Search Results For : " UNIVERSITEIT NYENOORD PHYSICS "
Special Programs - Major Organ Transplant (MOT)
nd Empire Health Plan (IEHP) is now responsible for coverage of the Major Organ Transplant (MOT) benefit for adult and pediatric transplant recipients and donors, including related services such as organ procurement and living donor care. What Transplant Services are Available for Members? Autologous Islet Cell Bone Marrow Cornea Heart Heart-Lung Liver Liver-Heart Liver-Intestinal Liver -Lung Lung Kidney Kidney-Liver Kidney - Pancreas Pancreas (after Kidney) Centers of Excellence (COE) For transplant care, IEHP has partnered with various, local, Centers of Excellence (COE). A COE is a recognized program within an existing healthcare center that provides a concentration of specialized care, delivered in a comprehensive, interdisciplinary manner. Their focused care in distinct areas provides exceptional, integrated care that can lead to better Member outcomes. Bone Marrow - CHLA, City of Hope, LLUMC, UCSD, USC (Norris) Heart - USC (Keck), LLUMC, Rady's Children, Sharp Memorial, UCSD Intestinal - CHLA Kidney-Pancreas - LLUMC, UCI Liver- CHLA, LLUMC, USD, USC (Keck) Lung - UCSD You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here
Medication Therapy Management
MTM is a term used to describe a broad range of services offered by Pharmacists on our health care team. The IEHP Clinical Pharmacy Team reviews your medicines, making sure you’re taking the right ones for your health conditions. If you are a Member who qualifies for the MTM Program, you will receive a letter from us. You will be enrolled—unless you opt-out. The program costs $0 for those who qualify. Who might be eligible? Some Members who have been identified for this program may have only Medi-Cal coverage with IEHP. Or they may be enrolled in the IEHP DualChoice (HMO D-SNP). They must meet the criteria and will receive the services for the Medicare MTM Program. (See description below.) What are MTM services? IEHP’s MTM services include these core elements: Medicine therapy reviews Medicine education - includes a medication action plan Disease management Our IEHP Clinical Pharmacy Team reviews the Member’s medicines, family history, disease states, and goals for medicine therapy. Based on a full review, this team then offers recommendations to the Member and Providers. A Team of registered Pharmacists and technicians work with your Doctor (or other Provider) and Pharmacies to offer full care. We also work with our Care Management teams to offer “whole health” care to our Members. Medicare MTM Program IEHP Clinical Pharmacy offers the MTM services at no extra cost for IEHP DualChoice Members who: have a number of health issues, and are taking many prescription drugs, and have high medicine costs Once enrolled in the program, you will get a packet by mail with details. You’ll also get information on how to disenroll, should you choose not to be in the program. If you decide not to take part in the program, your enrollment and eligibility with IEHP DualChoice will not change. We hope that if you qualify that you will take part in in this program that is offered free of charge—to help you better manage your medicines. The MTM program includes a yearly comprehensive medication review (CMR) and targeted medication review (TMR). Here are some details on MTM services: Comprehensive Medication Review (CMR) An IEHP Clinical Pharmacist will give you a full yearly review of your meds by phone. The Pharmacist goes over your medicines to make sure you have the right ones for your condition and that you avoid drug interactions, and more. Once your CMR is done, you will get your Medication Action Plan (MAP) and Personal Medication List (PML) by mail. MTM services documents, with a copy of a Personal Medication List, can be accessed by calling Member Services and asking to speak to the Clinical Pharmacy Team. 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. Eligibility Criteria These MTM Program services may have limited eligibility criteria and are not considered a benefit. They are available for these conditions: 1. The 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 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 Biophosphonates 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 $1,233.75 (one-fourth of $4,935) for the previous three months are likely to be incurred. To learn more about MTM, 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. Information on this page is current as of October 01, 2022. DSNP_23_3241532_M Pending Accepted
Mental Health - 988 Suicide & Crisis Lifeline
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.
Texting Program Terms and Conditions - Texting Program
Provider Resources - Health and Wellness
and achieve health goals. IEHP’s Health & Wellness Programs help Members learn how to manage their health and make healthy lifestyle changes. You can refer your IEHP Members to these programs anytime by logging into the Secure Provider Website and completing the Health Education Program Request Form. Health Resources Kids and Teens Managing Your Illness Pregnancy and Postpartum Senior Health Weight Management Health & Wellness Brochures and Handouts Inland Empire Health Plan (IEHP) offers many Wellness Programs that focus on the health and well-being of our Members. All of our programs are free, join us at our next session and learn ways to stay healthy. Get information on important health topics through our health education brochures and handouts: Controlling Asthma (PDF) Diabetes. What's next? (PDF) Eat Healthy, Feel Better (PDF) Fever in Children (PDF) Flu Decision Guide (PDF) Flu Shot (PDF) High Blood Pressure (PDF) Immunizations - English (PDF) Immunizations - Spanish (PDF) Immunizations - Chinese (PDF) Immunizations - Vietnamese (PDF) PAP and HPV Tests: What to Expect (PDF) Diabetes Prevention Program (DPP) - Live the Life You Love Format: Online (small group) Duration: One year Ages: 18 years and over This online year-long lifestyle change program helps you make real changes that last. During the first 6 months, you will meet weekly with a small online group to learn how to make healthy choices into your life. In the second 6 months, you will meet monthly to practice what you have learned. No person is alike, so the program will be tailored to meet your needs and honor your customs and values. You will also be paired with a health coach for one year to help you set your goals, such as how to: Eat healthier Add physical activity into your daily life Reduce stress Improve problem-solving and coping skills Studies have shown that those who finish the program can lose weight and prevent Type 2 Diabetes. Small changes can have big results! Let's start living the best version of you and living the life you love. Find out if you qualify! Click here to visit the Skinny Gene Project online, or Call Skinny Gene Project at (909) 922- 0022, Monday - Friday 8am – 5pm., or Email email@example.com For Providers DPP Rx Pad (PDF) Educational Resources 2021 Population Needs Assessment (PNA) Report IEHP’s Population Needs Assessment (PNA) identifies Member health status and behaviors, Member health education priorities, cultural/linguistics needs, health disparities, and gaps in service related to these issues. The findings of the PNA may help Providers better understand and serve our Members. For questions, please contact IEHP Health Education Department at firstname.lastname@example.org 2021 Population Needs Assessment (PNA) Report Loving Support Program IEHP supports and sponsors the Loving Support Program that is run by Riverside University Health System (RUHS). Loving Support is a program committed to helping mothers achieve their breastfeeding goals. This service offers help and support with the first days at home, return to work, support groups, and timely answers to challenges nursing mothers face. Members can directly contact the Loving Support 24/7 Helpline at 888-451-2499. No referral is necessary. English and Spanish-speaking certified lactation specialists and Internationally Board Certified Lactation Consultants (IBCLCs) are available 24 hours a day, 7 days a week to answer questions. Messages are recorded after hours and promptly addressed. Member Education Resources The following websites are good sources of easy-to-read patient information that can be downloaded, printed, or ordered. By clicking on these links, you will be leaving the IEHP website. RESOURCE DESCRIPTION Medline Plus A service of the US National Library of Medicine and the National Institutes of Health. Easy to read information and audio tutorials on many health topics in English and Spanish. Topics are available in multiple languages. Food and Drug Administration - Office of Women's Health Easy-to-read handouts in English, Spanish and other languages on nutrition, diabetes, depression, and other topics related to women’s health. Learning About Diabetes, Inc. Easy to read “Handouts and Visual Aids” in color on diabetes care and nutrition to help patients eat the right foods to control blood sugar. Weight Control Information Network An extensive list of health education materials about healthy weight and physical activity in English and Spanish. Materials can be printed or ordered. Health Information Translations Easy-to-read educational handouts on many health topics and in multiple languages. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Join Our Network - Screening & Enrollment
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
IEHP DualChoice - New to IEHP DualChoice
e important phone numbers including your Doctor, IEHP DualChoice Member Services, and IEHP’s 24-Hour Nurse Advice Line. Be sure to complete your health risk assessment (HRA). When you first join our plan, you get a health risk assessment (HRA) within 90 days before or after your effective enrollment date. We must complete an HRA for you. This HRA is the basis for developing your care plan. The HRA include questions to identify your medical, LTSS, and behavioral health and functional needs. We reach out to you to complete the HRA. We can complete the HRA by an in-person visit, telephone call, or mail. We’ll send you more information about this HRA upon your enrollment with the plan. If our plan is new for you, you can keep using the doctors you use now for a certain amount of time, if they are not in our network. We call this continuity of care. If they are not in our network, you can keep your current providers and service authorizations at the time you enroll for up to 12 months if all of the following conditions are met: You, your representative, or your provider asks us to let you keep using your current provider. We establish that you had an existing relationship with a primary or specialty care provider, with some exceptions. When we say “existing relationship,” it means that you saw an out-of-network provider at least once for a non-emergency visit during the 12 months before the date of your initial enrollment in our plan. We determine an existing relationship by reviewing your available health information available or information you give us. We have 30 days to respond to your request. You can ask us to make a faster decision, and we must respond in 15 days. You or your provider must show documentation of an existing relationship and agree to certain terms when you make the request. Note: You can only make this request for services of Durable Medical Equipment (DME), transportation, or other ancillary services not included in our plan. You cannot make this request for providers of DME, transportation or other ancillary providers. After the continuity of care period ends, you will need to use doctors and other providers in the IEHP DualChoice network that are affiliated with your primary care provider’s medical group, unless we make an agreement with your out-of-network doctor. A network provider is a provider who works with the health plan. Our plan’s PCPs are affiliated with medical groups or Independent Physicians Associations (IPA). When you choose your PCP, you are also choosing the affiliated medical group. This means that your PCP will be referring you to specialists and services that are affiliated with their medical group. A medical group or IPA is a group of physicians, specialists, and other providers of health services that see IEHP Members. Your PCP, along with the medical group or IPA, provides your medical care. This includes getting authorization to see specialists or medical services such as lab tests, x-rays, and/or hospital admittance. In some cases, IEHP is your medical group or IPA. Refer to Chapter 3 of your Member Handbook for more information on getting care. Be prepared for important health decisions Get the My Life. My Choice. app today. It stores all your advance care planning documents in one place online. Advance care planning (ACP) involves shared decision making to write down-in an advance care directive-a person’s wishes about their future medical care. ACP and the advance health care directive can bridge the gap between the care someone wants and the care they receive if they lose the capacity to make their own decisions. With this app, you or a designated person with Power of Attorney can access your advance health care directives at any time from a home computer or smartphone. Sign up for the free app through our secure Member portal. 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
IEHP DualChoice - Grievances, Coverage Determination and Appeals Process
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: email@example.com 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
P4P - Proposition 56 - GEMT - Prop 56 - Value Based Payment
OS June 30, 2022, payments will run out through June 2023. The Proposition 56 VBP Program provided direct payments incentivizing Providers to meet specific measures aimed at delivering key quality healthcare services that improve the quality of care to Medi-Cal beneficiaries. Targeted areas were behavioral health integration, chronic disease management, prenatal/post-partum care and early childhood prevention. For more information about the VBP Program, please visit the DHCS website at https://www.dhcs.ca.gov/provgovpart/Pages/VBP_Measures_19.aspx. By clicking on this link, you will be leaving the IEHP website. Value Based Payments Program Guide Value Based Payments (VBP) Program Guide (PDF) - Published: January 01, 2022 Value Based Payments Dispute Forms Value Based Payments Program - Paid Claims Dispute Request (PDF) Published: January 19, 2022 Value Based Payments Program - Encounter Dispute Request (PDF) Published: January 19, 2022 Please e-mail completed forms to ValueBasedPaymentsProgram@iehp.org At-Risk Condition Codes The At-Risk Condition Codes list includes diagnosis codes to identify Serious Mental Illness, Substance Use Disorder or Homelessness Conditions for the VBP Program. These conditions qualify Providers for an additional payment amount for VBP services. Please refer to page 4 of the VBP Program Guide for additional details. At-Risk Condition Codes (PDF) Published: March 25, 2020 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 - Compliance
h plan operations in compliance with ethical standards, contractual obligations under State and Federal programs, laws, and regulations applicable to Medi-Cal and IEHP DualChoice. This commitment extends to our business associates and delegated entities that support IEHP’s mission to organize and improve the delivery of quality, accessible, and wellness based healthcare services for our community. Our Compliance Program is designed to: Ensure we comply with applicable laws, rules, and regulations Reduce or eliminate Fraud, Waste, and Abuse (FWA) Prevent, detect, and correct non-compliance Reinforce our commitment to culture of compliance for which we strive Establish and implement our shared commitment to honesty, integrity, transparency, and accountability Code of Business Conduct and Ethics Inland Empire Health Plan (IEHP) expects Team Members and business entities doing business with IEHP to conduct business activities in an ethical and professional manner that promotes public trust and confidence in the integrity of IEHP. The Code is meant to provide guidance about the compliance culture at IEHP and the role that each Team Member, including management, Chief Officers and the Governing Board, plays in building and preserving that culture. IEHP Code of Business Conduct and Ethics (PDF) Compliance, Fraud, Waste, and Abuse (FWA), and Privacy Program Training The IEHP Compliance, FWA, and Privacy Training Program focuses on the elements of an effective Compliance Program, conduct & ethics, and the Fraud, Waste and Abuse and Privacy Programs. IEHP requires delegated entities to provide Compliance Training to their employees, Providers, downstream entities, Board of Directors, and Contractors within 90 days of hire/start, and annually thereafter. IEHP is committed to a culture of compliance, ethics, and integrity. The goal of Compliance Training is to provide all associated parties the ability to demonstrate awareness of IEHP’s requirements, including regulations and policies & procedures associated with Compliance as it relates to daily work. If you have questions or additional suggestions, please e-mail the IEHP Compliance Department at firstname.lastname@example.org. Compliance Training FWA HIPAA Privacy and Security (PDF) Eligibility to Participate in Federal and State Health Care Programs Inland Empire Health Plan (IEHP) is prohibited from issuing payment for services provided, ordered, or prescribed by an individual or entity that is excluded, ineligible, or terminated from participation in State and Federal health care programs in accordance with regulatory and contractual requirements. IEHP conducts regular reviews of Federal and State exclusionary databases and lists, including but not limited to: Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE list) GSA Excluded Parties List System (EPLS) DHCS Medi-Cal Suspended and Ineligible Provider List CMS Preclusion List Restricted Provider Database (RPD) Exclusion Screening IEHP has implemented a screening process to identify individuals and entities that appear on the DHHS OIG LEIE, the GSA EPLS, the CMS Preclusion List and the DHCS Medi-Cal Suspended and Ineligible Provider List prior to appointment, contracting, and/or employment and monthly thereafter to ensure that none of these individuals or entities are excluded, ineligible or terminated from participation in State and Federal health care programs. Delegated entities must implement a screening program for employees, Board Members, contractors, and business partners to avoid relationships with individuals and/or entities that tend toward inappropriate conduct. This program includes but is not limited to: Prior to contract and monthly thereafter, review of the GSA System for Award Management (SAM), the Department of Health Care Services Medi-Cal Suspended and Ineligible list, and the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) that are excluded from participation in government health care programs (42 CFR §10011901). A monthly review of the Department of Health Care Services Medi-Cal Suspended and Ineligible list. Criminal record checks when appropriate or as required by law. Review of the National Practitioner Databank (NPDB). Review of professional license status for sanctions and/or adverse actions. Reporting results to Compliance Committee, Governing Body, and IEHP as necessary. Fraud, Waste, and Abuse (FWA) IEHP has established a Fraud, Waste, and Abuse Program to detect, correct, and prevent fraud, waste, and abuse on part of Team Members, IEHP Members, Providers, Vendors, delegated entities and any other entity doing business with IEHP. Fraud Prevention Fraud Prevention, it’s a Team Effort In an effort to prevent fraud and abuse, IEHP encourages Providers and their staff to report any suspicious circumstances when they arise. You may want to ask for another form of identification in addition to the IEHP Member identification card. Identification with both a picture and a signature, such as a valid driver’s license or State identification card, are suggested. We are informing Members of this concern and are requesting that they have additional identification available when they come to you. To obtain more compliance guidelines, the Department of Health and Human Services (HHS) offers assistance (by clicking on this link you will be leaving the IEHP website). Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program, or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program. Examples include: Knowingly billing for services or prescriptions not furnished or supplies not provided Knowingly altering claim forms for a higher payment Selling medicine, medical equipment, or other things received through IEHP Waste includes overuse of services, or other practices that, directly or indirectly, result in unnecessary costs. Waste is generally not considered to be caused by criminally negligent actions but rather by the misuse of resources. Examples include: Conducting excessive office visits Writing excessive prescriptions or ordering excessive tests Prescribing more medications than necessary for the treatment of a specific condition Abuse includes actions that may, directly or indirectly, result in unnecessary costs and improper payment or services. Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment. Examples include: Billing for unnecessary medical services or medical equipment Billing for brand name drugs when generics are dispensed Misusing codes on a claim, such as upcoding and unbundling codes. Report potential FWA Click Here (By clicking on this link, you will be leaving the IEHP website). Privacy Incident/Breach IEHP has established a HIPAA Privacy Program to ensure that Member’s health information is properly protected while allowing the flow of health information needed to provide and promote high-quality health care. A privacy breach is defined as unauthorized acquisition, access, use, or disclosure of protected health information (PHI) which compromises the security or privacy of such information. PHI is health information that relates to a Member’s past, present or future physical or mental health or condition, including the provision of his/her health care, or payment for that care and contains personally identifiable information (PII) such as name, SSN, DOB, Member ID, address, or any other unique identifier related to the Member. This generally means that a breach occurs when PHI is accessed, used, or disclosed to an individual or entity that does not have a business reason to know that information. The law does allow information to be accessed, used, or disclosed when it is related to treatment, payment, or healthcare operations directly associated with the work that we do at IEHP on behalf of our Members. Report a Privacy Incident/Breach Click Here (By clicking on this link, you will be leaving the IEHP website). Reporting Information IEHP has the following resources available for reporting fraud, waste or abuse, privacy issues, and other compliance issues: Compliance Hotline: (866) 355-9038 Fax: (909) 477-8536 E-mail: email@example.com. Mail: IEHP Compliance Officer P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 Online: (By clicking on this link, you will be leaving the IEHP website) Report a Compliance Issue: Click Here Report a Privacy Incident/Breach: Click Here Report potential FWA: Click Here Frequently Asked Questions (FAQs) What are some common examples of fraud? Providers Billing for services not rendered Paying a "kickback" in exchange for a referral for medical services or goods Unbundling Overcharging for services or goods Using false credentials Members Allowing unauthorized individuals to use ID card to obtain benefits Altering prescriptions Falsifying residence information to obtain benefits Drug seeking or doctor shopping to obtain narcotics What do I do if I suspect an IEHP Member is engaging in possible fraud, waste, or abuse? First, document your suspicions. Then, contact IEHP’s Compliance Department at (866) 355-9038 and make a report with one of our Representatives. At times, IEHP may request additional information that is necessary to investigate. IEHP also has the following resources available for reporting fraud, waste or abuse, privacy issues, and other compliance issues: Compliance Hotline: (866) 355-9038 Fax: (909) 477-8536 E-mail: firstname.lastname@example.org Mail: IEHP Compliance Officer P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 Online: (By clicking on the following links, you will be leaving the IEHP website) Report a Compliance Issue Click Here Report a Privacy Incident/Breach Click Here Report potential FWA Click Here What do I do if my facility has made some billing errors? If you suspect that errors in billing may have occurred, contact your IEHP Provider Services Representative at (909) 890-2054. What are some other things I can do as a Provider? Periodically perform internal audits of billing practices and compare billing records with payments received. Do not leave prescription pads, which include a Provider's identification and license number, out in the open. For example, do not store prescription pads in exam room cabinets or leave on office counters. 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 or MS Internet Explorer Contact the OIG The Office of the Inspector General (OIG) is there to assist you and maintains a hotline, which offers a confidential means for reporting vital information. For information on confidentiality, please contact the hotline and ask about their confidential source program. Each caller is encouraged to assist the OIG by providing information on how they can be contacted for additional information but the caller may remain anonymous. Contacting the Office of the Inspector General Phone: (800) HHS-TIPS (447-8477) E-mail: Htips@oc.dhhs.gov Additional Hotlines DHCS Medi-Cal Fraud Hotline Phone: (800) 822-6222 E-mail: email@example.com Web: https://apps.dhcs.ca.gov/stopfraud/Default.aspx The recorded message may be heard in English and 10 other languages: Spanish, Vietnamese, Cantonese, Armenian, Hmong, Cambodian, Laotian, Farsi, Korean and Russian. The call is free and the caller may remain anonymous. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
IEHP DualChoice - IEHP DualChoice
Cal Plan, allows you to get your covered Medicare and Medi-Cal benefits through our plan. Our plan includes doctors, hospitals, pharmacies, providers of long-term services and supports, behavioral health providers, and other providers. It also has care coordinators and care teams to help you manage all your providers and services. They all work together to provide the care you need. IEHP DualChoice (HMO D-SNP) helps make your Medicare and Medi-Cal benefits work better together and work better for you. Some of the advantages include: You can work with us for all of your health care needs. You have a care team that you help put together. Your care team may include yourself, your caregiver, doctors, nurses, counselors, or other health professionals. You have access to a care coordinator. This is a person who works with you, with our plan, and with your care team to help make a care plan. Your care team and care coordinator work with you to make a care plan designed to meet your health needs. The care team helps coordinate the services you need. For example, this means that your care team makes sure: Your doctors know about all the medicines you take so they can make sure you’re taking the right medicines and can reduce any side effects you may have from the medicines. Your test results are shared with all of your doctors and other providers, as appropriate. Who is eligible for IEHP DualChoice? IEHP DualChoice is for people with both Medicare (Part A and B) and Medi-Cal. The following information explains who qualifies for IEHP DualChoice (HMO D-SNP). You are eligible for our plan as long as you: Live in our service area (incarcerated individuals are not considered living in the geographic service area even if they are physically located in it.), and Are age 21 and older at the time of enrollment, and Have both Medicare Part A and Medicare Part B, and Are currently eligible for Medi-Cal, and Are a full-benefit dual eligible beneficiary and enroll in IEHP DualChoice for your Medicare benefits and Inland Empire Health Plan (IEHP) for your Medi-Cal benefits. This is known as “Exclusively Aligned Enrollment”, and Are a United States citizen or are lawfully present in the United States. Service Area Only people who live in our service area can join IEHP DualChoice. Our service area includes all of Riverside and San Bernardino counties. How to Enroll To enroll, please call the: IEHP DualChoice Medicare Team at (800) 741-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays, TTY users should call (800) 718-4347 Visit our enrollment page to learn more. 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
Innovations and Quality Performance - Our Commitment to Innovation
healthcare needs of our Members for more than two decades. With our Strategic Priorities guiding us, we will continue to seek opportunities for innovation and improvement – putting access to quality healthcare and our Members, Providers and Community above all else. Community Health Assessment The 2022 Inland Empire Community Health Assessment Stakeholder Committee, comprised of over 40 representatives across 25 community organizations, united over the past year to collect and analyze the region’s health and wellness data. The group identified those four at-risk population groups, Senior citizens, communities of color, individuals with low incomes and those living in remote and rural areas, as well as six priority areas of focus: Basic Needs for Health and Safety, Human Housing, Meaningful Work and Wealth, Cardiovascular Disease and Diabetes, Maternal and Infant Health and Mental and Behavioral Health. The committee shared the findings in a first-of-its-kind joint regional Community Health Assessment report. Community Health Needs Assessment (CHNA) The 2022 Inland Empire Community Health Needs Assessment (CHNA) identifies the top health and well-being needs of Inland Empire residents. The findings in the CHNA will be used to build community interventions that generate collective investments addressing the identified priorities. There are seven assessments within the CHNA, the first three target the entire Inland Empire region, along with Riverside and San Bernardino counties. The remaining four assessments comprise drilled-down analyses for Montclair Hospital Medical Center, Redlands Community Hospital, San Antonio Regional Hospital and San Gorgonio Memorial Hospital service areas. Click here to view the assessment. Provider Recruitment IEHP’s innovative Network Expansion Fund (NEF) was the first program of its kind in the state. Established in 2014, the NEF allocates $30 million in specially designated funds to attract board-certified PCPs, Specialists and mid-level Providers to the Inland Empire, addressing the region’s chronic Provider shortage and improving access to care for more than 1.2 million IEHP Members. To date, more than 280 Providers have been recruited as a direct result of this program. Behavioral Health Integration Complex Care Initiative The Behavioral Health Integration Complex Care Initiative (BHICCI) is a collaboration between IEHP and more than 30 clinics in the Inland Empire that provides a footprint for the California Department of Health Care Services (DHCS) Health Homes Program, going live January 1, 2019. The goal is to improve Members’ health outcomes by staffing a complex care team to provide comprehensive care management and by coordinating complex physical and behavioral health needs across multiple Providers and health care systems in Riverside and San Bernardino counties. BHICCI care teams are currently transitioning into community-based care management entities (CB-CMEs) that provide Health Homes services in preparation for Health Homes go-live. Health Homes Program The Health Homes program (HHP) is an integrated care management program for patients with complex needs that builds on IEHP’s Behavioral Health Integration Complex Care Initiative (BHICCI), as legislated by the Department of Health Care Services (DHCS). The HHP coordinates the physical, behavioral, and community-based Long-Term Services and Supports (LTSS) needs of Members with severe chronic physical and/or mental health conditions. The primary goal of HHP is to improve the overall health outcomes of members through the delivery of care coordination and complex care management. Since the launch of the program in January 2019, more than 9,000 Members have seen overwhelmingly positive clinical health outcomes related to blood pressure, diabetes and depression. Click here to learn more about the Health Homes Program. EHR and Health Information Exchange IEHP has partnered with the San Bernardino County Medical Society and the Riverside County Medical Association to form the Inland Empire EHR Resource Center, to assist Providers and clinics in selecting and implementing electronic health record systems. Additionally, IEHP was part of the Inland Empire Health Information Exchange, which merged with the CalIndex Health Information Exchange to form Manifest Medex (MX). MX is a statewide health information exchange that has significant penetration and use in the Inland Empire, with all Inland Empire acute care hospitals and many medical groups and Physicians contributing patient clinical and administrative data. MX brings needed technology to access and securely share electronic patient health records for most of the 4.4 million people living in the Inland Empire. It allows Doctors, clinics, hospitals and other health care Providers to electronically review and access medical records, resulting in timely and improved quality of health care for patients in our community. DocOnline This innovative program provides another option for Members to receive medical advice after hours from a Physician. IEHP Members can speak to a board-certified Physician by phone or via video chat, quickly and easily. The Physician can access the IEHP formulary and the IEHP Pharmacy Network to e-prescribe medications for IEHP Members if needed. When fully implemented, this service will enhance Member access and convenience while reducing unnecessary emergency room and urgent care visits. Telehealth IEHP is supporting the expansion of telehealth services throughout the Inland Empire, to improve access to critically needed specialty care and to aid in rapid diagnosis and treatment. Telehealth eliminates one of the Inland Empire’s longstanding barriers to care – geographic distance to health care resources. With telehealth’s information and communication technologies, the treatment and prevention of disease or injury can occur long-distance, erasing geography as a critical factor impeding care. Telehealth can also be used to support Provider training and Member education. IEHP is currently supporting telehealth for certain services: behavioral health, retinal examinations, dermatology, and orthopedic consultations. Plans are underway to expand to additional services in alignment with Member needs. eConsult eConsult, a collaboration among IEHP, Arrowhead Regional Medical Center and Riverside University Health Care System, allows PCPs to connect directly with specialists electronically when a patient may need a specialist referral. Through a private, secure system, PCPs can receive timely clinical advice from specialists that may allow them to manage a majority of patients in the primary care setting (some patients may need a face-to-face visit with a specialist). IEHP is sponsoring the initiative for the first 24 months and will design, implement and evaluate eConsult at more than 70 clinic sites throughout Riverside and San Bernardino counties. Secure Online Member Portal and App IEHP Members can take an active role in managing their own health 24/7 via a secure online account that can be accessed through the IEHP website or mobile app. Members can view and print their IEHP Member Cards; view lab tests, Immunization Cards and authorizations; find or change Doctors; search the Provider Directory; enroll in health education classes; check eligibility; and more. The separate Baby-N-Me prenatal care app helps improve maternity health outcomes by making it easy for expectant moms to track pregnancy milestones, identify health issues, and stay healthy with reminders and helpful tools. Texting and Alerts IEHP uses two-way texting and Short Message Service (SMS) alerts to educate Members about their plan benefits and how to navigate the health care system. These alerts are targeted approaches that communicate seasonal health information about topics such as immunizations, preventive care, medication adherence, and new health plan features. Long-Term Services and Supports (LTSS) IEHP’s Long-Term Services and Supports (LTSS) program enables seniors and persons with disabilities to live independently in their homes as long as safely possible, and provides care in a Skilled Nursing Facility (SNF) when they cannot. LTSS includes the Multipurpose Senior Services Program (MSSP) and Community-Based Adult Services (CBAS), as well as SNF services when required. IEHP also helps coordinate any In-Home Supportive Services (IHSS) benefits. Since May 2018, IEHP has helped transition 750 Members out of long-term care facilities and back into the community. A 24-hour in-home emergency caregiver program and a case management program, developed in partnership with the Riverside County Department of Social Services, received the 2017 and 2018 Achievement Award from the National Association of Counties. IEHP has also partnered with the University of California, Los Angeles on a Geriatric Workforce Enhancement Program to provide patients, families and caregivers with the knowledge and skills they need to improve health outcomes and increase the quality of care for older adults.
COVID-19 - Testing Locations
provider, and receive treatment for COVID-19 – all in one place at a Test to Treat site. If you have a medical condition which makes you more likely to get very sick from COVID-19, you may be eligible to receive treatments. Adults and Children over the age of 12 can receive treatments, but treatment must be started as soon as possible and within 5 days of symptom onset. Click here for more information on the COVID-19 Test to Treat Program. Walgreens Test to Treat Program Select Walgreens pharmacies are now dispensing oral antivirals for the treatment of COVID-19. Eligible members must have a valid prescription from their healthcare provider. Walgreens offers a variety of delivery options, like same day or free 2-day delivery. Most prescriptions are eligible for Same Day Delivery. Click here for more information. FREE at-home COVID-19 tests Every home in the U.S. is eligible to order one free COVID-19 test kit, which includes four at-home tests. The tests are completely free. Click here to order your free at-home tests from USPS. Effective 2/1/22, Medi-Cal Members can receive at-home COVID-19 tests from a Medi-Cal enrolled pharmacy. California Department of Health Care Services (DHCS) will cover up to 8 test kits per month per member. For information on which test kits are covered or if you need assistance with a prescription, please ask your Doctor or your Pharmacist. Medi-Cal Members will be reimbursed for at-home test kits purchased between March 11, 2021, and January 31, 2022, by DHCS the cost (with a receipt) using the process outlined here. San Bernardino County-facilitated testing sites will offer free at-home COVID-19 tests kits to people who live, work, or attend school in San Bernardino County (proof of residency or employment required). Click here to find a list of county-facilitated testing sites. Testing If you believe you are at risk for COVID-19, you can get COVID-19 screening and testing at the sites below. IEHP covers provider-ordered tests, regardless of whether it’s PCR, rapid, at-home, 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 that are not ordered by a provider. Riverside County COVID-19 Testing Sites Banning Banning Family Care Center 3055 W. Ramsey, Banning Schedule an Appointment Beaumont Beaumont Women's Club 306 E 6th St., Beaumont, 92223 Call (888) 634-1123 Schedule an Appointment Borrego Health Multiple Locations Available Click here for information on COVID-19 sites in your area. Cathedral City Plaza Rio Vista Kiosk 67908 Vista Chino, Cathedral City Schedule an Appointment Coachella Our Lady of Soledad 52525 Oasis Palm Ave., Coachella Schedule an Appointment Coachella TODEC Legal Center COVID Testing 1560 6th St., Coachella Schedule an Appointment Corona Corona Community Health Center 2813 S. Main St., Corona Schedule an Appointment Corona Unicare Community Health Center 107 N. MicKinley St., Corona Call (909) 457-3603 CVS MinuteClinic Multiple Locations Available* Schedule an Appointment Hours vary by location Desert Hot Springs Henry V. Lozano Community Center 12800 West Arroyo, Desert Hot Springs Schedule an Appointment Indio Indio Fleet Services 82775 Plaza Ave., Indio Schedule an Appointment Indio Old Amistad High School 44801 Golf Center Pkwy, Indio Schedule an Appointment Jurupa Avalon Park Community Center 2500 Avalon St., Jurupa Schedule an Appointment La Quinta La Quinta Wellness Center 78450 Avenida La Fonda, La Quinta Schedule an Appointment Lake Elsinore The Outlets at Lake Elsinore Testing 17600 Collier Ave., Suite J-195 Parking Lot, Lake Elsinore Schedule an Appointment Moreno Valley Moreno Valley Family Care Center 23520 Cactus Ave., Moreno Valley Schedule an Appointment Moreno Valley Cottonwood Golf Center 13671 Frederick St., Moreno Valley Schedule an Appointment Moreno Valley Moreno Valley Kiosk 14075 Frederick St., Moreno Valley M-F 10am - 6:30pm Schedule an Appointment Moreno Valley Riverside University Health System Medical Center 26520 Cactus Ave., Moreno Valley M-F 10am - 6:30pm Schedule an Appointment Murrieta California Oaks Center Trailer 40565 California Oaks Rd., Murrieta Schedule an Appointment Palm Desert UCR Palm Desert Campus 75080 Frank Sinatra Dr., Palm Desert Schedule an Appointment Palm Springs Palm Springs Convention Center 277 N. Avenida Caballeros, Palm Springs Schedule an Appointment Perris Perris' City Council Chamber 101 N D St., Perris Schedule an Appointment Perris Perris Community Health Center 308 E. San Jacinto Ave., Perris Schedule an Appointment Perris Rapid Care Enterprises 126 Avocado Ave. Ste 102, Perris Call (951) 490-4910 Mon-Fri | 9 a.m. - 9 p.m. Sat-Sun | 12 p.m. - 5 p.m. Costs may be associated with this site Rite Aid Pharmacy Multiple Locations Available* Schedule an Appointment Mon-Fri | 10 a.m. - 8 p.m. Sat-Sun | 10 a.m. - 5 p.m. Riverside Jurupa Valley Family Care Center 8876 Mission Blvd., Riverside Schedule an Appointment Riverside Riverside City Hall Kiosk (test only) 3900 Main St., Riverside Schedule an Appointment Riverside Riverside Neighborhood Health Clinic 7140 Indiana Ave., Riverside Schedule an Appointment Riverside La Sierra Park Drive Through (test only) 5272 Mitchell Ave., Riverside Schedule an Appointment Temecula Vail Ranch Center Kiosk 31699 Temecula Pkwy., Temecula Schedule an Appointment For more information on COVID-19 testing sites in Riverside County, please visit the Riverside County Public Health website. San Bernardino County COVID-19 Testing Sites Adelanto Adelanto Health Center 11336 Bartlett Ave., Ste. 11, Adelanto Call (800) 722-4777 Apple Valley James A. Woody Community Center 13467 Navajo Rd., Apple Valley Schedule an Appointment Barstow Barstow Adult School 720 E. Main St., Barstow Schedule an Appointment Big Bear Big Bear Health Center 477 Summit Blvd., Big Bear Lake Schedule an Appointment Barstow Barstow Health Center 303 E. Mountain View St., Barstow Call (800) 722-4777 Bloomington Kessler Park COVID-19 Testing Bus 18401 Jurupa Ave., Bloomington Schedule an Appointment Borrego Health Multiple Locations Available Click here for information on COVID-19 sites in your area. Chino CVUSD Chino Valley Adult School 12970 3rd St., Chino Schedule an Appointment Chino Lani City Medical 4036 Grand Ave., Suite A, Chino (909) 465-5000 Schedule an Appointment Colton Arrowhead Regional Medical Center 400 N. Pepper Ave., Colton Call (855) 422-8029 Colton Colton Urgent Care Center 1181 N. Mt. Vernon Ave., Colton Colton Urgent Care Center Online Check-In Colton Gonzales Community Center 670 Colton Ave., Colton Schedule an Appointment Colton Unicare Community Health Center 308 N. La Cadena Dr., Colton Call (909) 457-3603 CVS Multiple Locations Available Schedule an Appointment Fontana Jessie Turner Health & Fitness Community Center 15556 Summit Ave., Fontana Schedule an Appointment Fontana West Point Medical Center 7774 Cherry Ave., Fontana Call (909) 355-1296, option 1 Hesperia Hesperia Health Center 16453 Bear Valley Rd., Hesperia Call (800) 722-4777 Joshua Tree Community Center 6171 Sunburst St., Joshua Tree Schedule an Appointment Loma Linda Loma Linda Senior Center 25571 Barton Rd., Loma Linda Schedule an Appointment Montclair Montclair Kid's Station - COVID Testing Bus 4985 Richton St., Montclair Schedule an Appointment Montclair Montclair Place - Moreno St. Market Food Court 5060 N. Montclair Plaza Ln., 2nd Floor, Ste. 2138 Schedule an Appointment Ontario Drive-Through COVID Clinic 2500 E. Airport Dr., Ontario Schedule an Appointment Ontario Drive-Through COVID Clinic 1 Mills Circle, Ontario Schedule an Appointment Ontario Ontario Health Center 150 E. Holt Blvd., Ontario Call (800) 722-4777 Ontario Parktree Community Health Center 2680 E. Riverside Dr., Ontario Call (909) 630-7927 Ontario Unicare Community Health Center 437 N. Euclid Ave., Ontario Call (909) 988-2555 Rancho Cucamonga Lani City Medical 1398 Kenyon Way, Suite J, Rancho Cucamonga (909) 727-3911 Schedule an Appointment Rancho Cucamonga RC Family Resource Center 9791 Arrow Rte., Rancho Cucamonga Schedule an Appointment Rancho Cucamonga Terra Vista Town Center - Theater Parking Lot COVID Testing Bus 10701 Town Center Dr., Rancho Cucamonga Schedule an Appointment Rancho Cucamonga West Point Medical Center 8520 Archibald Ave., St B., Rancho Cucamonga Call (909) 481-3909, option 1 Redlands Redlands Urgent Care Center 301 W. Redlands Blvd., Redlands Redlands Urgent Care Center Online Check-In Rialto Carl Johnson Center 214 N. Palm Ave., Rialto Schedule an Appointment Rite-Aid Pharmacy Multiple Locations Available Schedule an Appointment San Bernardino Court Street Square 349 N East St., San Bernardino Event Dates: March 3, 17 and 31 Schedule an Appointment San Bernardino Department of Public Health COVID-19 Testing Bus 172 W. 3rd St., San Bernardino Schedule an Appointment San Bernardino Drive-Through COVID Clinic 500 Inland Center Dr, San Bernardino Schedule an Appointment San Bernardino Premier Urgent Care Centers of California 284 E. Highland Ave., San Bernardino Daily | 9 a.m. - 9 p.m. San Bernardino SAC Health System 250 S. G St., San Bernardino Call (909) 771-2911 T/W/F | 3 p.m. - 5 p.m. San Bernardino San Bernardino Health Center 606 E. Mill St., San Bernardino Call (800) 722-4777 San Bernardino West Point Medical Center 1800 Medical Center Dr., St. 99, San Bernardino Call (909) 880-6400, option 1 Twentynine Palms Twentynine Palms - Patriotic Hall 5885 Luckie Ave., Twentynine Palms Schedule an Appointment Upland Advanced Medical & Urgent Care Center 974 W. Foothill., Upland Call (909) 981-2273 Mon-Fri | 8 a.m. - 2:30 p.m. Upland Landecena Community Building 1325 San Bernardino Rd., Upland Schedule an Appointment Victorville Drive-Through COVID Clinic 14400 Bear Valley Dr., Victorville Schedule an Appointment Victorville Green Tree Golf Course Banquet Room 14144 Green Tree Blvd., Victorville Schedule an Appointment Victorville Victor Valley College 65 Mojave Fish Hatchery Rd., Victorville Portables located behind Construction Technology Building 65 Schedule an Appointment Walgreens Multiple Locations Available Schedule an Appointment Yucaipa 7th Street Pool 12385 7th St., Yucaipa Schedule an Appointment Yucca Valley Yucca Valley Community Center COVID-19 Testing Bus 57090 Twentynine Palms Highway, Yucca Valley Schedule an Appointment Yucaipa Yucaipa Urgent Care Center 33494 Oak Glen Rd., Yucaipa Yucaipa Urgent Care Center Online Check-In For more information on COVID-19 testing sites in San Bernardino County, please visit the San Bernardino County COVID Testing Sites.
Healthy Living - Coronavirus
how eating right and being active are the secrets to a long, healthy life. These are important. But there’s more you can do to stop disease. Finding health problems early gives you more treatment choices or a cure. That’s where health screenings come in. Health screenings are vital for all people, from newborns to seniors. These tests are designed to look for signs that you may be at risk for certain conditions. They help spot health problems at an early stage, even if you do not have symptoms. Types of cancer screenings Breast Cancer A mammogram is a breast X-ray. It can spot breast cancer early when it’s most treatable and when your chance of a cure is much higher. Both women and men can get breast cancer and should get screened every two years, starting at age 50. Those who are at high risk or would like to start screening at an earlier age can talk to their Doctor about starting screening at age 40. Cervical Cancer (Pap Smear) The Pap test also known as a pap smear, can detect not normal cells on your cervix early enough so they can be treated before cancer has a chance to grow. The screening is recommended for woman ages 21-65 every 3-5 years, depending on the risk and type of screening. To schedule a screening, talk to your Doctor. Colorectal Cancer Colorectal cancer affects the colon and the rectum. Screening can find and remove growths in these areas before they turn into cancer. Everyone ages 50-75 should get screened for colorectal cancer every 1-10 years, depending on risk and type of test used. Talk with your Doctor about which test is the best for you. Lung Cancer Screening for lung cancer with imaging (CT scan) in people who smoke or who have quit within the past 15 years, can help find cancer at an early stage. Catching it early keeps you healthy. A yearly screening is recommended for anyone ages 50-80 who smokes cigarettes or has quit smoking in the last 15 years. If you’re due for a screening, call your Doctor today to schedule your appointment. Don’t wait. Take charge of your health! For help, call IEHP Member Services at 1-800-440-4347, Monday – Friday, 7 a.m. – 7 p.m., and Saturday-Sunday, 8 a.m. – 5 p.m.
CalAIM - Pay for Performance (P4P)
th Care Services (DHCS), California Advancing and Innovating Medi‐Cal (CalAIM) is a long‐term commitment to transform and strengthen Medi‐Cal, offering Californians a more equitable, coordinated, and person‐centered approach to maximizing their health and life trajectory.1 DHCS Goals For CalAIM 2 Identify and manage comprehensive needs through whole person care approaches and social drivers of health. Improve quality outcomes, reduce health disparities, and transform the delivery system through value-based initiatives, modernization, and payment reform. Make Medi‐Cal a more consistent and seamless system for enrollees to navigate by reducing complexity and increasing flexibility. Resource Links DHCS CalAIM page DHCS CalAIM Transformation Infographic (PDF) DHCS Medi-Cal Alignment Primer (PDF) IEHP Enhanced Care Management IEHP Enhanced Care Management (Member Page) IEHP Community Support Services IEHP Community Support Services (Member Page) 1,2https://dhcs.ca.gov/calaim You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Medicare DSNP Formulary Search Tool - IEHP DualChoice (HMO D-SNP) Formulary Search Tool
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.
Pharmacy Services - Pharmacy Quality Ratings
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
Medicare CMC Formulary Search Tool - IEHP DualChoice (HMO D-SNP) Formulary Search Tool
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.
Special Programs - Enhanced Care Management
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.