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Report an Issue - Report Fraud and HIPAA Privacy Issues

ay have. To ensure that our Members receive the best care, we need them to report any issues. Issues can be, witnessing any type of fraud, or if a Member feels that their personal and private information has been misused. How Do I Report an Issue? To report fraud the following resources are available: waste or abuse, privacy issues, and other compliance issues. Compliance Hotline: (866) 355-9038 Fax: (909) 477-8536 E-mail: compliance@iehp.org Mail: IEHP Compliance Officer P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 Click Report a Compliance Issue to report online. What is the 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. What is a privacy breach? An unauthorized acquisition, access, use, or disclosure of protected health information (PHI) which puts at risk 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. This includes the services 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. Click Report a Privacy Incident/Breach to report online. What is the Fraud, Waste, and Abuse (FWA) Program? IEHP has established a fraud, waste, and abuse program to detect, correct, and prevent fraud, waste, and abuse on part of IEHP Employees, IEHP Members, Providers, Vendors, delegated entities and any other entity doing business with IEHP. What is Fraud?  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: The use of someone else's identification or insurance card to obtain services. Falsifying income or location to obtain insurance. Selling of prescription medication or medical equipment obtained through IEHP. What is Waste? 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 actions of criminal neglect but rather by the misuse of resources. Examples include: Frequent visits to the ER or Urgent care for standard doctor visits. Visiting multiple doctors or hospitals to obtain controlled medications. What is Abuse? 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: Use of transportation benefits for non-medical purposes. Click Report Fraud/Waste/Abuse to report online.

Coronavirus (COVID-19) Announcements

of Phase 1A of its vaccination roadmap, vaccines will be distributed to caregivers with In-Home Support Services (IHSS), intermediate care centers, and public and community health centers, including facilities for mental health. Click here to learn more. 1/12/21: San Bernardino County introduces a coronavirus quarantine and isolation calculator. This tool allows people to determine how long they should self-isolate after testing positive for COVID-19, being sick with COVID-19, or being exposed to someone with COVID-19. Click here for more info. 12/7/20: The governor announced a stay at home order for Southern California regions, including Riverside and San Bernardino County, for a minimum of three weeks. This order is in response to a rapid growth in COVID-19 cases and a substantial increase in hospitalizations and ICU admissions. Click here to learn more.  9/11/20: To continue to help slow the spread of COVID-19, Riverside County is urging residents to get tested. In addition, increased testing will help the county move into the next level of the state’s reopening plan. For testing locations, visit gettested.ruhealth.org.   8/21/20: Health officials urge Riverside County residents to get tested for COVID-19, whether or not they are experiencing symptoms. For testing locations, visit gettested.ruhealth.org.  8/21/20: To stop the spread of COVID-19, San Bernardino County Public Health Director urges all residents to get tested. Watch this video to learn more.  7/24/20: Fraud reports have increased due to uncertainty surrounding COVID-19, leaving many San Bernardino residents unsure how to avoid scams or report them to authorities. Scams include fake at-home COVID-19 testing kits or vaccinations, IRS impersonators, illegal robocalls and fake charities. For more information visit the San Bernardino County Public Website. 6/29/20: San Bernardino County is encouraging all residents, including those who have not experienced symptoms of COVID-19, to be testing for the Coronavirus. Click here for testing locations.  6/19/20: Governor Newsom requires California residents to wear face coverings while in public. Click here to learn more. For information on how to wear a proper face covering, watch this short video. 6/12/20: A COVID-19 testing site returns to Blythe. Testing started on June 10th and will continue for two weeks. In addition, a testing site opens at the Edgemont Women’s Club in Moreno Valley and will operate June 17 through June 19th. Click here for more information.  5/29/20: Cooling Centers open throughout Riverside County, offering residents an escape from extreme heat and are open to the public at no cost. The centers will be available through October. Click here for more information.  5/29/20: New COVID-19 testing sites open in San Bernardino County. They are scheduled to run through June with appointment registrations opening weekly. For a complete list of testing locations click here: Click here for a complete list of testing locations.  5/27/20: A drive up COVID-19 testing site will be opened at the old Sears parking lot in Riverside, replacing the testing location at Harvest Christian Fellowship that is closing. Click here for a complete list of testing.   5/22/20: Riverside County added three new COVID-19 testing sites in Corona, San Jacinto and Temecula. Click here for a complete list of testing locations.  4/30/20: Riverside County’s Public Health Officer is extending his order requiring residents to wear face coverings when outside and to continue practicing social distancing through June 19. Residents are still required to remain in their primary residence under Governor Newsom’s existing “stay at home” order unless they are engaged in an essential business or activity, such as grocery shopping or visiting the doctor.  Click here for more information. 4/28/20: San Bernardino County opens up criteria for COVID-19 testing. Beginning April 30th, residents 65 and older, healthcare workers, emergency responders, and law enforcement can get tested without displaying symptoms of COVID-19. For testing information, visit the San Bernardino County website.  4/24/20: In response to an increasing number of requests for resources, Riverside County released an online map to connect residents to local food resources. Resources include senior meal sites, school district meal sites and food pantries. Click here to find food resources.  4/20/20: Testing for COVID-19 has been expanded to all Riverside County residents, including those who do not have any COVID-19 symptoms.  In addition, a fifth COVID-19 testing site will be established at the Blythe Fairgrounds on April 22nd. All residents interested in testing must call 800-945-6171 for an appointment. Click here for more information. 4/13/20: A fourth drive-up COVID-19 testing site opens in Riverside County on Tuesday, April 14th. The site has been established at the Perris Fairgrounds, located at 18700 Lake Perris Drive. Perris, California. Residents who want to get tested must have symptoms to make an appointment, symptoms include fever, cough, sore throat, runny nose or cough. Residents must call 800-945-6171 to make an appointment. For more information on testing locations, visit the Riverside County Public Health website.  4/13/20: San Bernardino County Public Health will conduct a community drive-through event for COVID-19 testing in Montclair on Tuesday, April 14. This event is open to San Bernardino County residents by appointment only. Residents can make an appointment online at http://wp.sbcounty.gov/dph/coronavirus/ at 2 p.m. on Monday, April 13 or by calling (909) 387-3911. Additional community drive-through events are scheduled throughout this month in Yucaipa, Big Bear Lake, Joshua Tree, and Rancho Cucamonga, California. For more information visit the San Bernardino County website.  4/8/20: Arrowhead Regional Medical Center will begin a COVID-19 drive-thru testing site on Thursday, April 9th. Appointments are required. To make an appointment call 855-422-8029. For more information visit Arrowhead Regional Medical Center.   4/7/20: CalWORKs and CalFresh renewals and SAR 7 status reports do not need to be submitted for March, April or May. This does not apply to Transitional CalFresh or Transitional Nutrition benefits. To access your benefits, visit: c4youself.com or call 877-410-8829 (San Bernardino County) 877-410-8827 (Riverside County).  4/7/20: The San Bernardino County’s Acting Health Officer ordered everyone in San Bernardino County to wear face coverings when leaving home and interacting with other people. Face coverings may include homemade cloth ear loop covers, bandannas and handkerchiefs, and neck gaiters. Also, orders all religious services to be done electronically, including upcoming Easter celebrations.Click here for more information. 4/4/20: The Riverside County Public Health Officer orders the public to stay home and cover their face when leaving and interacting with other people, including essential workers. Face coverings can be bandanas, scarves, neck gaiters or other clothing that does not have visible holes. Click here to learn more. 4/4/20: The Small Business Association (SBA) is offering forgivable loans that help businesses keep their workforce employed during the Coronavirus (COVID-19) crisis. The Paycheck Protection Program is a loan designed to provide a direct incentive for small businesses to keep their workers on the payroll. The loan application period opens on Friday, April 3, 2020. For more information visit the SBA website.   3/31/20: San Bernardino County will conduct a drive-thru sample collection event for COVID-19 in the High Desert on April 2nd. This event is open to San Bernardino County residents only. Residents can request an appointment online at sbcovid19.com or by calling (909) 387-3911. For more information on this event visit: http://www.sbcounty.gov/main/default.aspx 3/30/20 – A third drive-up COVID-19 testing site opens in Riverside County on April 1st. The site has been established at Harvest Christian Fellowship church in Riverside.  Residents must have symptoms to make an appointment, which include fever, cough, sore throat, runny nose or cough.  Residents must call 800-945-6171 to make an appointment. For more information on testing locations, visit the Riverside County Public Health website. 3/30/20 – A COVID-19 testing site in Indian Wells will be relocated to the Riverside County Fairgrounds in Indio. The first day of testing at the fairgrounds is Tuesday (March 31). Residents must have symptoms to make an appointment, which include fever, cough, sore throat, runny nose or cough. Appointments must be scheduled by calling 800-945-6171. For more information on testing locations, visit the Riverside County Public Health website. 3/27/20: San Bernardino County Public Health will conduct a drive-thru specimen collection for COVID-19 on Friday, March 27. The specimen collection for COVID-19 testing will be available for the public by appointment only. Appointment sign-up and details will be available on the county website. 3/25/20: COVID-19 testing for IEHP Members is now available at SAC Health Systems in San Bernardino. IEHP Members must call (909) 771-2911 to schedule a telephone appointment with a Doctor. The Doctor will evaluate the Member and determine if they need COVID-19 testing and will provide details on how to obtain testing. 3/20/2020: Gov Gavin Newsom announces a California statewide order for residents to “stay at home,” excluding essential entities which include grocery stores, take-out and delivery and health care organizations. IEHP is an essential entity and will continue operations to support our Members and Providers through telephonic contact only. OUR BUILDINGS ARE CLOSED TO NON-EMPLOYEES. We highly encourage you (our Members and Providers) to call us if you need any services or have any questions. Continue to visit our website for frequent updates and news from Gov Gavin Newsom. 3/19/2020: IEHP Chief Medical Officer, Dr. Hansberger, has an important message for our Members in the Coachella Valley region about the COVID-19 situation and ways for them to protect their health. Click here.  3/18/2020: To help our IEHP Members stay home and avoid public places, we encourage Members to use mail order delivery service for both new and refill prescriptions. By using this service, Members can get medicines mailed to their home at no cost by using standard shipping. 3/13/2020: We are requesting when you (including Members, Providers, Community Partners, Vendors, and all Visitors) need IEHP services, please call IEHP or your IEHP contact directly to get the help you need. If you must visit IEHP in person, please ensure that you do not have a fever, cough or breathing problem. 3/13/2020: All classes and events at IEHP’s Community Resource Centers are canceled until further notice for the protection and safety of our community during the Coronavirus (COVID-19) situation. We apologize for any inconvenience and expect to resume classes as soon as possible.

Testimonials - Jean

ely a part of that village. She first signed up with the health plan when she became pregnant with her daughter, Sophia. Regular prenatal check-ups lead to the discovery that Jean had gestational diabetes. But the diabetes didn’t go away after Sophia was born. As a new mom, Jean was hesitant to take medications. So she asked her Doctors if she could try to control her diabetes with lifestyle and diet changes instead. They agreed and set her up with a nutritionist and a company that mails glucose testing strips directly to her home. “My Doctors actually listened to my concerns and were very supportive,” the 41-year-old Rancho Cucamonga resident said. “It meant a lot to me because it showed they weren’t just treating my condition, they were treating me – the person.” When Jean struggled with behavioral health issues, her Doctors listened to her again. IEHP approved referrals for a therapist and continues to approve them as needed. Jean said she noticed a huge difference after attending sessions regularly. “If you’re not okay emotionally, then you can’t be okay physically,” she explained. And Jean added that Sophia’s Doctors are just as amazing as hers. Getting immunizations, check-ups and medicines for her 5-year-old are never an issue. And that goes a long way toward keeping both mom and daughter healthy and happy. “They know us by name whenever we go into the office for an appointment,” she said. “They’ve seen my daughter grow up and it’s like they’re part of our family now. Everyone there and at IEHP are taking very good care of us.”  

Testimonials - Jason Lohr

es a huge impact on quality.  “Our partnership with IEHP means that our patients can get the care they need, when they need it,” said Dr. Lohr, who specializes in Family Medicine and is the CEO of SAC Health System.  SAC Health System has five sites in both Riverside and San Bernardino counties and sees about 12,000 visits per month – 90 percent of which are covered under IEHP. Specialists are housed under the same roof which results in more efficient referrals, quicker follow-up appointments and limits unnecessary testing.  Unless, a Member can’t get there at all.  “We had a patient, a man in his mid-thirties, who was completely blind and living with uncontrolled diabetes. Although we would schedule appointments for him, he had a very high no-show rate,” Dr. Lohr explained. Further investigation into his case revealed that this IEHP Member had problems with transportation and literacy, coupled with some behavioral health and depression issues. Dr. Lohr knew that his health would not improve unless the other barriers to care were addressed as well.  “He was at the point where he was basically giving up on his health. It was just too hard,” he said. That’s when the IEHP Member was referred to the Health Homes program.  “The Behavioral Health team provided wellness coaching to help him with his depression, a nurse educated him on how to control his sugars and social workers connected him with transportation assistance,” he said. “His diabetes is now controlled for the first time. He’s a great testament to the team’s care. Even he will tell you that the way he feels now is the difference between night and day.” While Dr. Lohr appreciates IEHP’s innovative programs like Health Homes, he also believes the basic day-to-day responsiveness by IEHP also makes a huge impact on how he and other Providers deliver quality care.  “When you get answers back in a timely manner, then care doesn’t have to be delayed. That’s important when it comes to keeping the trust of our patients. That makes a difference,” he said.   

Accessibility

technologies for individuals with disabilities by generating content that conforms to the Web Content Accessibility Guidelines (WCAG) 2.0, and Section 508 of the Rehabilitation Act meeting the requirements within the Americans with Disabilities Act. As part of the development process and ongoing website maintenance, IEHP tests the site using assistive technologies, including screen readers, screen magnifiers, speech recognition software and text-only browsers. IEHP uses tools, such as the W3C HTML. Validator, WAVE by WebAIM and the Color Contrast Analyzer, to ensure the best experience possible for all visitors. Should you have any feedback or concerns related to the accessibility of this webpage and resources contained within it, please contact us via email at ada@iehp.org If applicable, please include the web address, brief description of the issue encountered and your contact information.

Special Programs - Baby-N-Me

ne of 2018. This free app provides expectant mothers with clinically approved information and access to exclusive content based on their due date. IEHP Members can download this app in Google Play or Apple App stores. Flyers for Members: 2021 Baby-N-Me App - English (PDF) 2021 Baby-N-Me App - Spanish (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Special Programs - My Path Palliative Care

centered care that optimizes quality of life by anticipating, preventing, and treating suffering. My Path addresses the Member’s needs, including physical, emotional, and spiritual, while facilitating Member autonomy, access to information, and choice. The My Path program consists of: a palliative care assessment and consultation; advanced care planning; individualized written plan of care; pain and symptom management; mental health and medical social services; care coordination; and a palliative care team. My Path Program Brochure (PDF) My Path Program - Pediatric Brochure (PDF) My Path Program Guidelines (PDF) My Path Program FAQs (PDF) My Path - A Palliative Care Approach (PDF) Certification of Advanced Disease (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.

Special Programs - Total Fracture Care

ticipating Orthopedist for global fracture care without a prior authorization.  This Program ensures that Members in need of fracture care by an Orthopedist, as determined by an Emergency Department Physician, Urgent Care Physician or Primary Care Provider, will receive timely access to care. Policy Reference: 10 - Medical Care Standards Total Fracture Care Providers Arrowhead Orthopaedics  For more information and locations, please visit: https://www.arrowheadortho.com/ Orthopaedic Medical Group of Riverside Inc. For more information and location, please visit: https://omgnet.com/   You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Pregnancy and Postpartum

al care as early as possible improves the chances of a healthy pregnancy and childbirth.  Receiving postpartum care after childbirth is just as crucial for a woman to make sure she is healing properly and gets the help she needs to care for herself and her baby. IEHP has programs that offer support for our pregnant Members throughout their pregnancy and after.   Baby-N-Me App     This is a free app for IEHP Members who are pregnant or have a baby under 2 years old. On this app pregnant Members can get up-to-date information about their growing baby like ultrasound videos, get handy tools like a weight gain calculator, complete a survey that screens for postpartum depression, set appointment reminders, and much more!    Parents of a baby under 2 years old can get parenting tips and advice, age-adapted information about their baby’s growth, feeding patterns, and tools to track diaper changes, growth, and vaccines.  You can download this app for free through iTunes or Google Play Loving Support Loving Support is committed to helping mothers achieve their breastfeeding goals. The Helpline offers advice, referrals to mom support groups and support and encouragement to get breastfeeding off to a good start. International Board Certified Lactation Consultants (IBCLCs) also offer guidance, pumping strategies and tips for returning to work/school or are pumping for their premature babies.  Call Loving Support with any questions or concerns you may have throughout the first year and beyond.  You can contact the Loving Support 24/7 Helpline at 888-451-2499/951-358-7212. The staff speaks English and Spanish. Additional Resources The ABC's of Safe Sleep (Video) Centers for Disease Control and Prevention: Pregnancy Depression During and After Pregnancy

Pharmacy Services - Clinical Information

ude printable reference documents for your convenience and ease of use. Go to the Quality & Clinical Resources and Tools page. In this section find information regarding Clinical Practice Guidelines. Safety Resources

COVID-19 - Jaime Camil Video Series

much of California is returning to some sense of normalcy after more than a year and a half of battling COVID-19, it’s important to recognize that the pandemic is not over. In fact, the number of cases and hospitalizations have been rising since the state reopened in mid-June, with the contagious Delta variant of the coronavirus spreading quickly. Many Californians have put off annual check-ups, vaccinations, and preventive medicine during the pandemic to avoid the virus. In an effort to ensure our combined 3.8 million members and communities are getting vaccinated and resuming their routine wellness care, we've teamed up with L.A. Care Health Plan to launch a multi-pronged educational campaign with the help of award-winning actor Jaime Camil. Check out clips from the series below! Actor Jaime Camil and Ernesto Campos debunk COVID-19 myths.   Jaime Camil discusses with Dr. Ernesto Campos where YOU can get vaccinated.   Jaime Camil and Dr. Ernesto Campos talk about how COVID-19 affects the unvaccinated.   Jaime Camil and Dr. Ernesto Campos discuss how COVID-19 is still a contagious disease.   Debunking COVID-19 myths such as magnetism.   Debunking COVID-19 myths   Jaime Camil and Dr. Ernesto Campos talk about the efficacy of the COVID vaccine.   Jaime Camil and Dr. Ernesto Campos talk about the importance of the COVID vaccines.  

COVID-19 - Resources

19. Below you will find resources and information on how to protect yourself and your loved ones during this time.  How vaccines build immunity While the COVID-19 vaccines are relatively new - the technology and science behind the vaccines have been in development for decades. In the video below, we demonstrate how years of vaccine research and advanced technology allowed researchers and scientists worldwide to be prepared to develop an mRNA vaccine that could help fight the spread of a global infectious disease. COVID-19: Home isolation tips If you or someone in your household has been diagnosed with COVID-19, there are necessary steps you can take to reduce the risk of it spreading to those you live with. COVID-19: What to do when you're sick IEHP Chief Medical Officer, Dr. Karen Hansberger, is here to discuss what you need to do if you find yourself sick from COVID-19. Face Mask Resources Proper use of face coverings (CDC)  How to make a homemade mask How to make your own face mask (whether or not you know how to sew) Refer to the following resources for information on self isolation during COVID-19.  Riverside County COVID-19 Self Isolation Recommendations  For IEHP DualChoice Members A healthcare fraud alert has been issued in relation to COVID-19 complaints. Scammers are giving COVID-19 tests to Medicare Members in trade for personal details. They are reaching out to Medicare Members by sales calls, social media platforms, and door to door visits. The personal details taken may be used to falsely bill Federal health care programs and the COVID-19 test kits may cause harm to Members. If you suspect COVID-19 fraud, call IEHP right away at: Compliance Hotline: (866) 355-9038 Fax: (909) 477-8536 E-mail: compliance@iehp.org Mail: IEHP Compliance Officer P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 Click here to report a compliance issue online. Refer to the following websites/resources for more information on coronavirus (COVID-19). Centers for Disease Control and Prevention (CDC) Riverside County Public Health  San Bernardino Public Health   State of California Coronavirus (COVID-19) Updates CA COVID-19 Rent Relief Portal California Workplace Rights Immigrant Eligibility for Public Programs during COVID-19  Protections for Housing and Utility Shutoff Order ConnectIE Below you will find resources and information on local food pantries in your area.  Riverside County Pantries: A list of food pantries in Riverside County San Bernardino County Pantries: A list of food pantries in San Bernardino County Connect IE: A free website that provides community resources 24/7. It can connect you to housing services, job training's, food pantries and more.  High Desert Food Distribution:The High Desert is hosting a food distribution on the last Thursday of every month.

San Bernardino County Medi-Cal

of Americans. About nine percent of San Bernardino County residents under the age of 65 were uninsured based on the last count of the US Census. That is why Inland Empire Health Plan (IEHP) provides coverage to millions of Members in San Bernardino and Riverside counties. Discover the health plan that puts its members at the center of their universe. IEHP will not rest until our communities enjoy optimal care and vibrant health. Keep reading to learn more about IEHP and the benefits offered to Medi-Cal recipients. IEHP Provides Coverage for San Bernardino County Medi-Cal Recipients Medi-Cal is a no-cost or low-cost health coverage program. It provides health, dental and vision coverage to qualified low-income California residents. IEHP is the health plan for Medi-Cal recipients in San Bernardino County. We are dedicated to providing our Members and local communities with optimal care and vibrant health. Top-Class Medi-Cal Services Medi-Cal is a no-cost or low-cost health coverage program. It provides health, dental and vision coverage to qualified low-income California residents. IEHP is the health plan for Medi-Cal recipients in San Bernardino County. We are dedicated to providing our Members and local communities with optimal care and vibrant health. With IEHP and Medi-Cal coverage, Members not only have access to general health care but also advanced and specialized care such as: Transgender services Laboratory services Radiology services Pediatric care Mental health services Addiction rehabilitation care These are just a few examples of how IEHP’s network of Providers gives Members and their families in San Bernardino County a wide range of medical care. To apply for Medi-Cal in San Bernardino County call the IEHP Enrollment Advisors at (866) 294-4347, Monday – Friday, 8am – 5pm. TTY users should call (800) 720-4347. You may also call Health Care Options at 1-800-430-4263 or visit www.healthcareoptions.dhcs.ca.gov. TTY users should call 1-800-430-7077. Vision Services IEHP provides vision coverage and has a wide network of vision specialists. IEHP Members get a free vision exam every 24 months, additional or more frequent eye exams are covered if medically necessary, such as those with diabetes. You also get a pair of eyeglasses, with both frames and lenses every 24 months, when you have a valid prescription. Contact lens testing and contact lenses may be covered if the use of eyeglasses is not possible due to eye disease or condition. Medi-Cal San Bernardino Dental Services Through Medi-Cal, you and your family get professional dental services. This benefit is included with your Medi-Cal coverage at little to no cost to you.  Some of the types of dental care offered include: Diagnostic and preventive dental hygiene (such as examinations, X-rays, and teeth cleanings) Emergency services for pain control Tooth extractions Root canal treatments (anterior/posterior) Scaling and root planning Crowns (prefabricated/laboratory) Orthodontics for children who quality Complete and partial dentures Topical fluoride If you have any questions or need help finding a Medi-Cal dental provider, call the Medi-Cal Dental Customer Service Line at 1-800-322-6384, or visit www.smilecalifornia.org. Medical Trip Transportation Your Medi-Cal benefits include round trip transportation for plan-covered health services and Medi-Cal-covered services, such as mental health, substance abuse and dental, within San Bernardino and Riverside counties. IEHP covers: Visits to your Primary Care Doctor, Specialists and urgent care clinics. Visit for dental, mental health, substance abuse and other services. Click here to learn more about transportation services offered by IEHP. San Bernardino County: How to Apply for Medi-Cal IEHP’s mission to heal and inspire the human spirit is made possible through its Vision—to not rest until our communities enjoy optimal care and vibrant health.  This is why we continue to serve all communities throughout San Bernardino County. You have many options to apply for Medi-Cal, these include: Call IEHP Call 1-866-294-4347, 8am-5pm Monday-Friday. TTY users should call 1-800-720-4347. You’ll speak to one of IEHP’s friendly bilingual Enrollment Advisors. By Mail You can mail your completed and signed application to:   Covered California P.O. Box 989725 West Sacramento, CA 95798-9725 Or mail it to the Riverside County Medi-Cal Office. Apply in Person Click here to find the Riverside County Medi-Cal Office. Apply Online Click here to apply online. Get Health Coverage Now Become a member of the IEHP family and get access to the top-rated California state medical insurance. For more than 25 years, IEHP has proudly served Inland Empire residents and their families. Join IEHP now and make your health our top priority.  

Medicaid Manged Care Explained

to know during this guide. What is Managed Care? Managed care is a healthcare delivery system used to manage quality, utilization, and cost. Managed care refers to a group of activities that helps lower the cost of offering for-profit healthcare services and health insurance while boosting the quality of healthcare services. IEHP is a managed health care plan that organizes care for their member. IEHP works with doctors, hospitals, and other health care Providers to give improved health care coordination and quality of care to the Members they serve. Medicaid Managed Care Medicaid managed care helps to provide Medicaid health benefits and other services through managed care organizations, also known as MCOs, and state Medicaid agencies. Managed care organizations accept a specific payment per member per month for their services. The main goals of Medicaid-managed care are to improve healthcare outcomes, healthcare quality, and health plan performance. How Does Managed Care Work? Managed-care plans tend to ask for less paperwork and offer a lower premium payment. The choice of treatment, drugs, and Doctors are limited. Healthcare providers, hospitals, and Doctors make plans with managed care plans to serve members at a lower rate. When you have a managed care plan, you are need to choose a primary care Doctor or PCP, who is part of the network, the doctor you choose will take care of all your medical needs, including annual exams, preventive care, and treatment for common illnesses. Your PCP will decide whether you need to be referred to a specialist like an oncologist. With a managed care plan, you cannot get coverage for specialist services without getting referred by your PCP. The cost for a managed care plan is typically less than a fee-for-service plan. You will typically pay a copayment every time you visit your doctor, as long as they are part of the plan network. This cost will depend on the type of managed health plan you choose. Choosing a Medicaid Health Plan MCO Medicaid can offer members the chance to select a health plan under Medicaid. Here is what you should look for in a Medicaid health plan: Excellent plan coverage. When you are looking for a Medicaid health plan, you should look for something that covers everything you could possibly need, including hospital stays, pregnancy, and newborn care, hospice and palliative care, emergency services, outpatient or ambulatory services, transgender services, mental health services, rehabilitative services, prescription drugs, lab services, preventative and wellness services, sensitive services, chronic illness management, substance use treatment services, dental services, vision services, pediatric services, telehealth services, non-medical transportation or NMT, non-emergency medical transportation or NEMT, and long-term services and supports or LTSS. Low premiums. Look for a Medicaid health plan that offers low to no premium payments. Some Medicaid plans offer a $0 monthly premium. Accessibility. You should also look for a Medicaid health plan accessible to you and others who need it, including children, adults, seniors, and those with disabilities who live in your area. What does IEHP offer? With IEHP, you also get access to: 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! If you need healthcare coverage, or have questions about what IEHP offers, 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.

Gender Health - Gender Health

rse population of the Inland Empire has been estimated at almost 27,000 people. At Inland Empire Health Plan (IEHP), we want you to get all the care you need with the respect you deserve. IEHP covers all medically necessary Medi-Cal covered Gender Health services. IEHP has Doctors and Specialist who have experience in gender health services. To find out more information, call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347. How to Get Started See your IEHP PCP on a regular basis. If you have not seen your Doctor yet or in a long time, set up a visit today. Your Doctor, the key to your overall health care, knows your health history and helps make sure you get the care you need. Your Doctor can refer you to Specialists, if needed. This includes any gender health options that meet your medical needs, so share your treatment goals with your Doctor. You can change your IEHP Doctor at any time. Benefits Talk to your Doctor about these Gender Health Benefits: Behavioral Health Services Hormone Replacement Therapy Surgeries and Procedures IEHP has a dedicated team of Care Managers who are familiar with Gender Health services and are ready to help with: Referrals to see a specialist Getting medical supplies  Getting medicines  Connecting you to community resources IEHP also provides non-clinical resources such as: Care Coordination Community and Legal Resources Demographic updates Family Support Groups  Resources For education and training on gender health care, please access the following resources: Gender Health Brochure for Adults (PDF)  Gender Health Brochure for Children (For Parents and Children under 18) (PDF)  Clinical Guidelines (PDF)  LGBTQ Resources (PDF)  You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download a free copy. Click Adobe Acrobat Reader.  

Medi-Cal Behavioral Health Treatment

ed benefit solely for Members Diagnosed with Autism Spectrum Disorder. The coverage criteria have been expanded to include IEHP Members who meet ALL the below: Under 21 years of age Have a recommendation from a licensed physician and surgeon or a licensed psychologist that evidence based BHT services are medically necessary. Be medically stable Not need 24-hour medical/nursing monitoring or procedures provided in a hospital or intermediate care facility for persons with intellectual disabilities. Behavioral Health Treatment (BHT) is the design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the direct observation, measurement and functional analysis of the relations between environment and behavior. BHT services teach skills using behavioral observation and reinforcement, or through prompting to teach each step of targeted behavior. BHT services are based on reliable evidence and are not experimental. Treatment may or may not include Applied Behavioral Analysis (ABA). BHT is medically necessary after the Provider has completed a comprehensive developmental surveillance and screening, and have recommended BHT services is clinically warranted to treat persistent developmentally inappropriate behavior and/or diagnoses that may be able to be corrected or ameliorated with BHT services. Aberrant behaviors include but are not limited to self-injury, aggression, and deficits in language skills, daily living skills, and social skills. PCPs will continue to referral a Member directly to IEHP Behavioral Health for any BHT services and/or diagnostic needs regardless of IPA. If you have any questions or ask your PCP for screening, diagnosis and treatment, you can 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. Cost to Member There is no cost to the Member for these services. Visit IEHP's Mental Health page for general mental health information.   

How to Get Care

network is a group of Doctors, hospitals and other providers who work with IEHP. You must choose a PCP within 30 days from the time you become an IEHP Member. If you do not choose a PCP, IEHP will choose one for you. You may choose the same PCP or other PCPs for all family members in IEHP. If you have a Doctor you want to keep, or you want to find a new PCP, you can look in the IEHP Provider Directory. To help you choose the right one for you, PCPs listed in the IEHP network include their name, address, phone number, specialty, etc.  If you change PCPs, you will get a new IEHP Member ID card in the mail. It will have the name of your new PCP. To change your PCP, call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347.

How to Get Care - How to Get Care

l care, like: Routine checkups Sick visits, such as colds, flu and fever Chronic illnesses, like asthma and diabetes Order medical tests Your Doctor also handles your preventive care, such as vaccines, shots, health screenings and other tests.  Preventive care is about preventing disease. Regular checkups, even when you are not sick, can help your Doctor spot a health problem early, and treat it before it gets worse. 2. Getting care from a Specialist When you need specialty care, your Doctor will refer you to a Specialist. This is how referrals work:  When the request is received by IEHP, a decision will be made within 5 business days for a regular referral. For an urgent referral, this is done within 72 business hours. For a regular referral, expect a letter from your medical group or IEHP within 2 days after a decision has been made. When the request is approved, call your Specialist to make an appointment. If the request is denied, talk to your Doctor or call IEHP Member Services at (800) 440-4347 or (800) 718-4347 (TTY) to learn more. 3. Getting your medicine You can fill your prescription at any IEHP contracted pharmacy. There are more than 760 pharmacies in our network. From major chains, like Walgreens, CVS, Rite Aid, Walmart and many others. To find one close to you, check your IEHP Doctor Directory or click the Provider Search link. Helpful tips to help your treatment: Be sure to call the pharmacy five days before you run out of medicine. Take your medicine the way your Doctor tells you to.   4. Find a Doctor To find more information on Primary Care Physician's (PCPs), Specialists, Pharmacies, etc., click here to visit the Doctor search.  5. Getting help from Member Services If you need 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. The call is toll free. If you reach IEHP Member Services after hours, you will be able to leave a secure voice message. Calls will be returned the next working day. If you call after midnight and leave a secure voice message, we will return your call the same working day. Resources Barriers to Care: We all have our own cultural, religious or health beliefs. This document includes some common beliefs that may keep you from getting the care you need—along with some facts to help you make informed decisions about your health.

Community Supports - Flexible Care Choices: Community Supports

e options. These may be offered (instead of state plan-covered services) to qualified Members at medium to high levels of risk. Community Supports can help you remain healthy, reduce complications from illnesses, and avoid unnecessary stays in the hospital, nursing facilities, and emergency departments You may find that Community Supports with IEHP can help during a transition in housing or care. If you need help managing your health, IEHP’s Community Supports might be the right choice. When you need extra care IEHP’s Community Supports are open to any Medi-Cal or IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) Member who needs supportive care. Community Supports may nurture your whole health—to care for your body and mind. Members who could benefit from Community Supports may be: Facing times without housing Struggling to get food for their loved ones Having asthma issues and need changes to their living space How your Care Team can help you If you can be helped by Community Supports, you may get a care team that can assist in identifying your needs. Then, they will coordinate no-cost services. This includes finding resources for housing, care after leaving the hospital, and dealing with asthma at home. Who may be on your care team: Nurse Care Manager Behavioral Health Care Manager Care Coordinator Community Health Worker Support when you need it Your care team can assist you by phone or in person, and they can even meet you at your location. You are not alone with IEHP’s Community Supports. What community supports are offered? Asthma Remediation: Environmental Asthma Trigger Remediations are physical modifications to a home environment that are necessary to ensure the health, welfare, and safety of the individual, or enable the individual to function in the home and without which acute asthma episodes could result in the need for emergency services and hospitalization. Community Transition Services/Nursing Facility Transition to a Home: Assist members to live in the community and avoid further institutionalization.These services are non-recurring set-up expenses for individuals who are transitioning from a licensed facility to a living arrangement in a private residence where the person is directly responsible for his or her own living expenses. Environmental Accessibility Adaptations (Home Modifications): Environmental Accessibility Adaptations (EAAs also known as Home Modifications) are physical adaptations to a home that are necessary to ensure the health, welfare, and safety of the individual, or enable the individual to function with greater independence in the home: without which the Member would require institutionalization. Housing Deposits: Housing Deposits assist with identifying, coordinating, securing, or funding one-time services and modifications necessary to enable a person to establish a basic household that do not constitute room and board. Housing Tenancy & Sustaining Services: This service provides tenancy and sustaining services, with a goal of maintaining safe and stable tenancy once housing is secured. Housing Transition Navigation Services: Housing transition services assist Members with obtaining housing. Medically Supportive Food/Meals/Medically Tailored Meals: Malnutrition and poor nutrition can lead to devastating health outcomes, higher utilization, and increased costs, particularly among Members with chronic conditions. Meals help individuals achieve their nutrition goals at critical times to help them regain and maintain their health. Results include improved Member health outcomes, lower hospital readmission rates, a well-maintained nutritional health status, and increased Member satisfaction. Nursing Facility Transition/Diversion to Assisted Living Facilities: Nursing Facility Transition/Diversion services assist individuals to live in the community and/or avoid institutionalization when possible. The goal is to both facilitate nursing facility transition back into a home-like, community setting and/or prevent skilled nursing admissions for Members with an imminent need for nursing facility level of care (LOC). Individuals have a choice of residing in an assisted living setting as an alternative to long-term placement in a nursing facility when they meet eligibility requirements. Recuperative Care (Medical Respite): Recuperative care, also referred to as medical respite care, is short-term residential care for individuals who no longer require hospitalization, but still need to heal from an injury or illness (including behavioral health conditions) and whose condition would be exacerbated by an unstable living environment. An extended stay in a recovery care setting allows individuals to continue their recovery and receive post-discharge treatment while obtaining access to primary care, behavioral health services, case management and other supportive social services, such as transportation, food, and housing. Short-Term Post-Hospitalization Housing: Short-Term Post-Hospitalization housing provides Members who do not have a residence and who have high medical or behavioral health needs with the opportunity to continue their medical/psychiatric/substance use disorder recovery immediately after exiting an inpatient hospital (either acute or psychiatric or Chemical Dependency and Recovery hospital), residential substance use disorder treatment or recovery facility, residential mental health treatment facility, correctional facility, nursing facility, or recuperative care and avoid further utilization of State plan services. Sobering Centers: Sobering centers are alternative destinations for individuals who are found to be publicly intoxicated (due to alcohol and/or other drugs) and would otherwise be transported to the emergency department or jail. Sobering centers provide these individuals, primarily those who are homeless or those with unstable living situations, with a safe, supportive environment to become sober. To learn more about Community Supports, 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.

COVID-19 - Mental Health

otions and how that balance (or imbalance) affects behavior and thoughts.   What is stigma? 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 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 statistics before COVID were 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 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 overdue it 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 seek help. Resources Psychiatry Walk-in Clinic (Montclair) Psychiatry Walk-in Clinic (Palm Desert) Teen Mental Health Guide  A simple guide to manage stress