Search Results For : " MAKE FREEDHARDEMAN UNIVERSITY "

doesn’t have to be a scary adventure.  Through a new print and digital media campaign, Inland Empire Health Plan (IEHP) encourages residents to take their best shot at health and wellness this season by getting their annual flu vaccine. The campaign will reach Inland Empire residents through commercials on local television stations, radio spots, community outreach and social media posts, directing them to IEHP’s website for vaccine information and details.  “No one wants to be slowed down in 2023,” said IEHP Chief Medical Officer, Dr. Takashi Wada. “This campaign is to serve as a reminder that staying healthy and well can be as easy as stopping by a vaccine clinic or checking in with your primary care physician.” The campaign began in winter 2022 and will run through spring 2023. “The flu isn’t isolated to a particular time and the flu vaccine can protect you throughout the year. Like the COVID-19 vaccine, it can also significantly reduce symptoms in case you do contract it.”  To receive a free flu vaccine, no visit to a wizard or good witch is required! Residents in Riverside County can visit ruhealth.org/flu. Residents in San Bernardino County can visit dhp.sbcounty.gov to find free local clinics. Flu vaccines are always free for IEHP members. To learn more, visit iehp.org.

anagement (CMM) Pilot Program, utilizing artificial intelligence (AI) to manage medication use among Members was recently published in the Journal of Managed Care & Specialty Pharmacy. Using an advanced AI platform, health plan data, and clinical pharmacists, trained in disease management and CMM, were able to engage with Members via telephone and enhance care coordination, reducing serious drug interactions by 15.2%, emergency room visits by 15%, hospital admissions by 9%, and more.   Noting the pilot program’s ability to significantly improve Member health outcomes and reduce utilization, the Journal of Managed Care & Specialty Pharmacy estimates that California’s Medicaid (Medi-Cal) program could save more than $1B annually by applying the program’s measures to a similar group of patients. “This study affirms that Medication Therapy Management for Medicaid patients is essential for optimizing patient care,” said Dr. Michael Blatt, IEHP Clinical Director of Pharmacy and Product Strategy. Pilot program participants included 2,150 IEHP Members between 40 to 60 years old with an average of 25 medications prescribed to manage chronic conditions. “This comprehensive medication management program, created by pharmacists and aided by novel decision technology, enables us to engage a team of support around individual Members by connecting the right Members to the right resources at the right time,” said Dr. Edward Jai, IEHP Senior Director of Pharmaceutical Services. To share additional learnings from this effort and to support other health plans looking to leverage AI in a CMM program, Dr. Jai will be presenting program results and lessons at the 2021 Academy of Managed Care Pharmacy Nexus Conference on October 18. His presentation will also include details from IEHP’s Medication Reconciliation Program, which also decreased readmissions and hospitalizations. For more information about this study, visit jmcp.org.

lle Community Resource Center on-site partner, is hosting housing support workshops for county residents.  These free workshops will offer residents a wide range of information on housing assistance resources, including how to sign up for rental assistance and learn more about the county’s housing voucher program. Each workshop is open to the public and will be held at the Victorville Community Resource Center located at 12353 Mariposa Road, Suites C-2 & C-3.  The workshops are scheduled from 9-10 a.m. on the following Wednesdays: Aug. 3 Aug. 17 Sept. 7 Sept. 21 By providing housing resources workshops at the Victorville Community Center, customers can learn about affordable housing services offered by HACSB and access supportive services from other community partners in one location,” said HACSB Director of Policy and Public Relations, Nicole Beydler. “Our hope is that this partnership helps to connect affordable housing and related services, and that customers will be able to leverage these services toward achieving their goals.” HACSB focuses on providing housing assistance through resources authorized and funded through the U.S. Department of Housing and Urban Development. Through this work, HACSB is one of the most progressive housing authorities in the country and the largest provider of affordable housing in San Bernardino County. Currently, HACSB assists about 26,000 people, most of whom are seniors, individuals with disabilities, veterans and children. “We are proud to partner with IEHP to bring these housing resource workshops to the community. Safe and stable housing is fundamental, but it takes more than housing to achieve an enriched quality of life,” added Beydler. Through IEHP and HACSB’s collaboration, the health plan’s Victorville Community Resource center was also designated as a United States Department of Housing and Urban Development (HUD) EnVision Center last year. This highlights the center's ability and commitment to empower households with resources and support needed to become self-sufficient. Resources pertain to economic empowerment, educational advancement, health and wellness and character leadership.  “Knowledge and information are power,” said IEHP Victorville Community Resource Center Manager Delia Orosco. “In collaboration with HACSB and our other center partners, we can empower our communities with information needed to truly inspire positive change in their own lives.” In addition to HACSB, IEHP’s Victorville center currently hosts five, on-site partners to support community residents. Partners include Young Visionaries Youth Leadership Academy, TODEC Legal Center, Community Action Partnership of San Bernardino County and the Goodwill of Southern California.  Click here for more information on IEHP’s Community Resource Centers.   

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.   

ly contracted provider. PLEASE NOTE, IEHP is currently not accepting new: DME Hospice Specialty Pharmacy Clinical Laboratories Non-Emergent Medical Transportation (NEMT) Community Based Adult Services (CBAS) outside of the Inland Empire Please check monthly for updates on Network Availability. Prior to extending a contract, we must receive the following documents: 1. Ancillary Provider Network Participation Request Form (PDF) 2. W-9 Form A current Taxpayer Identification Number and Certification Form 3. Liability Insurance Certificate Professional general liability in the minimum amount of One Million Dollars ($1,000,000) per occurrence. Three Million Dollars ($3,000,000) aggregate per year for professional liability. 4. Ownership Information (PDF) Name, Title and Percentage of Ownership 5. Provider Accreditation Certificate 6. CMS/DHCS Passing Site Survey (Approval Letter) Required for each facility 7. California State License (if applicable) Required for each facility 8. Urgent Care Minimum Qualifications (if applicable) All Ages (PDF) Pediatrics (PDF) 9. Medi-Cal Number Ancillary Providers need to successfully enroll in the State's Medi-Cal Program 10. Provider Acknowledgment of Receipt (AOR) (PDF) IEHP is required by State and Federal regulators to maintain an AOR form on file for our Providers signifying your receipt and review of the Policy & Procedure manuals, including annual updates 11. Electronic Remittance Advice (ERA) Form (PDF) Ancillary Providers must complete the ERA form   Contracts Maintenance Request Form can be found here (PDF). Any delay in receiving the above stated documents will affect the effective date of the contract that will be mailed to you.  The contract collateral and other supporting contract documents should be e-mailed to contract@iehp.org. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

rting our providers. We are committed to quality, driving us to create programs and services to meet the needs of our members and providers. In fact, IEHP is one of the top-rated Medicaid plans in California. Determined by both the Healthcare Effectiveness Data and Information Set (HEDIS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS), NCQA has awarded IEHP an Accreditation status for Medi-Cal. This status is only given to health plans that have clinical and service programs that meet or exceed NCQA standards. Learn more about how IEHP delivers quality services and care below.  Quality Report Inside the 2023 Quality Report, we take you through our quality journey by looking at our performance over the past year with critical measures. We show you how that data translates into tangible outcomes for our Members, Providers and Team Members. While there were many areas where we excelled, there were also places where we found opportunities for improvement. The goal of this Quality Report is to be transparent—with you and with ourselves. This journey is ongoing, and we hope to learn from it so we can do better and be better for those who rely on us the most. 2023 Annual Quality Report (PDF) 2022 Annual Quality Report 2020 Annual Quality Report (PDF) Quality Management IEHP supports an active, ongoing, and comprehensive quality management program with the primary goal of continuously monitoring and improving the quality of care, access to care, patient safety, and quality of services delivered to IEHP Members. The Quality Management (QM) Program provides a formal process to systematically monitor and objectively evaluate, track and trend the health plan’s quality, efficiency and effectiveness. Quality Management Evaluation 2022 Quality Management Annual Evaluation (PDF) Quality Management Program Description 2023 Quality Management Program Description (PDF) HEDIS Every year, IEHP assesses the overall quality of health care experienced by IEHP members. To achieve this IEHP uses  NCQA, a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS® which provides: a set of standardized performance measures based on statistically valid samples of members the public with information to compare health plan performance HEDIS Rate: 2021 Medi-Cal HEDIS Rates (PDF) 2021 Medicare HEDIS Rates (PDF) Physician Satisfaction IEHP values a strong partnership with our providers. To support them we offer many services from online support to a call center, to a dedicated service representative. That's why doctors think highly of IEHP. In fact, according to the 2022 Provider Satisfaction Survey conducted by SPH Analytics, 98.2% of physicians would recommend IEHP to other physicians. See the full results of the 2022 Provider Satisfaction Survey (PDF). Population Needs Assessment Every year, IEHP sends out a Population Assessment Survey to IEHP Members to learn more about their needs. View the results below.  2020 Population Needs Assessment Results  You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader. 

d is to support the hiring of PCPs, Specialists, and Advanced Practice Providers that will serve the Medi-Cal population in the Inland Empire. Entities that hire qualified candidates are eligible to receive a subsidy up to $75,000 for Advanced Practice Providers, $100,000 for PCPs, and $150,000 for Specialists. All candidates must be a new access point in IEHP's network and not have prior history in the Inland Empire. Please take note of the following: The NEF Program will be targeting specific Provider types. The Provider types and corresponding regions displayed below comprise the list of positions that are currently eligible to receive a subsidy through the NEF Program.   The funding disbursement schedule is as follows:  50% when the qualified candidate completes credentialing 25% when the candidate completes six (6) months of service 25% when the candidate completes one (1) year of service Entities that are interested in receiving support through the NEF Program must submit a complete application to be considered for the funding opportunity. Completed applications and questions should be e-mailed to NEFProgram@iehp.org NEF Program Description (PDF) NEF Application (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. Click on the following links to jump to that specific section: Corona/Temecula/Hemet High Desert Low Desert Mohave Valley Palo Verde Valley Riverside San Bernardino Proper West San Bernardino Corona/Temecula/Hemet Dermatology Family Practice Internal Medicine Pediatrics Cardiac/Thoracic Surgery General Surgery Genetics Neurology OB/GYN Oncology Ophthalmology Orthopedic Surgery Pulmonary Medicine Plastic Surgery Psychiatry Urology   High Desert Family Practice Internal Medicine Pediatrics Allergy and Immunology Cardiac/Thoracic Surgery Cardiology Dermatology General Surgery Genetics Neurology Neurosurgery OB/GYN Oncology/Hematology Ophthalmology Orthopedic Surgery Otolaryngology Pain Management Pediatric Subspecialties Physical Therapy Podiatry Psychiatry Psychology Pulmonary Medicine Rheumatology Speech Therapy Urology   Low Desert Dermatology Family Practice Internal Medicine Pediatrics Allergy and Immunology Cardiology General Surgery Neurology OB/GYN Oncology Ophthalmology Orthopedic Surgery Pain Management Pediatric Surgery Physical Therapy Psychiatry Pulmonary Medicine Rheumatology Urology   Mohave Valley Family Practice Internal Medicine Pediatrics Allergy and Immunology Cardiology Dermatology Gastroenterology General Surgery Nephrology Neurology OB/GYN Oncology Oncology/Hematology Ophthalmology Orthopedic Surgery Otolaryngology Pain Management Psychiatry Pulmonary Medicine Rheumatology Urology   Palo Verde Valley Family Practice Internal Medicine Pediatrics Allergy and Immunology Cardiology Dermatology Endocrinology Gastroenterology General Surgery Neurology OB/GYN Oncology Ophthalmology Orthopedic Surgery Otolaryngology Pain Management Physical Therapy Podiatry Psychiatry Pulmonary Medicine Speech Therapy Urology   Riverside Family Practice Internal Medicine Pediatrics Cardiology Dermatology General Surgery Genetics Neurology OB/GYN Occupational Therapy Oncology Ophthalmology Orthopedic Surgery Pain Management Podiatry Psychiatry Speech Therapy Urology   San Bernardino Proper Family Practice Internal Medicine Pediatrics Allergy and Immunology Dermatology Neurology OB/GYN Oncology Ophthalmology Orthopedic Surgery Pain Management Pediatric Surgery Psychiatry Pulmonary Medicine Urology   West San Bernardino Dermatology Family Practice Internal Medicine Pediatrics Genetics Neurology OB/GYN Oncology Ophthalmology Orthopedic Surgery Pediatric Surgery Plastic Surgery Psychiatry Urology   Updated July 25, 2023    

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.

of Lisa Wright as its new interim president.    Wright brings a wealth of experience and expertise, having recently served as President and CEO of Inland So Cal United Way and Inland So Cal 211+.    "We are pleased to have Lisa join us to help the Foundation through the transition as we complete a search for a new CEO/president," said Board Vice Chair Karen Scott, who led the search for this position.     "I am grateful and honored to serve as the IEHP Foundation interim president," said Wright. "As a proud community member of the Inland Empire and longtime local nonprofit leader, I am excited to embark on this journey and work collaboratively with the board and staff to help advance the Foundation's mission – to inspire and ignite the health of the IE."    The search for the new president has begun using a national search firm, which is expected to take six months to complete.   About IEHP Foundation    IEHP Foundation is on a mission to inspire and ignite the health of the Inland Empire. It was created by Inland Empire Health Plan (IEHP) in 2021 as a separate 501c3 public charity.     The Foundation will provide more information regarding its strategy and community engagement over the next few months.    To learn more as the organization moves forward, please visit iehpfoundation.org and follow IEHP Foundation on Instagram and LinkedIn.   ###     Press Contact Deanna Hendrick Marketing and Communications Manager, IEHP Foundation Deanna.hendrick@iehpfoundation.org 909-204-1673

gural graduating class of its Community Health Worker (CHW) Residency Program during a special celebration at its Rancho Cucamonga-based headquarters. The spotlight was placed on eight CHWs who completed the weeks-long program focused on the mission of reducing barriers to health care services in marginalized and underserved communities. “I know [going through the program] was a journey and you’ve learned a lot and brought your experience, your wisdom and your connections to the community and really helped shape our program going forward,” said Dr. Takashi Wada, IEHP’s chief medical officer, during the ceremony on July 27. “We’ve been learning along with you in how to deliver a meaningful program that’s going to provide value to our communities and give you the experience and tools that you’ll need to be successful in any role as a community health worker.” IEHP’s CHW program launched in March, with the first cohort beginning their studies on May 6. CHWs participated in six weeks of in-person training, followed by three weeks of field practicum training, explained IEHP Community Behavioral Health Manager Belinda Hernandez. “We developed training around the community health worker core competencies and enhanced training by including an introduction to health care services,” she said. “Topics covered focused on foundational skills with enhanced training on specific areas such as quality measures, health outcomes and evidence-based approaches and techniques.” CHWs will receive ongoing training to ensure they stay up to date on any new resources. They also will be paired with a provider in the community to address chronic conditions, preventative health care needs and health-related social needs throughout Riverside and San Bernardino counties.  Estrella Garcia, among the eight graduates, summed up the CHW program as an “eye-opening journey filled with growth, empathy and empowerment that has not only opened my perspective but also has equipped me with invaluable skills in challenging situations.” “My team has been so supportive and have inspired me to embrace who I am and love myself the way I am,” she continued. “They are truly, truly community health workers at heart.” In addition to Garcia, IEHP’s inaugural CHW cohort included Astin Medina Carranza, April Watkins, Serena Hong, Jackiie Tovar-Sandoval, Princess Egiebor, Dre Graves and Lizette Olmedo. The next cohort is expected to begin their studies on Aug. 21.   For more information on the CHW benefit, go to www.dhcs.ca.gov/community-health-workers. Inland Empire Health Plan celebrated the first graduating class of its Community Health Worker Residency Program. Students began their studies earlier this year to reduce barriers to health care services in marginalized and underserved communities. Eight CHWs were part of the inaugural group.   Estrella Garcia speaks at a graduation ceremony on July 27 to celebrate Inland Empire Health Plan’s inaugural Community Health Worker Residency Program cohort. Garcia was one of eight CHWs to complete the program focused on the mission of reducing barriers to health care services in marginalized and underserved communities.

P’s human resources functions by developing best practices and strategies to advance IEHP’s efforts to be a high-performance organization fueled by a skilled, engaged and diverse workforce. In this role, Ms. Sood oversees talent acquisition, compensation administration and benefits (total rewards), HR operations, and learning and development. Additionally, Supriya will lead the department’s efforts that support IEHP’s Mission, Vision, Values, and strategic direction.  

HP Members who are infants, children, and youth up to age 21 can get these services at no cost. What are preventive care services? Services that ensure that infants, children, and youth under age 21 get the care they need at the right age. This includes screenings for medical, dental, vision, hearing, mental health, and substance use disorders. You or your child may also get developmental services, specialty care, and needed vaccines to keep you healthy.  Developmental services include early intervention through screening tools such as the Ages and Stages Questionnaire (ASQ-3). The ASQ-3 is a developmental screening for children ages 0-5 that provides a fast, helpful, and detailed look at how your child is growing and developing. IEHP provides a free online ASQ-3 screening for your child at any time. Click here to request a free ASQ-3 screening. IEHP covers screenings (including lead blood-level assessment) any time you need them at no cost to you.  Check-ups and screenings can help Doctors find health issues early. If a physical or behavioral health issue is found during a check-up or screening, IEHP will cover the care needed to address it. How do I get preventive care services? Set up a visit for any check-ups, screenings or other preventive care through your or your child’s Doctor.  If you or your child are eligible to receive the COVID-19 vaccine (5 years or older), it is also important that you get the vaccine as soon as possible. To set up an appointment, please visit https://myturn.ca.gov/. To learn more about preventive care services, 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. What to do if your child is denied care? Children enrolled in Medi-Cal have the right to regular check-ups and medical services.  If your child's care was denied, reduced, or stopped, please see Your Medi-Cal Rights Guide for more information. DHCS - MediCal Rights Letter (PDF) Immunization schedule 2022 (PDF)

ited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when you are out of the area), out-of-area dialysis services, and cases in which IEHP DualChoice (HMO D-SNP) authorizes use of out-of-network providers. What are Network providers? Network providers are the doctors and other health care professionals, medical groups, hospitals, and other health care facilities that have an agreement with us to accept our payment as payment in full. We have arranged for these providers to deliver covered services to members in our plan. All of our plan participating providers also contract us to provide covered Medi-Cal benefits. Find a Doctor Use the IEHP DualChoice Provider and Pharmacy Directory below to find a network provider: 2023 IEHP DualChoice Provider and Pharmacy Directory (PDF) What is a Primary Care Provider (PCP) and their role in your Plan? A PCP is your Primary Care Provider. You will usually see your PCP first for most of your routine health care needs. Your PCP will also help you arrange or coordinate the rest of the covered services you get as a member of our Plan. "Coordinating" your services includes checking or consulting with other Plan providers about your care and how it is going. This includes: your X-rays laboratory tests, therapies care from doctors who are specialists hospital admissions, and follow-up care Primary Care Providers (PCPs) are usually linked to certain hospitals. When you choose your PCP, remember the following: You must choose your PCP from your Provider and Pharmacy Directory. Call IEHP DualChoice Member Services if you need help in choosing a PCP or changing your PCP. Choose a PCP that is within 10 miles or 15 minutes of your home. The PCP you choose can only admit you to certain hospitals. Try to choose a PCP that can admit you to the hospital you want within 30 miles or 45 minutes of your home. Some hospitals have “hospitalists” who specialize in care for people during their hospital stay. If you are admitted to one of these hospitals, a “hospitalist” may serve as your caregiver as long as you remain in the hospital. When you are discharged from the hospital, you will return to your PCP for your health care needs. If you need to change your PCP for any reason, your hospital and specialist may also change. Your PCP should speak your language. However, your PCP can always use Language Line Services to get help from an interpreter, if needed. If you do not choose a PCP when you join IEHP DualChoice, we will choose one for you. We will send you your ID Card with your PCP’s information. Remember, you can request to change your PCP at any time. You can switch your Doctor (and hospital) for any reason (once per month). If your change request is received by IEHP by the 25th of the month, the change will be effective the first of the following month; if your change request is received by IEHP after the 25th of the month, the change will be effective the first day of the subsequent month (for some providers, you may need a referral from your PCP).  How to Get Care from a Specialist You will usually see your Primary Care Provider (PCP) first for most of your routine healthcare needs such as physical check-ups, immunization, etc. When your PCP thinks that you need specialized treatment or supplies, your PCP will need to get prior authorization (i.e., prior approval) from your Plan and/or medical group. This is called a referral. Your PCP will send a referral to your plan or medical group.  It is very important to get a referral (approval in advance) from your PCP before you see a Plan specialist or certain other providers. If you don't have a referral (approval in advance) before you get services from a specialist, you may have to pay for these services yourself. What if you are outside the plan’s service area when you have an urgent need for care? Suppose that you are temporarily outside our plan’s service area, but still in the United States. If you have an urgent need for care, you probably will not be able to find or get to one of the providers in our plan’s network. In this situation (when you are outside the service area and cannot get care from a network provider), our plan will cover urgently needed care that you get from any provider. Our plan does not cover urgently needed care or any other care if you receive the care outside of the United States. Changing your Primary Care Provider (PCP) You may change your PCP for any reason, at any time. Also, it’s possible that your PCP might leave our plan’s network of providers and you would have to find a new PCP. If this happens, you will have to switch to another provider who is part of our Plan. If your PCP leaves our Plan, we will let you know and help you choose another PCP so that you can keep getting covered services. IEHP DualChoice Member Services can assist you in finding and selecting another provider. You can change your Doctor by calling IEHP DualChoice Member Services. Please call IEHP DualChoice Member Services at (877) 273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY users should call (800) 718-4347. For more information on network providers refer to Chapter 1 of the IEHP DualChoice Member Handbook. IEHP DualChoice (HMO D-SNP) is a HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) is dependent on contract renewal. This is not a complete list.  You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Click here to download a free copy by clicking Adobe Acrobat Reader.  Information on this page is current as of October 01, 2022 H8894_DSNP_23_3241532_M

vision* coverage to qualified low-income California residents. Who Can Apply for Medi-Cal and Join IEHP? People who live in our service area (Riverside and San Bernardino counties) Adults with or without children, children, seniors, and people with a disability People who meet income guidelines and other program requirements Undocumented adults ages 50+ How Much Will I Pay? Adults pay no monthly premium for Medi-Cal coverage. Children with Medi-Cal coverage under the Children’s Health Insurance Program (CHIP) will have a low monthly premium. What Care Will I Get with Medi-Cal Through IEHP? Your plan coverage includes:  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 (*). How do I apply for Medi-Cal:  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. Important Reading for IEHP Medi-Cal Members Medi-Cal Member Handbook (PDF): explains how to get care with IEHP and plan covered benefits. IEHP Member Handbook Guide to Medi-Cal Benefits (PDF): This guide helps you find important information about benefits and services in your IEHP Member Handbook. Medi-Cal Provider Directory (PDF): lists our growing network and options to get needed care quickly – day and night.  Resources for the uninsured  You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download a free copy by clicking Adobe Acrobat Reader.     

t the compliance culture at IEHP and the role that each Team Member, including management, Chief Officers and the Governing Board, plays in building and preserving that culture. Code of Business Conduct and Ethics (PDF)

HP Community Resource Centers (CRC) are your local resource for healthcare information in Riverside, San Bernardino and Victorville. Our friendly, bilingual staff can help you take free classes, learn about health care, and about health coverage programs. Our doors are open to IEHP Members and the community.  We Have In-Person and Online Classes Fitness Classes Stay active with classes like Yoga, Zumba (all levels), Tai Chi, Line Dance, Yoga for Seniors & People with Disabilities, Meditation, Aerobic Box, Latin Dance, Strength and Conditioning, and Kid Aerobics. Wellness Classes Learn about nutrition, managing asthma symptoms, controlling diabetes, stress management, breathing and relaxation. Where can I find Classes? In Person: Riverside | San Bernardino | Victorville Online: Virtual Classes Riverside Community Resource Center VIEW OUR MONTHLY RIVERSIDE CRC CALENDAR Click to Download PDF Click Para Descargar PDF Riverside CRC Address: 3590 Tyler Street, Suite 101, Riverside, CA 92503 Riverside CRC Phone: 1-866-228-4347 TTY users should call 711 View Our Other CRC Locations: San Bernardino CRC Victorville CRC  Virtual/Online  Click to view in Google Maps San Bernardino Community Resource Center VIEW OUR MONTHLY SAN BERNARDINO CRC CALENDAR Click to Download PDF Click Para Descargar PDF San Bernardino CRC Address: 805 West 2nd Street, Suite C, San Bernardino, CA 92410 San Bernardino CRC Phone: 1-866-228-4347 TTY users should call 711 View Our Other CRC Locations: Riverside CRC Victorville CRC  Virtual/Online  Click to view in Google Maps Victorville Community Resource Center VIEW OUR MONTHLY VICTORVILLE CRC CALENDAR Click to Download PDF Click Para Descargar PDF Victorville CRC Address: 12353 Mariposa Road, Suites C-2 & C-3, Victorville, CA 92395 Victorville CRC Phone: 1-866-228-4347 TTY users should call 711 View Our Other CRC Locations: Riverside CRC San Bernardino CRC Virtual/Online  Click to view in Google Maps Visit our on-site partner agencies for the following services: Goodwill Southern California: A workforce provider helping individuals empower themselves with the skills and job support services they need and want to thrive. Housing Authority of the County of San Bernardino: Affordable housing provider and rental assistance to low-income families via vouchers or affordable housing units. Young Visionaires Youth Leadership Academy: Mentorship enriching lives of young people through life building activities and instruction in the areas of education, employment, health, mentoring, and community service. Community Action Partnership of San Bernardino County: Providing Home Energy Assistance Program (HEAP) and Housing Assistance for San Bernardino County residents. TODEC: Provides legal immigration services, advocacy, community organizing, and civic engagement. Virtual Classes VIEW OUR MONTHLY ONLINE CLASSES CALENDAR Click to Download PDF Click Para Descargar PDF Join the Classes via Facebook: Our Community Resource Centers are now offering virtual classes via Facebook. Join a class today. Join the Classes via WebEx:   Webex Classes (Password: 12345): Apple Users Android Users PC Users

will now be held at the following address: Dr. Bradley P. Gilbert Center for Learning & Innovation 9500 Cleveland Ave. Rancho Cucamonga, CA 91730 Click here to view the meeting room map. Any Member of the public may observe the scheduled proceedings by using the link listed below. Click here to join the virtual meeting. September 2023 Watch Video (YouTube) Agenda Board Report Under $200k Summary Report August 2023 Watch Video (YouTube) Agenda Board Report Under $200k Summary Report July 2023 Watch Video (YouTube) Agenda Board Report Under $200k Summary Report

cond year in a row, ranking 14th on the list. The Rancho Cucamonga-based, not-for-profit health organization joins other national companies on the list like Humana, Cleveland Clinic and Elevance Health. This is the third time IEHP has been recognized in 2023 for effective practices to ensure its team members and providers work in a positive, uplifting environment with personal and career growth benefits available year-round. In June, IEHP was designated a Great Place To Work™; then in July, PEOPLE named the organization one of its 100 Companies That Care©, ranking in at No. 87. “We are incredibly proud to be recognized again as one of the country’s best workplaces in health care,” said Jarrod McNaughton, IEHP’s chief executive officer. “This achievement reflects our organization’s strong team culture and deep commitment to serving our community and one another.” IEHP’s Chief People Officer Supriya Sood agreed. “Our entire team is a vital component in the work we do to support our nearly 1.7 million IEHP members living and working in both San Bernardino and Riverside counties,” she said. “From cultivating a strong culture of communication and recognition to offering employees a myriad of growth opportunities, IEHP strives to be the prime example of how to shape a positive workplace environment in one of the fastest growing areas in the state.” The Best Workplaces in Health Care list is highly competitive. Great Place To Work, the global authority on workplace culture, determines its list using its proprietary For All™ Methodology to evaluate and certify thousands of organizations in America’s largest ongoing annual workforce study, based on over 1.3 million survey responses and data from companies representing more than 7.5 million employees this year alone. Survey responses reflect a comprehensive picture of the workplace experience. Honorees were selected based on their ability to offer positive outcomes for employees regardless of job role, race, gender, sexual orientation, work status or other demographic identifier. According to IEHP employees surveyed: 92% said IEHP is a great place to work compared to 57% of employees at a typical U.S.-based company. 96% say they felt good about the ways IEHP contributes to the community. 95% said IEHP has special and unique benefits and believed the company made them feel welcome upon employment. 94% said IEHP’s facilities contribute to a good working environment, and they are proud to tell others they work for the organization. “Congratulations to the Best Workplaces in Health Care,” said Michael C. Bush, CEO of Great Place To Work. “These companies know that it isn’t the industry but the company that determines the employee experience. By putting people first, they are reaping the rewards: lower labor costs, higher standards of care, and happier employees.” “Fortune congratulates the Best Workplaces in Health Care,” added Fortune Editor-in-Chief Alyson Shontell. “Creating a vibrant workplace culture that draws the best talent in health care is vital for the success of leaders in this highly competitive industry. It is also what’s needed to ignite the innovation and deliver best-in-class performance.”

(IEHP) Pay for Performance program, also known as P4P. IEHP’s P4P was designed to increase the provision of preventive health services to IEHP Members as well as improve HEDIS® results to ensure that all IEHP Direct DualChoice Members receive timely annual assessment visits with an emphasis on review and management of chronic illnesses. IEHP Direct PCPs will be reimbursed directly by IEHP through the DualChoice Annual Visit program. PCPs participating in IEHP's network through an IPA only are not eligible for this program: Overview (PDF) DualChoice Annual Visit (PDF) To learn more about P4P IEHP DualChoice Annual Visit, contact a Provider Services Representative at (909) 890-2054. Click on the following links to jump to that specific section: Provider Quality Incentives Brochure Medicare P4P IEHP Direct IEHP Direct Stars Incentive Program D-SNP Model of Care Incentive Program Global Quality P4P Program OB/GYN P4P Program Hospital P4P Program Provider Quality Incentives Brochure Inland Empire Health Plan (IEHP) is pleased to announce the 2022 Provider Quality Incentive Brochure. 2022 Provider Quality Incentive Brochure (PDF) | June 22, 2022 (Back to P4P Menu) Medicare P4P IEHP Direct Program Inland Empire Health Plan (IEHP) is pleased to announce the Medicare P4P IEHP Direct Program.  The goal of the program is designed to reward IEHP Direct Primary Care Providers (PCPs) for providing quality care to IEHP DualChoice Members. Medicare P4P IEHP Direct Program Guide (PDF) Published: February 16, 2023 (Back to P4P Menu) IEHP Direct Stars Incentive Program Inland Empire Health Plan (IEHP) is pleased to announce the IEHP Direct Stars Incentive Program for Primary Care Physicians (PCPs). The goal of the program is to reward PCPs who provide high-quality care to IEHP DualChoice (HMO D-SNP) members. IEHP Direct Stars Incentive Program Guide (PDF) Updated: June 29, 2023 (Back to P4P Menu) D-SNP Model of Care Incentive Program Inland Empire Health Plan (IEHP) is pleased to announce the D-SNP Model of Care Incentive Program for Independent Physicians Associations (IPAs). The goal of the program is to reward IPAs who provide high-quality care to IEHP DualChoice (HMO D-SNP) members. D-SNP Model of Care Incentive Program (PDF) Published: July 24, 2023 (Back to P4P Menu) Chronic Care Improvement Program Planning and Reporting Document The Chronic Care Improvement Program (CCIP) Planning and Reporting document can be used for the following D-SNP Model of Care Incentive Program activity: Chronic Care Improvement Program (CCIP) Activity. CCIP Planning and Reporting Document (Word Document) CCIP Planning and Reporting Document - Reference Guide (PDF) Global Quality P4P Program If you would like more information about IEHP’s GQ P4P Program or best practices to help improve quality scores and outcomes, visit our Secure Provider Portal, email the Quality Team at QualityPrograms@iehp.org or call the IEHP Provider Relations Team at (909) 890-2054. 2023 IEHP Global Quality P4P Program Guide PCP (PDF) Published: July 25, 2023 2023 IEHP Global Quality P4P Program Guide IPA (PDF) Published: July 25, 2023 2022 IEHP Global Quality P4P Program Guide PCP (PDF) Published: August 28, 2023 2022 IEHP Global Quality P4P Program Guide IPA (PDF) Published: July 25, 2023 2023 Provider Quality Resource Guide (PDF) Published: June 21, 2023 (Back to P4P Menu) Quality Improvement Activity Strategy Forms The Quality Improvement Activity (QIA) Strategy Forms can be used for the following 2023 and 2022 Global Quality P4P QIA Activities: Reducing Health Disparities and Potentially Avoidable Emergency Department Visits or Potentially Preventable Admissions. 2023 Equity Quality Improvement Activity #1 - Strategy Form (PDF) 2023 Quality Improvement Activity #2 - Strategy Form (PDF) 2022 Equity Quality Improvement Activity #1 - Strategy Form (PDF) 2022 Quality Improvement Activity #2 - Strategy Form (PDF) (Back to P4P Menu) Potentially Avoidable Emergency Department (ED) Visits: Potentially Preventable Diagnosis Code The Potentially Preventable Diagnosis Code List includes diagnosis codes for visits to an ED in which the condition could be treated by a Physician or other health care Provider in a non-emergency setting or conditions that are potentially preventable or are ambulatory care sensitive. Potentially Preventable Diagnosis List (PDF) Published: February 04, 2022   Patient Experience This toolkit is full of proven tips and successful strategies based on the kinds of questions your IEHP Members could be asked to answer regarding their Provider's service. Your Provider Relations Team has targeted nine specific topics in this toolkit to help Providers and their staff continue to achieve the highest marks in Patient experience from their IEHP Members. Serve Well Customer Service Toolkit (PDF) Well Child 2021 Recommendations for Preventive Pediatric Health Care from the American Academy of Pediatrics (PDF) Immunizations IEHP provides vaccine coverage based on the latest ACIP recommendation and guidelines. Please refer to the Immunization Update and "Summary of Recommendations" for both Child and Adolescents AND Adult Vaccines as follows: 2023 Immunization Timing Chart - English (PDF) 2023 Immunization Timing Chart - Spanish (PDF) 2023 Immunization Timing Chart - Chinese (PDF) 2023 Immunization Timing Chart - Vietnamese (PDF) 2023 Recommended Child and Adolescent Immunization Schedule (0-18 years) (PDF) 2023 Recommended Adult Immunization Schedule (19+ years) (PDF) Adult Vaccines are a covered benefit and do not require prior authorization (must adhere to CDC/ACIP Immunization Recommendation and/or FDA approved indication). Grow Well Childhood Immunization Toolkit for Providers (PDF) This toolkit contains commonly used immunization codes, best practices for reporting immunizations including information on registering with CAIR, tips on talking with parents and information on understanding vaccination hesitancy. CAIR2 Resource Guide (PDF) This guide contains helpful links and contact information for locations to register for CAIR2 or current users. Reimbursement process: Complete a CMS1500 form by including the appropriate CPT codes, quantity dispensed and billed amount. Mail: IEHP Claims Department P.O. Box 4349 Rancho Cucamonga, CA 91729-4349 For the latest updates and news regarding the vaccines, please visit CDC's ACIP website at: https://www.cdc.gov/vaccines/hcp/acip-recs/index.html Quality Bonus Services Dispute Form Please e-mail completed forms to QualityPrograms@iehp.org Quality Bonus Service Dispute Request Form (PDF) OB/GYN P4P Program Inland Empire Health Plan (IEHP) has released the OB/GYN P4P Program Guide which details the program requirements, performance measures, updated code sets, and payment timelines. OB/GYN P4P Program Guide (PDF) Published: January 01, 2023 OB P4P Frequently Asked Questions FAQs (PDF) Published: February 13, 2023 Postpartum Depression Screening (PDF) (Back to P4P Menu) Urgent Care + Wellness Quality Incentive Program Inland Empire Health Plan (IEHP) is pleased to announce the Urgent Care + Wellness Quality Incentive Program. The goal of the program is to reward urgent care providers for providing wellness services to IEHP Medi-Cal Members. Urgent Care + Wellness Quality Incentive Program Guide (PDF) Published: September 08, 2023 (Back to P4P Menu) Hospital P4P Program Inland Empire Health Plan (IEHP) is pleased to announce the Hospital Pay For Performance Program (Hospital P4P) for IEHP Medi-Cal contracted Hospitals servicing Riverside and San Bernardino Counties. The goal of the Hospital P4P Program is to provide substantial financial rewards to Hospitals that meet quality performance targets and demonstrate high-quality care to IEHP Members. 2023 Hospital P4P Program Guide (PDF) Published: July 24, 2023 P4P 2023 MX Data Contributions (PDF) Published: February 02, 2023 IEHP P4P 2023 Data Guidelines (PDF) Published: February 02, 2023 2022 Hospital P4P Program Guide (PDF) Published: March 20, 2023 P4P 2022 MX Data Contribution (PDF) Published: April 18, 2022 P4P 2022 MX Data Guidelines (PDF) Published: April 18, 2022 (Back to P4P Menu) Potentially Avoidable Emergency Department (ED) Visits: Potentially Preventable Diagnosis Code The Potentially Preventable Diagnosis Code List includes diagnosis codes for visits to an ED in which the condition could be treated by a Physician or other health care Provider in a non-emergency setting or conditions that are potentially preventable or are ambulatory care sensitive. Potentially Preventable Diagnosis List (PDF) Published: February 04, 2022 Substance Use Disorders and Mental Health Diagnosis Lists The Substance Use Disorders and Mental Health Diagnosis Lists includes diagnosis codes to identify substance use disorders, drug overdose, mental health or intentional self-harm diagnoses. Mental Health Diagnosis List (PDF) Published: June 23, 2023 Substance Use Disorders Diagnosis List (PDF) Published: June 23, 2023 You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website. Medicare: For IEHP DualChoice (HMO D-SNP) - Medicare-Medicaid Plan - Formulary and Criteria information, please click here IEHP DualChoice (HMO D-SNP). Medicaid: On January 7, 2019, Governor Gavin Newsom issued Executive Order N-01-19 (EO-N-01-19) for achieving cost-savings for drug purchases made by the state. A key component of EO N-01-19 requires the Department of Health Care Services (DHCS) transition all Medi-Cal pharmacy services from managed care (MC) to fee for service (FFS). Click here to go to the “DHCS Medi-Cal Rx” page on IEHP website Click here to go to “Medi-Cal Rx: Transition” page on DHCS website Updated April 7, 2021, this document describes DHCS’ multi-faceted pharmacy transition policy, inclusive of “grandfathering” previously approved PAs from managed care and fee-for-service, as well as a 180-day period with no PA requirements for existing prescriptions, to help support the Medi-Cal Rx transition. During this transition period, Magellan will provide system messaging, reporting and outreach to provide for a smooth transition to Medi-Cal Rx. Click here to view “Medi-Cal Rx Pharmacy Transition Policy” from DHCS website To view Drug Criteria Referenced in Summary Table - Click Links Below: Clinical Practice Guidelines - CPGs Drug Prior Authorization Criteria HP Acthar (repository corticotropin injection) (PDF) Nucala (PDF) Synagis (PDF) Xolair (omalizumab) (PDF)  Zynteglo (PDF) Drug Class Prior Authorization Criteria Erythropoiesis Stimulating Agents (PDF) Growth Hormones (PDF) Immuno Globulins (PDF) Pharmacy Policies Discharge Policy (PDF) Drug Trial and Failure (PDF) High Daily Morphine Milligram Equivalent (PDF) IEHP Drug Prior Authorization Policy (PDF) Intradialytic Parenteral Nutrition (IDPN) Policy (PDF) Non-Formulary Drug (PDF) Non-Sterile Compounded Medication (PDF) Off-Label Indication Policy (PDF) Pharmacy Drug Management Program for Pain (PDF) Quantity Limit Policy (PDF) Information on this page is current as of September 08, 2023.