Search Results For : " DIPLOMA IN ENVIRONMENTAL SCIE "
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.
Special Programs - California Children Services
page. What is CCS? CCS is a statewide program that enables children with qualifying conditions to receive specialized services related to that condition independent from IEHP. The CCS program provides diagnostic and treatment services, and medical case management for those who have qualifying conditions. CCS also provides occupational and physical therapy services through the Medical Therapy Program (MTP). The Medical Therapy Program (MTP) is a special program that provides physical therapy (PT), occupational therapy (OT), for children who have disabling conditions, generally due to neurological or musculoskeletal disorders Who Qualifies? The CCS program services children and young adults under the age of 21 who have eligible medical conditions. Examples of CCS-eligible conditions include, but are not limited to, chronic and acute medical conditions such as cystic fibrosis, hemophilia, cerebral palsy, heart disease, cancer, traumatic injuries, and infectious diseases producing major sequelae. For a more inclusive list of diagnoses and medical criteria of qualifying conditions please reference the below links: https://www.dhcs.ca.gov/services/ccs https://www.dhcs.ca.gov/services/ccs/Documents/CCSMedicalEligibility.pdf Provider Responsibilities Primary Care Physicians (PCPs), Specialty Providers, and IPA/Medical Groups are responsible for performing appropriate baseline health assessments and diagnostic evaluations sufficient to identify children and young adults with potential CCS-qualifying conditions and refer to CCS as needed. PCPs are responsible for all well child and pediatric preventative services as these services are not a covered benefit of CCS. PCPs are also responsible in assisting CCS members with transition from CCS to IEHP authorizations at the age of 21 when members age out of the CCS program. Benefits of CCS Enrollment CCS Clients are not restricted to in area providers but have access to any CCS paneled provider within the state of California when a need for the specialty care has been determined to be CCS eligible. Once a client is determined to be eligible for CCS, the client will continue to be medically eligible for CCS until treatment is complete or age 21 when the CCS program ends. Additional Resources To assist our valued Providers, every Member active with CCS has a distinct red “CCS” widget in the Provider Portal. Opening that widget enables you to view the diagnosis being treated and any Specialists and their treatment authorization range. For any questions about your Member’s CCS care or management, please do not hesitate to contact IEHP’s CCS Team at: (800) 706-4347 or by email at CCSCareManagement@iehp.org . (By clicking on the links below, you will be leaving the IEHP site) For additional CCS resources please reference the below links: CCS Program Overview: https://www.dhcs.ca.gov/services/ccs CCS Program Application: https://www.dhcs.ca.gov/formsandpubs/forms CCS Brochure (English/Spanish): https://www.dhcs.ca.gov/services/ccs/Pages/CCSBrochure.aspx How to become a CCS Provider: https://www.dhcs.ca.gov/services/ccs/Pages/ProviderEnroll.aspx You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Provider Resources - Clinical Practice Guidelines
assist primary care providers in delivering care in accordance with IEHP standards. Resources are reviewed regularly and updated to reflect changes from a regulatory and clinical standpoint. Preventive Care Guidelines American College of Obstetricians and Gynecologists (ACOG) American Academy of Pediatricians (AAP) / Bright Futures Comprehensive Perinatal Services Program (CPSP) Clinical Practice Guidelines Library The guidelines contained on this page are recommended by IEHP with the intent to enhance Member care. IEHP’s Clinical Practice Guidelines topics are organized using the following categories: United States Preventive Services Task Force (USPSTF); IEHP Internal Library; Healthcare Effectiveness Data Information Set (HEDIS); and Managed Care Accountability Set (MCAS) Links or documents embedded within the Internal Library category indicate literature that has been published by leading, formal organizations and have been endorsed/approved by IEHP’s Medical Directors and Quality Committee. IEHP produced information relevant to the topic will also be listed in this category. We have also indicated any HEDIS/ MCAS measures that are pertinent to the topic. Additionally, IEHP accepts USPSTF guidelines to help primary care clinicians identify clinical preventive services that are appropriate for their patients. IF there is a USPSTF guideline relevant to the topic, we have identified it below. Library Catalog Click on a letter to jump to that specific section: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z A Asthma USPSTF N/A IEHP Internal Library Global Strategy for Asthma Management and Prevention (PDF) HEDIS Asthma Medication Ratio (AMR) Medication Management for People with Asthma (MMA) MCAS Asthma Medication Ratio (AMR) (Back to Library Catalog) B Breast Cancer USPSTF Breast Cancer Screening Use of Medications to Prevent Breast Cancer BRCA Testing IEHP Internal Library N/A HEDIS Breast Cancer Screening (BCS) MCAS Breast Cancer Screening (BCS) (Back to Library Catalog) C Cervical Cancer USPSTF Cervical Cancer Screening IEHP Internal Library N/A HEDIS Cervical Cancer Screening (CCS) MCAS Cervical Cancer Screening (CCS) (Back to Library Catalog) Chlamydia USPSTF Chlamydia and Gonorrhea Screening IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS Chlamydia Screening in Women (CHL) MCAS Chlamydia Screening in women (CHL) (Back to Library Catalog) Cholesterol USPSTF Statin Therapy for Primary Prevention of CVD Healthful Diet and Physical Activity for CVD Prevention in Adults with CVD Risks IEHP Internal Library American Heart Association – Blood Cholesterol Management (PDF) American Heart Association – Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (PDF) HEDIS Statin Therapy for Patients with Cardiovascular Disease-Adherence (SPC) Statin Therapy for Patients with Cardiovascular Disease – Statin Therapy (SPC) MCAS N/A (Back to Library Catalog) Chronic Obstructive Pulmonary Disorder USPSTF N/A IEHP Internal Library Global Initiative for Chronic Obstructive Lung Disease – COPD (PDF) HEDIS Pharmacology Management of COPD Exacerbation – Systemic Corticosteroids (PCE) Pharmacology Management of COPD Exacerbations – Bronchodilators (PCE) Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR) MCAS N/A (Back to Library Catalog) Colorectal Cancer USPSTF Colorectal Cancer Screening IEHP Internal Library N/A HEDIS Colorectal Cancer Screening (COL) MCAS N/A (Back to Library Catalog) D Depression USPSTF Screening for Depression in Adolescents Screening for Depression in Adults including Pregnant Women Screening for Perinatal Depression IEHP Internal Library American Academy of Pediatrics – Adolescent Depression in Primary Care (PDF) American Psychiatric Association – Major Depressive Disorder (PDF) HEDIS Antidepressant Medication Management Acute Phase (AMM) Antidepressant Medication Management Continuation Phase (AMM) MCAS Antidepressant Medication Management Acute (AMM-Acute) Antidepressant Medication Management Continuation (AMM-Cont) (Back to Library Catalog) Diabetes USPSTF Gestational Diabetes Screening Prediabetes and Type 2 Diabetes: Screening IEHP Internal Library American Diabetes Association – Diabetes Care (PDF) National Kidney Foundation – Diabetes and Chronic Kidney Disease (PDF) HEDIS Statin Therapy for Patients with Diabetes – Adherence (SPD) Statin Therapy for Patients with Diabetes – Statin Therapy (SPD) Comprehensive Diabetes Care – HbA1C Testing (CDC) Comprehensive Diabetes Care - HbA1C Control (<=9) (CDC) Comprehensive Diabetes Care (<8) (CDC) Comprehensive Diabetes Care - Eye Exam (CDC) Comprehensive Diabetes Care – Monitoring for Nephropathy (CDC) Comprehensive Diabetes Care – Blood Pressure Control (<140/90) (CDC) MCAS Comprehensive Diabetes Care HbA1C Testing (CDC HT) Comprehensive Diabetes Care HbA1C Testing >9%) (CDC H9) (Back to Library Catalog) E (Back to Library Catalog) F (Back to Library Catalog) G Gonorrhea USPSTF Chlamydia and Gonorrhea Screening IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS N/A MCAS N/A (Back to Library Catalog) H Hepatitis C USPSTF Hepatitis C Virus Infection in Adolescents and Adults: Screening IEHP Internal Library American Association for the Study of Liver Diseases – Hepatitis C (PDF) HEDIS N/A MCAS N/A (Back to Library Catalog) Human Immunodeficiency Virus (HIV) USPSTF HIV Screening in Pregnant Persons HIV Screening in Adults and Adolescents HIV Prevention – Preexposure Prophylaxis IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS N/A MCAS N/A (Back to Library Catalog) Hypertension USPSTF Screening for Hypertension in Adults IEHP Internal Library Joint National Committee – Hypertension Guidelines (PDF) HEDIS Controlling high blood pressure (CBP) MCAS Controlling high blood pressure (CBP) (Back to Library Catalog) I (Back to Library Catalog) J (Back to Library Catalog) K (Back to Library Catalog) L (Back to Library Catalog) M (Back to Library Catalog) N (Back to Library Catalog) O Obesity USPSTF Weight Loss to Prevent Obesity Related Morbidity and Mortality in Adults - Counseling Screening for Obesity in Children and Adolescents Behavioral Health Counseling for Adults that are Overweight or Obese and Have Other CVD Risk Factors IEHP Internal Library N/A HEDIS Weight Assessment and Counseling (WCC-BMI) Adult Body Mass Index (ABA) MCAS Weight Assessment and Counseling (WCC-BMI) Adult Body Mass Index (ABA) (Back to Library Catalog) Osteoporosis USPSTF Osteoporosis to Prevent Fractures: Screening IEHP Internal Library N/A HEDIS Osteoporosis management in women who have had a fracture (OMW) MCAS N/A (Back to Library Catalog) P (Back to Library Catalog) Q (Back to Library Catalog) R (Back to Library Catalog) S Sexually Transmitted Infections USPSTF Syphilis Screening in Pregnant Women Syphilis Screening for those at Increased Risk for Infection Chlamydia and Gonorrhea Screening HIV Screening in Pregnant Persons HIV Screening in Adults and Adolescents HIV Prevention – Preexposure Prophylaxis IEHP Internal Library Centers for Disease Control Public Health Media Library – STD Treatment You may also refer to individual topics as they appear in this library: Chlamydia Gonorrhea HIV Syphilis HEDIS Chlamydia Screening in women (CHL) MCAS Chlamydia Screening in women (CHL) (Back to Library Catalog) Skin Cancer Behavioral Counseling USPSTF Skin Cancer Prevention: Counseling IEHP Internal Library N/A HEDIS N/A MCAS N/A (Back to Library Catalog) Smoking Cessation/Tobacco Usage USPSTF Smoking Cessation Smoking Cessation – Pharmacotherapy Lung Cancer Screening Tobacco Use in Children and Adolescents – Primary Care Interventions IEHP Internal Library N/A HEDIS N/A MCAS N/A (Back to Library Catalog) Syphilis USPSTF Syphilis Screening in Pregnant Women Syphilis Screening for Those at Increased Risk for Infection IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS N/A MCAS N/A (Back to Library Catalog) T Tuberculosis USPSTF Latent Tuberculosis Screening IEHP Internal Library N/A HEDIS N/A MCAS N/A (Back to Library Catalog) U (Back to Library Catalog) V (Back to Library Catalog) W (Back to Library Catalog) X (Back to Library Catalog) Y (Back to Library Catalog) Z (Back to Library Catalog) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Care After Hours - Get Care After Hours
hen you can't reach your Doctor after-hours or your Doctor is not available, you have options to get your needed care. Call the IEHP 24-Hour Nurse Advice Line at (888) 244-4347, TTY 711. 1. Speak to our Nurse Our Nurse can offer you medical advice on the phone or guide you to get the care you need. Common reasons to call our Nurse: Cough Mild stomach ache Mild fever Sore throat Cold or flu Questions about your medicine Ear ache Nurse Advice Video 2. Speak to a Doctor Our Nurse may decide you need to talk with a Doctor. If so, our Nurse will connect you with a Doctor for a live phone chat or schedule a virtual visit through an app. 3. Visit an IEHP Urgent Care Clinic Our Nurse may direct you to an Urgent Care Clinic, so you can see a Doctor the same day. Many clinics are open late, weekends and holidays. Some clinics have X-rays and lab tests. We have more than 90 Urgent Care Clinics in our network. For one near you, visit the IEHP Provider Search. Common reasons to visit an Urgent Care Clinic: Mild sore throat Mild fever Rash Nose bleed Minor trauma Animal or insect bite Asthma (non-critical) Cuts & lacerations Call 911 or go to the nearest Emergency Room (ER) for emergency medical and behavioral health conditions. Don’t wait! Urgent Care Video
Helpful Information and Resources - Emergency Safety
y when there is a power shutoff or fire. We want to ensure you get the needed care and services to help you during these events. If you are impacted by these events and need help with your durable medical equipment (such as wheelchairs, ventilators, oxygen monitors, etc.) 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. If you need a medicine refill, go to your pharmacy and request a refill. For medical advice after-hours, please call the IEHP 24-Hour Nurse Advice Line at 1-888-244-4347 or 711 (TTY). How to prepare for an emergency. Public Safety Power Shutoff Alerts A Public Safety Power Shutoff, also called a PSPS, occurs in response to severe weather. Power is turned off to help prevent wildfire and keep communities safe. We encourage you to sign up for alerts so you know when a Public Safety Power Shutoff may occur and when your power is restored. Click here to sign up. Medicine Safety Some medicines may need to be stored in a refrigerator to keep their strength, including many liquid medicines. When the power is out for a day or more, throw away any medicines that should be refrigerated, unless the medicines label says otherwise. If a life depends on the refrigerated medicines (for example, insulin), use them only until a new supply is available. Replace all refrigerated medicines as soon as you can. Resources Refrigerated Medicine Storage (PDF) Insulin Storage and Product Switching in an Emergency (PDF) Comparison of Insulins (PDF) Durable Medical Equipment Safety Use the checklist below to prepare for a power outage. Check your backup power equipment frequently to ensure it will function during an emergency. Call your power and water companies about your needs for life-support devices (home dialysis, suction, breathing machines, etc.) in advance of a disaster. Many utility companies keep a “priority reconnection service” list and map of the locations of power-dependent customers for use in an emergency. Ask the customer service department of your utility companies if this service is available. Keep the shut-off switch for oxygen equipment near you so you can get to it quickly in case of emergency. Generator users should operate generators in open areas to ensure good air circulation. Test generators once a month, and take your generator to be serviced at least once a year, to make sure it will work when needed. Create a plan for how to recharge batteries when the power is out. Reference resources below. When power is restored, make sure the settings on your medical device have not changed. Resources Emergency Power Planning for a Durable Medical Equipment Checklist (PDF): this booklet helps you establish a plan to obtain and organize your medical device information. How to Prepare for and Handle Power Outages for Medical Devices that Require Electricity - FDA Emergency Power Planning for People Who Use Electricity and Battery Dependent Assistive Technology and Medical Devices: this checklist will help you create a plan for your electric and battery-dependent devices. Mental Health If you have been impacted by a fire and need mental health, related to stress or grief, call IEHP Member Services at 1-800-440-IEHP (4347), 8am-5pm (PST), Monday-Friday. TTY users should call 1-800-718-4347. For medical advice after-hours, please call the IEHP 24-Hour Nurse Advice Line at 1-888-244-4347 or 711 (TTY). Additional Tips Build or restock your emergency supply kit, including food, water, flashlights, a radio, fresh batteries, first aid supplies and cash. Click here to find local resources that help you build an emergency supply kit. Identify backup charging methods for phones such as a battery power pack, a car charger and solar battery charger. Learn how to manually open your garage door. Create a plan based off what you can do by yourself and what you will need help with. Create an emergency contact list. If you own a backup generator, ensure it is ready to safely operate. Create an emergency action plan that includes evacuation planning for your home, family and pets. Resources https://www.sce.com/wildfire: how to safety prepare for a wildfire https://www.sce.com/wildfire/psps: Power Safety Power Shutoff resources https://prepareforpowerdown.com/: how to prepare for a power shutoff http://www.jik.com: emergency preparedness information prepared by Jule Kiles https://www.readyforwildfire.org/prepare-for-wildfire/get-set/: how to prepare for a wildfire Emergency Supplies Kits for People with Disabilities and Activity Limitations: checklist suggests emergency kit contents including no cost supplies, that you can tailor to your needs and abilities. Emergency Evacuation Preparedness: Taking Responsibility For Your Safety, A Guide For People with Disabilities and Other Activity Limitation: how to develop plans that integrates people with disabilities and others with access and functional needs. Emergency Health Information: Savvy Health Care Consumer Series: a guide to develop your emergency health information. Emergency Travel Safety Tips for Overnight Stays: a guide for people with disabilities. Tips for Emergency Use of Mobile Devices: preparing your device for an emergency.
ht thing for you and your family when it comes to getting the care you need. For the past 25 years, we’ve made it our mission to help our Members get quality medical, behavioral health and wellness services. Who is IEHP? IEHP is a managed care health plan. We launched in 1996 with 62,000 Medi-Cal Members and today we have grown to become one of the top 10 largest Medi-Cal health plans. With a network of more than 8,000 Providers and more than 2,000 employees, IEHP serves more than 1.4 million residents in Riverside and San Bernardino counties). We work with doctors, hospitals, and other health care Providers in your area to give improved health care coordination and quality of care to our Members. What benefits do I get as an IEHP Member? A network of more than 8,000 Doctors, Specialists and other health care Providers Care coordination 24-Hour Nurse Advice Line Vision services Urgent Care centers Healthy lifestyle classes and programs And so much more! For more information on IEHP’s benefits and services, contact IEHP Member Services. Can I still have Medi-Cal as an IEHP Member? Yes, you will still have Medi-Cal and all the benefits and services you had before, such as no monthly premiums and zero cost for Doctor visits, medicines and hospital stays. The only difference is that your health care services will now be coordinated through IEHP. Other Medi-Cal services include preventive care, such as vaccines and screenings for mental health, development and substance abuse disorders. You can get Fee-For-Service Medi-Cal dental services through the Medi-Cal Dental Program. Can I stay with my same Doctor when I join IEHP? If he or she is part of IEHP’s Provider Network, you will be able to continue to get care from the same Doctor. You can check this by calling IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347. If you also have Medicare, you can keep seeing your doctors whose services are provide by Medicare. Who we are Our Mission We heal and inspire the human spirit. Our Vision We will not rest until our communities enjoy optimal care and vibrant health. Our Values We do the right thing by: Placing our Members at the center of our universe. Unleashing our creativity and courage to improve health & well-being. Bringing focus and accountability to our work. Never wavering in our commitment to our Members, Providers, Partners, and each other. We’re here to answer your questions and help you get started on your journey to good health.
Medical Benefits & Coverage Of Medi-Cal In California
d services as a Member of IEHP. Your covered services are at no cost if they are medically necessary, and you get the approved services from our Provider network. “Medically necessary” means it is reasonable and needed to protect life, to keep you from becoming seriously ill or disabled, or to reduce pain from a diagnosed disease, illness or injury. To learn more about IEHP’s benefits and services, read Chapter 4 of the IEHP Medi-Cal Member Handbook (PDF) or 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. IEHP offers these types of services: Outpatient (ambulatory) services* Emergency services Transgender services* Hospice and palliative care* Hospitalization* Maternity and newborn care Mental health services Prescription drugs Rehabilitative and habilitative services and devices* Laboratory and radiology services, such as X-rays* Preventive and wellness services and chronic disease management Sensitive services Substance use disorder treatment services Pediatric services Vision services* Non-emergency medical transportation (NEMT) Non-medical transportation (NMT) Long-term services and supports (LTSS) Telehealth services Some of the services listed are covered only if IEHP or your IPA approves first. Covered services that may need an approval from IEHP or your IPA or medical group first are marked by an asterisk (*). Vision services The plan covers: Routine eye exam once every 24 months; IEHP may pre-approve (prior authorization) additional services as medically necessary. Eyeglasses (frames and lens) once every 24 months; contact lens when required for medical conditions such as aphakia, aniridia and keratoconus Limitations Single vision lenses only. Members under 18 automatically get polycarbonate lenses. Contacts in lieu of glasses only if medically necessary. Dental services The Medi-Cal Dental Program covers some dental services, such as: Diagnostic and preventive dental hygiene (e.g., examinations, x-rays, and teeth cleanings) Emergency services for pain control Tooth extractions Fillings Root canal treatments Prosthetic appliances Orthodontics for children who qualify Members can access dental services through providers enrolled in the Medi-Cal Dental Program. They will advise you on the best course of treatment and when these services may be attained. To learn more about dental services, call the Medi-Cal Dental Program at 1-800-440-IEHP (4347) / TTY (800) 718-4347. You may also visit the Denti-Cal website at www.smilecalifornia.org. Transportation services 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. The plan covers: Visits to your Primary Care Doctor, Specialists and urgent care clinics. Visit for dental, mental health, substance abuse and other services. Exclusions and Limitations IEHP does not cover: One-way trips and non-medical visits. Visits to Social Security, Workers Compensation Claims, Personal Injury cases, Courts, Parole or Probation or Social Services Offices. IEHP offers two types of transportation: Bus passes* for Non-Medical Transportation (NMT): approved when you do not have any physical or medical issue that does not allow you to travel by bus, car, taxi or other forms of public transportation. Uber for Non-Medical Transportation (NMT): approved when your area doesn’t support bus passes, or you are crossing counties. For this type of transportation, you need to wait for your ride at the curb. Non-Emergent Medical Transportation (NEMT): approved when your medical or physical issue does not allow you to travel by bus, car, taxi or other forms of public transportation. For this type of transportation, your Doctor must submit a Physicians’ Certification Statement online. Effective March 1, 2020, transportation for routine medical visits including Behavioral Health and Substance Use must be scheduled five business days before your appointment. To set up transportation, call IEHP Transportation Department at 1-800-440-4347 (option two), Monday – Friday, 8am – 5pm. TTY users should call 1-800-718-4347 (option two). *For bus passes, call our transportation vendor Call the Car (CTC) at 855-673-3195 select option 1. Once you get your bus pass, you can use this for all of your health care visits. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. To download a free copy click Adobe Acrobat Reader. The Postpartum Care Extension Program The Postpartum Care Extension Program provides extended coverage for Medi-Cal members during both the pregnancy and after pregnancy. The Postpartum Care Extension Program extends coverage by IEHP for up to 12 months after the end of the pregnancy regardless of income, citizenship, or immigration status and no additional action is needed. Rapid Whole Genome Sequencing Rapid Whole Genome Sequencing (rWGS), including individual sequencing, trio sequencing for a parent or parents and their baby, and ultra-rapid sequencing, is a covered benefit for any Medi-Cal member who is one year of age or younger and is receiving inpatient hospital services in an intensive care unit. rWGS is an emerging method of diagnosing conditions in time to affect ICU care of children one year of age or younger. If your child is eligible for California Children’s Services (CCS), CCS may be responsible for covering the hospital stay and the rWGS. Referrals For some types of care, your PCP or specialist will need to ask IEHP for permission before you get the care. This is called asking for prior authorization, prior approval, or pre-approval. It means that IEHP must make sure that the care is medically necessary or needed based on appropriateness of care and services and existence of coverage. Care is medically necessary if it is reasonable and necessary to protect your life, keeps you from becoming seriously ill or disabled, or reduces severe pain from a diagnosed disease, illness or injury. For some services, you need pre-approval (prior authorization). Under Health and Safety Code Section 1367.01(h)(2), IEHP will decide routine pre-approvals within 5 working days of when IEHP gets the information reasonably needed to decide. For requests in which a provider indicates or IEHP determines that following the standard timeframe could seriously jeopardize your life or health or ability to attain, maintain, or regain maximum function, IEHP will make an expedited (fast) pre-approval decision. IEHP will give notice as quickly as your health condition requires and no later than 72 hours after receiving the request for services. If IEHP does not approve the request, IEHP will send you a Notice of Action (NOA) letter. The NOA letter will tell you how to file an appeal if you do not agree with the decision. IEHP will contact you if IEHP needs more information or more time to review your request. Continuity of Care If you now go to providers who are not in the IEHP network (out-of-network), in certain cases you may get continuity of care and be able to go to them for up to 12 months. If your providers do not join the IEHP network by the end of 12 months, you will need to switch to providers in the IEHP network. If you are a new Member, you may request to keep getting medical services from an out of network provider if you were getting this care before enrolling in IEHP. IEHP will decide if this treatment with an out of network provider is medically appropriate. Continuity of care does not extend to durable medical equipment, transportation, ancillary services, carved out services or services not covered by Medi-Cal. To learn more about continuity of care and eligibility qualifications, call IEHP Member Services at 1-800-440-IEHP (4347). Prescription drugs Most prescription drugs are covered by Medi-Cal Rx, some drugs may be covered by IEHP. Your provider can prescribe you drugs that are on the Medi-Cal Rx Contract Drugs List. To find out if a drug is on the Contract Drug List or to get a copy of the Contract Drug List, call Medi-Cal Rx at 1-800-977-2273 (TTY 1-800-977-2273 and press 5 or 711), visit the Medi-Cal Rx website at www.MediCalRx.dhcs.ca.gov/home/, or call IEHP Member Services at 1-800-440-IEHP (4347), Monday-Friday, 8am-5pm. TTY users should call 1-800-718-4347 or 711. Pharmacies If you are filling or refilling a prescription, you must get your prescribed drugs from a pharmacy that works with Medi-Cal Rx. You can find a list of pharmacies that work with Medi-Cal Rx in the Medi-Cal Rx Pharmacy Directory at www.Medi-CalRx.hcs.ca.gov/home/. You can also find a pharmacy near you by calling Medi-Cal Rx at 1-800-977-2273 (TTY 1-800-977-2273 and press 5 or 711). Or call IEHP Member Services at 1-800-440-IEHP (4347), Monday-Friday, 8am-5pm. TTY users should call 1-800-718-4347 or 711.
Senior Health - Senior Health
This includes making a plan to improve safety and taking routine tests and health screenings to detect health problems and treat them early. Advanced Care Directive What’s an Advanced Care Directive and why do I need someone else to help me? Advanced Care Directive is a specific type of power of attorney or health care proxy, in which the person authorizes someone (an agent) to make decisions on their behalf when they are unable to do so. Decisions can be large and small. For example, “Who will be responsible for communicating with your family?” or “In the final stages of living, do you want to be at home?” IEHP offers free Advanced Care Directive Workshops to help you. Call IEHP Health Education Department at 1-866-224-IEHP (4347) or 1-800-718-4347 for TTY users to see if a workshop is coming up near you! See also: Advanced Care Directive Guide (PDF) Advanced Care Directive Form (PDF) PREPARE: A California program to help you make medical decisions for yourself and others. National Library of Medicine: Seniors' Health You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader.
Senior Health - Advanced Care Planning
ing is not just about old age. At any age, a medical crisis could leave you too ill to make your own health care decisions. Even if you are not sick now, planning for health care in the future is an important step toward making sure you get the medical care you would want, if you are unable to speak for yourself and doctors and family members are making the decisions for you. MY LIFE. MY CHOICE. is IEHP’s Advance Care Planning program for IEHP DualChoice Members. The online program helps you fill out Advance Care Directive forms and gives you a place to keep them safe to share with your Doctor. IEHP can also store related documents like Physician Orders for Life-Sustaining Treatment, Living Wills, Health Care Power of Attorney and Do Not Resuscitate forms. MY LIFE. MY CHOICE. is accessible through the IEHP Member Portal. You can easily upload your Advance Care Directives and access them at any time from your home computer or smartphone. You can also share your forms with your family, friends and caregivers by email, SMS and fax. If you get sick and cannot make medical decisions, having these documents lets others know your wishes about medical care. This ensures you get the treatment and medical care you want. You can learn more about Advance Care Planning by accessing MY LIFE. MY CHOICE. through the IEHP Member Portal OR attending an in-person workshop. Register online: Log in to the Member portal. Log in to MY LIFE. MY CHOICE. Follow the steps to begin your Advance Care Planning. Register for an in-person workshop: Log in to the Member portal at www.iehp.org. Click the Health & Wellness tab. Choose “Senior Health” for a list of workshops with dates and times. Choose the workshop you want to attend. For assistance with MY LIFE. MY CHOICE. please call IEHP Member Services at 1-800-440-IEHP (4347). TTY users should call 1-800-718-4347.
Care After Hours - Emergency Room vs. Urgent Care Clinic
iding between the ER and Urgent Care. For medical advice before visiting the ER or an Urgent Care Clinic, you can call your Doctor or IEHP 24-Hour Nurse Advice Line (888) 244-4347, TTY 711. Note that ERs are open 24 hours a day and many Urgent Care clinics close in the late evening. When Should I Go to the ER? An emergency is when a person could die or be permanently hurt. The ER provides care for critical or life-threatening conditions. Visit your closest ER or call 911 if you experience: Changes in mental status, such as confusion Chest pain or pressure Coughing or vomiting blood Difficulty breathing or shortness of breath Severe allergic reaction Severe or persistent vomiting or diarrhea Sudden dizziness, weakness or changes in vision Sudden or severe pain Visit Provider Search for listing of emergency room locations near you. When Should I go to an Urgent Care? Go to an Urgent Care Clinic when you need care after hours for non-life-threatening conditions. Here are some examples of conditions: A common illness like the flu Minor fever or headache Painful sore throat Earache or sinus pain Minor injuries like a sprained ankle Back pain Cuts or small wounds Small burns Rash or minor allergic reactions Nausea Diarrhea Urinary tract infections There are more than 90 clinics in our IEHP network. Many are open late and on weekends. Search Provider Search or call the IEHP 24-Hour Nurse Advice Line (888) 244-4347, TTY 711.
Urgent Care and Medi-Cal
ic of the moment, it may not always be clear where to go to get help. Besides the worry of the injury or illness itself, you may also be thinking, “does Medi-Cal cover urgent care?” Finding an urgent care clinic that takes Medi-Cal is not the only priority. You also need to think about what kind of treatment you need and where to go to get it. Consider the following example: It is a Saturday morning, and you have a severe stomachache and now start to have a fever. You want to get medical treatment as soon as possible but know your Doctor is closed on the weekend. So, you are not sure whether to go to an urgent care clinic or the emergency room. You also want to make sure there are urgent care clinics nearby that accepts Medi-Cal. Yes, many urgent care clinics do accept Medi-cal. At IEHP we have over 90 urgent care clinics in our network that offer Members care afterhours, on weekends and on holidays, when your primary care doctor might be closed. Click here to search for an IEHP urgent care clinic in your area. Now, that you know that urgent care clinics accept Medi-Cal, let’s review when you might need urgent vs emergency care. Urgent Care vs. Emergency Room Urgent care is not the same as emergency care. Urgent care centers are for illnesses and injuries that are not life-threatening, yet still require treatment. Some examples include common illness like the flu, minor fever or headache, painful sore throat, earache or sinus pain, back pain, minor injuries like a sprained ankle, etc. Most urgent care centers provide same-day services and usually have shorter waiting times than emergency rooms. Emergency rooms (ER) are for life-threatening emergencies and accidents where immediate treatment is required. Emergency rooms are open 24 hours a day 7 days a week and provide care for critical or life-threatening conditions. Visit your nearest ER or call 911 if you experience: changes in mental status, such as confusion, chest pain or pressure, coughing or vomiting blood, difficulty breathing or shortness of breath etc. When to Visit Urgent Care Urgent care clinics are not a substitute for your regular doctor. When you can't reach your Doctor after-hours or your Doctor is not available, you have options to get your needed care. Many people don’t realize there is a middle ground between a doctor’s visit and a trip to the ER. Urgent care centers regularly handle a range of medical problems, including: Fevers Dehydration Small wounds Vomiting/diarrhea Sprains Allergies Bites Cold or flu symptoms Emergency rooms handle life threatening conditions, including: Head injuries Broken bones Chest pains Breathing difficulties Heart attack Stroke Serious burns Serious bleeding Be Prepared Does urgent care take medical history into account? Absolutely! Your medical records form an important part of your treatment and follow-up care. As such, we always recommend you are ready with the following details: Information on pre-existing conditions. Details of past surgeries, when you had them, and which hospital and doctors performed them. A list of prescription medications you take, the dosage, and how often you take them. A list of any over-the-counter medications you take, the dosage, and how often you take them. Any allergies you have. Make sure to bring your IEHP Member Card While nobody likes to think about being in an accident or suffering a sudden illness, it is important to be prepared. Your Doctor understands your health and medical background. Doctors at urgent care clinics will not have access to the same depth of information as your primary doctor, therefore, we recommend you that you follow up with your primary care Doctor after visiting an urgent care. After-Hour and Urgent Care Services for IEHP Members If you think you need urgent care, it’s always recommended to call your doctor’s office. If your doctor’s office is closed, you can call the IEHP 24-Hour Nurse Advice Line at (888) 244-4347, TTY 711, or click here to search for an IEHP Urgent Care clinic. Of course, always call 911 if immediate medical care is needed. At IEHP, we pride ourselves on improving lives by delivering quality and accessible healthcare and will not rest until our communities enjoy optimal care and vibrant health. If you have any questions about your Medi-Cal benefits please call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347 to learn more.
Medi-Cal Evidence of Coverage Updates
book for the benefit year of January 1, 2022 – December 31, 2022. How to get care Sensitive care Minor consent services You may only get the following services without your parent or guardian’s permission if you are 12 years old or older: Outpatient mental health care for (minors age 12 or older): Sexual assault (no lower age limit) Incest Physical assault Child abuse When you have thoughts of hurting yourself or others (minors age 12 or older) HIV/AIDS prevention/testing/treatment Sexually transmitted infections prevention/testing/treatment Substance use disorder treatment services (minors age 12 or older). For more information see “Substance use disorder treatment services” in this handbook. If you are under 18 years old, you can go to a doctor without permission from your parents or guardian for these types of care: Pregnancy Family planning/birth control Abortion services For pregnancy testing, family planning services, birth control, or sexually transmitted infection services, the doctor or clinic does not have to be part of the IEHP network. You can choose any Medi-Cal provider and go to them for these services without a referral or pre-approval (prior authorization). Services from an out-of-network provider not related to sensitive care may not be covered. For help finding a doctor or clinic giving these services, or for help getting to these services (including transportation), you can call IEHP Member Services at 1-800-440-IEHP (4347) (TTY 1-800-718-4347 or 711). Minors can talk to a representative in private about their health concerns by calling the 24/7 at 1-888-244-IEHP (4347) (TTY 711). Benefits and services What your health plan covers This chapter explains your covered services as a member of IEHP. Your covered services are free as long as they are medically necessary and provided by an in-network provider. You must ask us for pre-approval (prior authorization) if the care is out-of-network except for sensitive services, emergencies and some urgent care services. Your health plan may cover medically necessary services from an out-of-network provider. But you must ask IEHP for pre-approval (prior authorization) for this. Medically necessary services are reasonable and necessary to protect your life, keep you from becoming seriously ill or disabled, or reduces severe pain from a diagnosed disease, illness or injury. For Members under the age of 21, Medi-Cal services include care that is medically necessary to fix or help relieve a physical or mental illness or condition. For more details on your covered services, call IEHP Member Services at 1-800-440-IEHP (4347) (TTY 1-800-718-4347 or 711). Members under 21 years old get extra benefits and services. Read Chapter 5: Child and youth well care for more information. Some of the basic health benefits IEHP offers are listed below. Benefits with a star ( * ) may need pre-approval. Acupuncture* Acute (short-term treatment) home health therapies and services Adult immunizations (shots) Allergy testing and injections Ambulance services for an emergency Anesthesiologist services Asthma prevention Audiology* Behavioral health treatments* Cardiac rehabilitation Chiropractic services* Chemotherapy & Radiation therapy Cognitive health assessment Dialysis/hemodialysis services Durable medical equipment (DME)* Emergency room visits Enteral and parenteral nutrition* Family planning office visits and counseling (you can go to a non-participating provider) Habilitative services and devices* Hearing aids Home health care* Hospice care* Inpatient medical and surgical care* Lab and radiology* Long-term home health therapies and services* Maternity and newborn care Major organ transplant* Occupational therapy* Orthotics/prostheses* Ostomy and urological supplies Outpatient hospital services Outpatient mental health services Outpatient surgery* Palliative care* PCP visits Pediatric services Physical therapy* Podiatry services* Pulmonary rehabilitation Rapid Whole Genome Sequencing Rehabilitation services and devices* Skilled nursing services Specialist visits Speech therapy* Surgical services Telemedicine/Telehealth Transgender services* Urgent care Vision services* Women’s health services
Complex Care Management
Do you need help coordinating care with your Doctors? IEHP can help. Our Complex Care Management (CCM) Program was designed to assist Members who are ill. This includes a serious illness, like heart disease, lung disease, kidney disease, AIDS, Hepatitis C, spinal injury or any other chronic uncontrolled condition. IEHP’s Care Management Team will work with you and your Doctor to make sure you get the care you need. We can help you manage your illness and medicines, coordinate care, work with your Providers and help you to get any needed medical equipment. We also offer and invite you to make use of an Interdisciplinary Care Team (ICT) to help you with your personalized plan of care. This Team consists of your Primary Care Doctor, Complex Care Manager and others who support your health care needs. You may be referred to the CCM program through the following options: Medical Management Program Referral Discharge Planner Referral Practitioner Referral Caregiver Referral Self-Referral How to opt in to the CCM program First, we will need to complete a health survey with you to assess your needs. This will help determine if you are eligible for the program. If you are eligible for the program and wish to opt in, you will be automatically enrolled. If you are not eligible for the CCM program but want more information on other Care Management Services available, please contact IEHP Member Services at 1-800-440-4347. After enrollment into the CCM program, you will be assigned a Primary Case Manager. The Case Manager will contact you at least once every 30 days to discuss your health goals. They will also assist you with a plan to meet those goals. To get started, 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 opt out of the CCM Program Once enrolled, you may opt out of the program at any time. Simply contact IEHP Member Services at 1-800-440-4347 and let them know you no longer wish to be involved with the program. Be sure to notify your Case Manager as well.
Report an Issue - Report a problem with your care
ppy or you are having problems with your care, talk to your Doctor. Your Doctor will help you. If you need more help, call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347. You can also file a grievance. Ask your Doctor for a form or select from the options below. GRIEVANCE FORM Print and mail grievance form (PDFs are below) Call IEHP Member Services and we will mail you a form If you are mailing your grievance form please send it to: IEHP, Attention: Grievance Dept. P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader. Medi-Cal Member Complaint Form (PDF) IEHP DualChoice (HMO D-SNP) Complaint Form Within 5 days of getting your complaint, we will send you a letter letting you know we received it. Within 30 days, we will send you another letter that tells you how we resolved your problem. If you call IEHP about a grievance that is not about health care coverage, medical necessity, or experimental or investigational treatment, and your grievance is resolved by the end of the next working day, you may not receive a letter.
Helpful Information and Resources - Holiday Schedule
January 2, 2023 Martin Luther King, Jr. Day - Monday, January 16, 2023 President's Day - Monday, February 20, 2023 Memorial Day - Monday, May 29, 2023 Juneteeth - Monday, June 19, 2023 Day before Independence Day - Monday, July 3, 2023 Independence Day - Tuesday, July 4, 2023 Labor Day - Monday, September 4, 2023 In observance of Veteran's Day - Friday, November 10, 2023 Thanksgiving Day - Thursday, November 23, 2023 Day after Thanksgiving - Friday, November 24, 2023 Christmas Day - Monday, December 25, 2023
Member Advisory Committee - Public Policy Participation Committee
ces and feedback guide our services. As a result, we are able to improve how we deliver care and services. The PPPC meets every three months. We bring together IEHP staff and Members to give our Members a platform for open discussion. During the meetings, Members will have the opportunity to give feedback on member materials and their overall experience while receiving care with IEHP. We also discuss the IEHP Cultural and Linguistic (C&L) services program. Members who are selected to participate, will get $75 for each meeting they attend. All meetings will take place at IEHP headquarters from 12 p.m. - 2 p.m. 2023 Meeting Schedule March 15, 2023 June 21, 2023 September 20, 2023 December 20, 2023
Healthy Living - Flu
at you can to protect yourself from the flu virus. Everyone should get the flu shot. Members who are especially high risk for complications are: 65 years of age or older. Pregnant. Residents of nursing homes and long-term care facilities. Children, 6 months or older. Remember, in many cases, the flu shot can prevent the flu, lessen the symptoms if you get the flu and reduce spreading it to others. Common myths about the flu shot Myth 1: I can get the flu from the flu shot. False. The flu shot is made from a virus that is not active, so it doesn’t cause infection. Myth 2: I’m healthy; I don’t need the flu shot. False. Healthy people can get sick, too. Very sick. The flu shot can help lower your chances of getting sick. Myth 3: I got a flu shot last year. I don’t need a shot this year. False. The flu virus changes every year and so does the flu shot. You need a flu shot every year to fight this year's flu. Frequently Asked Questions Q: Where can I get the flu shot? A: Your Doctor’s office (for adults and children), certain network pharmacies like CVS, Rite Aid and Walgreens (for adults only). Q: What are ways I can avoid getting the flu? A: To avoid getting the flu, you should: Get the flu shot. Avoid close contact with people who are sick. Wear something to cover your mouth and nose when in public. Wash your hands often with soap and water. If you don't have soap and water, use an alcohol-based hand sanitizer. Avoid touching your eyes, nose, and mouth. Eat healthy. Drink lots of fluids, especially water. Get plenty of rest. Clean and disinfect surfaces around you. Q: What should I do if I get the flu? A: If you get the flu, be sure to: Stay home and rest. Avoid others. Drink lots of fluids, like water and juice. See your Doctor if symptoms do not improve. If you have the flu but can’t reach your Doctor, call the IEHP 24-Hour Nurse Advice Line at 1-888-244-IEHP (4347) or 711 for TTY users. Our nurses can connect you with a Board-Certified Doctor by telephone or virtual visit via video chat.
Helpful Information and Resources - Texting Program