP Internal Library Centers for Disease Control Public Health Media Library – STD Treatment You may also refer to individual topics as they appear in this library: Chlamydia Gonorrhea HIV Syphilis HEDIS Chlamydia Screening in women (CHL) MCAS Chlamydia Screening in women (CHL) (Back to Library Catalog) Skin Cancer Behavioral Counseling USPSTF Skin Cancer Prevention: Counseling IEHP Internal Library N/A HEDIS N/A MCAS N/A   (Back to Library Catalog) Smoking Cessation/Tobacco Usage USPSTF Smoking Cessation Smoking Cessation – Pharmacotherapy Lung Cancer Screening Tobacco Use in Children and Adolescents – Primary Care Interventions IEHP Internal Library N/A HEDIS N/A MCAS N/A (Back to Library Catalog) Syphilis USPSTF Syphilis Screening in Pregnant Women Syphilis Screening for Those at Increased Risk for Infection IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS N/A MCAS N/A (Back to Library Catalog) T Tuberculosis USPSTF Latent Tuberculosis Screening IEHP Internal Library N/A HEDIS N/A MCAS N/A (Back to Library Catalog) U (Back to Library Catalog) V (Back to Library Catalog) W (Back to Library Catalog) X (Back to Library Catalog) Y (Back to Library Catalog) Z (Back to Library Catalog) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

hen you can't reach your Doctor after-hours or your Doctor is not available, you have options to get your needed care.  Call the IEHP 24-Hour Nurse Advice Line at (888) 244-4347, TTY 711. 1. Speak to our Nurse  Our Nurse can offer you medical advice on the phone or guide you to get the care you need.  Common reasons to call our Nurse:   Cough Mild stomach ache Mild fever Sore throat Cold or flu Questions about your medicine  Ear ache  Nurse Advice Video 2. Speak to a Doctor Our Nurse may decide you need to talk with a Doctor. If so, our Nurse will connect you with a Doctor for a live phone chat or schedule a virtual visit through an app. 3. Visit an IEHP Urgent Care Clinic Our Nurse may direct you to an Urgent Care Clinic, so you can see a Doctor the same day. Many clinics are open late, weekends and holidays. Some clinics have X-rays and lab tests. We have more than 90 Urgent Care Clinics in our network. For one near you, visit the IEHP Provider Search. Common reasons to visit an Urgent Care Clinic:  Mild sore throat Mild fever Rash Nose bleed Minor trauma Animal or insect bite Asthma (non-critical) Cuts & lacerations Call 911 or go to the nearest Emergency Room (ER) for emergency medical and behavioral health conditions. Don’t wait!   Urgent Care Video

ht thing for you and your family when it comes to getting the care you need. For the past 25 years, we’ve made it our mission to help our Members get quality medical, behavioral health and wellness  services. Who is IEHP? IEHP is a managed care health plan. We launched in 1996 with 62,000 Medi-Cal Members and today we have grown to become one of the top 10 largest Medi-Cal health plans. With a network of more than 8,000 Providers and more than 2,000 employees, IEHP serves more than 1.4 million residents in Riverside and San Bernardino counties). We work with doctors, hospitals, and other health care Providers in your area to give improved health care coordination and quality of care to our Members. What benefits do I get as an IEHP Member? A network of more than 8,000 Doctors, Specialists and other health care Providers Care coordination 24-Hour Nurse Advice Line Vision services Urgent Care centers Healthy lifestyle classes and programs And so much more! For more information on IEHP’s benefits and services, contact IEHP Member Services. Can I still have Medi-Cal as an IEHP Member? Yes, you will still have Medi-Cal and all the benefits and services you had before, such as no monthly premiums and zero cost for Doctor visits, medicines and hospital stays. The only difference is that your health care services will now be coordinated through IEHP. Other Medi-Cal services include preventive care, such as vaccines and screenings for mental health, development and substance abuse disorders. You can get Fee-For-Service Medi-Cal dental services through the Medi-Cal Dental Program. Can I stay with my same Doctor when I join IEHP? If he or she is part of IEHP’s Provider Network, you will be able to continue to get care from the same Doctor. You can check this by calling IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347. If you also have Medicare, you can keep seeing your doctors whose services are provide by Medicare. Who we are Our Mission We heal and inspire the human spirit.  Our Vision We will not rest until our communities enjoy optimal care and vibrant health.  Our Values We do the right thing by: Placing our Members at the center of our universe. Unleashing our creativity and courage to improve health & well-being.  Bringing focus and accountability to our work.  Never wavering in our commitment to our Members, Providers, Partners, and each other. We’re here to answer your questions and help you get started on your journey to good health.

iding between the ER and Urgent Care. For medical advice before visiting the ER or an Urgent Care Clinic, you can call your Doctor or IEHP 24-Hour Nurse Advice Line (888) 244-4347, TTY 711. Note that ERs are open 24 hours a day and many Urgent Care clinics close in the late evening. When Should I Go to the ER? An emergency is when a person could die or be permanently hurt. The ER provides care for critical or life-threatening conditions.   Visit your closest ER or call 911 if you experience: Changes in mental status, such as confusion Chest pain or pressure Coughing or vomiting blood Difficulty breathing or shortness of breath Severe allergic reaction Severe or persistent vomiting or diarrhea Sudden dizziness, weakness or changes in vision Sudden or severe pain Visit Provider Search for listing of emergency room locations near you. When Should I go to an Urgent Care? Go to an Urgent Care Clinic when you need care after hours for non-life-threatening conditions.  Here are some examples of conditions: A common illness like the flu Minor fever or headache Painful sore throat Earache or sinus pain Minor injuries like a sprained ankle Back pain Cuts or small wounds Small burns Rash or minor allergic reactions Nausea Diarrhea Urinary tract infections There are more than 90 clinics in our IEHP network. Many are open late and on weekends. Search Provider Search or call the IEHP 24-Hour Nurse Advice Line (888) 244-4347, TTY 711.

book for the benefit year of January 1, 2022 – December 31, 2022. How to get care Sensitive care Minor consent services You may only get the following services without your parent or guardian’s permission if you are 12 years old or older: Outpatient mental health care for (minors age 12 or older): Sexual assault (no lower age limit) Incest Physical assault Child abuse When you have thoughts of hurting yourself or others (minors age 12 or older) HIV/AIDS prevention/testing/treatment Sexually transmitted infections prevention/testing/treatment Substance use disorder treatment services (minors age 12 or older). For more information see “Substance use disorder treatment services” in this handbook. If you are under 18 years old, you can go to a doctor without permission from your parents or guardian for these types of care: Pregnancy Family planning/birth control Abortion services For pregnancy testing, family planning services, birth control, or sexually transmitted infection services, the doctor or clinic does not have to be part of the IEHP network. You can choose any Medi-Cal provider and go to them for these services without a referral or pre-approval (prior authorization). Services from an out-of-network provider not related to sensitive care may not be covered. For help finding a doctor or clinic giving these services, or for help getting to these services (including transportation), you can call IEHP Member Services at 1-800-440-IEHP (4347) (TTY 1-800-718-4347 or 711). Minors can talk to a representative in private about their health concerns by calling the 24/7 at 1-888-244-IEHP (4347) (TTY 711). Benefits and services What your health plan covers This chapter explains your covered services as a member of IEHP. Your covered services are free as long as they are medically necessary and provided by an in-network provider. You must ask us for pre-approval (prior authorization) if the care is out-of-network except for sensitive services, emergencies and some urgent care services. Your health plan may cover medically necessary services from an out-of-network provider. But you must ask IEHP for pre-approval (prior authorization) for this. Medically necessary services are reasonable and necessary to protect your life, keep you from becoming seriously ill or disabled, or reduces severe pain from a diagnosed disease, illness or injury. For Members under the age of 21, Medi-Cal services include care that is medically necessary to fix or help relieve a physical or mental illness or condition. For more details on your covered services, call IEHP Member Services at 1-800-440-IEHP (4347) (TTY 1-800-718-4347 or 711). Members under 21 years old get extra benefits and services. Read Chapter 5: Child and youth well care for more information. Some of the basic health benefits IEHP offers are listed below. Benefits with a star ( * ) may need pre-approval. Acupuncture* Acute (short-term treatment) home health therapies and services Adult immunizations (shots) Allergy testing and injections Ambulance services for an emergency Anesthesiologist services Asthma prevention Audiology* Behavioral health treatments* Cardiac rehabilitation Chiropractic services* Chemotherapy & Radiation therapy Cognitive health assessment Dialysis/hemodialysis services Durable medical equipment (DME)* Emergency room visits Enteral and parenteral nutrition* Family planning office visits and counseling (you can go to a non-participating provider) Habilitative services and devices* Hearing aids Home health care* Hospice care* Inpatient medical and surgical care* Lab and radiology* Long-term home health therapies and services* Maternity and newborn care Major organ transplant* Occupational therapy* Orthotics/prostheses* Ostomy and urological supplies Outpatient hospital services Outpatient mental health services Outpatient surgery* Palliative care* PCP visits Pediatric services Physical therapy* Podiatry services* Pulmonary rehabilitation Rapid Whole Genome Sequencing Rehabilitation services and devices* Skilled nursing services Specialist visits Speech therapy* Surgical services Telemedicine/Telehealth Transgender services* Urgent care Vision services* Women’s health services

M Members 7K+ Providers 3K+ Team Members

ppy or you are having problems with your care, talk to your Doctor. Your Doctor will help you. If you need more help, call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347. You can also file a grievance. Ask your Doctor for a form or select from the options below. GRIEVANCE FORM Print and mail grievance form (PDFs are below) Call IEHP Member Services and we will mail you a form If you are mailing your grievance form please send it to: IEHP, Attention: Grievance Dept. P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader.   Medi-Cal Member Complaint Form (PDF) IEHP DualChoice (HMO D-SNP) Complaint Form Within 5 days of getting your complaint, we will send you a letter letting you know we received it. Within 30 days, we will send you another letter that tells you how we resolved your problem. If you call IEHP about a grievance that is not about health care coverage, medical necessity, or experimental or investigational treatment, and your grievance is resolved by the end of the next working day, you may not receive a letter.  

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