Search Results For : " BUSINESS DEGREE CERTIFICATEWE "
MediCal - IEHP DualChoice - Model of Care
als who are dual eligible for both Medicare and Medi-Cal in Riverside and San Bernardino counties, including the most vulnerable population. This also includes members transitioning from IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan).
IEHP has identified the most vulnerable as the following:
Age 21-70
Identified as High and Rising Risk
Diagnosed with Cardiovascular Disease AND/OR Diabetes
RUB Score of 4 & 5. *RUB is Resource Utilization Band which is a predictor of using acute or costly services.
IEHP will identify the most vulnerable members assigned to IPAs
IEHP and its IPAs must design care management specific interventions to demonstrate how they support these member's health and wellness goals.
Examples of Specially Tailored Services for the Most Vulnerable Population
Remote Patient Monitoring
Medically Tailored Meals and Other Community Supports
Nutrition Education
Pharmacy Services (medication reconciliation and other programs)
Long-Term Services and Supports (LTSS)
Telehealth Behavioral Health Services
Transportation
More frequent care management contact
IEHP DualChoice (HMO D-SNP) Model of Care Training
The Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) and the National Committee for Quality Assurance (NCQA) require that IEHP staff and contracted consultants/vendors, our Medicare IPAs, Hospitals/SNFs, and Providers, receive training on the Plan’s Model of Care for our D-SNP Members:
Interdisciplinary Care Team (ICT) Fact Sheet (PDF)
IEHP DualChoice (HMO D-SNP) Model of Care Training (PDF)
IEHP DualChoice (HMO D-SNP) Model of Care Training (HTML)
*We recommend opening file in: Mozilla Firefox, MS Edge, Chrome or MS Internet Explorer
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
MediCal - Pharmacy
gram, Prior Authorization Criteria, Clinical Practice Guidelines, Forms, IEHP Formulary, and Safety Resources with drug recall information.
If you have any questions regarding services provided by the Pharmaceutical Services Department, please feel free to contact the IEHP Pharmacy Department at (909) 890-2049.
Pharmaceutical Services
MediCal - Medication Therapy Management
MTM is a term to describe a broad range of services offered by Pharmacists on our health care team.
The IEHP Clinical Pharmacy Team reviews the Members’ medicines, making sure they’re taking the right ones for their health conditions. If you are a Provider for IEHP Members who qualify for the MTM Program, you can let them know to look out for a letter from us. They will be enrolled automatically—unless they opt-out. MTM is offered to Members at no additional cost.
IEHP's MTM services include these core elements:
Medication therapy reviews
Medication education
Disease management
A team of Pharmacists and Doctors developed these MTM services to help provide better prescription drug coverage for our Members. For example, MTM also helps identify possible medication errors.
Medicare MTM Program
This is a free program under Medicare Part D for IEHP DualChoice Members who have multiple medical conditions, take many prescription drugs, and have high drug costs to assist with better medication management and overall health.
IEHP DualChoice Members’ enrollment includes a yearly comprehensive medication review (CMR) and regular targeted medication review (TMR) services throughout the year. MTM services include:
Comprehensive Medication Review (CMR)
An IEHP Clinical Pharmacist will provide an annual comprehensive review of the IEHP DualChoice Member’s medications over the phone. The Pharmacist will review IEHP DualChoice Member’s medications and make clinical recommendations to IEHP DualChoice Members and Providers.
Targeted Medication Review (TMR)
The IEHP Clinical Pharmacy Team will also offer TMRs through the year by reviewing issues with the participating IEHP DualChoice Member’s medicines. The team will perform TMRs for all enrolled beneficiaries every three months. The beneficiary may get TMR recommendations by mail and their Primary Care Provider may receive recommendations by fax—if the IEHP Clinical Pharmacy Team deems it necessary.
For more information, IEHP DualChoice Members eligible for CMR or TMR services can call 1-877-273-IEHP (4347), 8am-5pm (PST), 7 days a week, including holidays. TTY users should call 1-800-718-4347. Click here for a blank personal medication list.
Medicare MTM Program services may have limited eligibility criteria. They are available for the following conditions:
1. The IEHP DualChoice Member has a minimum of three (3) disease states:
Bone Disease-Arthritis-Osteoporosis
Bone Disease-Arthritis-Rheumatoid Arthritis
Chronic Heart Failure (CHF)
Diabetes
Dyslipidemia
End-Stage Renal Disease (ESRD)
Hypertension
Mental Health Chronic/ Disabling Mental Health Conditions
Respiratory Disease – Asthma
Respiratory Disease – Chronic Obstructive Pulmonary Disease (COPD)
2. The IEHP DualChoice Member is prescribed a minimum of five (5) different medications to treat those disease states:
ACE-Inhibitors
Angiotensin II Receptor Blockers (ARBs)
Antidepressants
Antihyperlipidemic
Antihypertensives
Antipsychotics
Beta Blockers
Bronchodilators
Calcium Channel Blockers
Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
Diuretics
Insulins
Oral Hypoglycemics
Selective Serotonin Reuptake Inhibitors (SSRIs)
Tumor Necrosis Factors (TNFs)
Inhaled Corticosteroids
Calcimimetic
Cardiac Glycoside
Colony Stimulating Factors
Glucagon-Like Peptide-1
Glucocorticosteroids
Neprilysin Inhibitor
NSAIDs
Phosphate Binders
Vitamin D Analogs
3. Drug costs of $1,233.75 (one-fourth of $4,935) for the previous three months are likely to be incurred.
To learn more about MTM, call IEHP DualChoice (HMO-DSNP) at 1-877-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays.
TTY users should call 1-800-718-4347.
For answers to frequently asked questions, please download the FAQ document below:
MTM FAQs (PDF)
For details, contact the IEHP Pharmaceutical Services Department at (909) 890-2049, Monday-Friday, 8am-5pm.
IEHP DualChoice (HMO-D-SNP) [Medicare-Medicaid Plan] is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.
Information on this page is current as of March 2023.
H5355_CMC_20_1900233_Accepted
MediCal - IEHP DualChoice (HMO D-SNP)
P DualChoice (HMO D-SNP) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. It is an organization made up of doctors, hospitals, pharmacies, providers of long-term services and supports, behavioral health providers, and other providers. It also has care coordinators and care teams to help you manage all your providers and services. They all work together to provide the care you need.
What is the goal of this program?
The goal is to improve care by integrating the following healthcare services:
Medicare and Medi-Cal benefits
Long-term care
Behavioral health
Home and community-based services (HCBS) such as Community-Based Adult Services (CBAS) and Multipurpose Senior Services Program (MSSP).
Who is eligible for IEHP DualChoice (HMO D-SNP)?
People who have both Medicare and Medi-Cal. For a complete list of who is included or excluded, visit Who Qualifies?
Plans and Benefits
IEHP DualChoice (HMO D-SNP) integrates healthcare services to better coordinate care and improve health.
How to Enroll
To enroll, please call:
IEHP DualChoice (HMO D-SNP) Team at 1-800-741-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY/TDD users should call 1-800-718-4347, OR
Health Care Options (HCO) at 1-844-580-7272, 8am – 5pm (PST), Monday – Friday. TTY/TDD users should call 1-800-430-7077.
For more information, visit the DHCS website. By clicking on this link, you will be leaving the IEHP DualChoice (HMO D-SNP) website. You may also call IEHP DualChoice (HMO D-SNP) for help at 1-877-273-IEHP (4347), 8am – 8pm (PST), 7 days a week, including holidays. TTY/TDD users should call 1-800-718-4347 (4347).
Plan Benefits and Cost-Sharing: Find out about plan benefits which are the types of medical care that are covered. Also view information on cost-sharing which is how much you will pay for services or prescription drugs, including monthly plan premium and co-payment.
Part D Prescription Drugs: Get information on pharmacy benefits, IEHP network pharmacies, out-of-network coverage, pharmacy transition process, drug utilization management, and prescription mail order.
Provider Access Information: Learn about network providers, primary care providers, specialists and how to choose a provider in our network. Read about our quality assurance activities and find out what happens if your doctor leaves our plan.
Grievances, Coverage Determination and Appeals Process: Find out what to do if you have a problem or complaint about your medical care or Part D.
Helpful Information: View your rights and responsibilities upon disenrollment and as a Member of IEHP. You will also find important forms, such as our Privacy Notice, Plan Transition Process and the section of CMS' website regarding Best Available Evidence.
Service Area: Only people who live in our service area can join IEHP DualChoice. Our service area includes all of Riverside and San Bernardino counties.
IEHP DualChoice (HMO D-SNP) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.
Information on this page is current as of April 19, 2023.
H5355_CMC_19_1059755 Accepted
Niños y Adolescentes - Salud de Niños
Círculo para Niños
Formato: Grupo pequeño
Duración: Sesión de 30 minutos
Edades: de 0 a 5 años, los niños deben estar acompañados por el padre, la madre o el tutor.
Estas clases están diseñadas para familias con bebés, niños y niños de 0 a 5 años. Las clases promueven el desarrollo saludable y las habilidades relacionadas con la formación de los hijos mediante juegos atractivos e interacción social. Los padres son motivados a acceder a recursos de atención medica y trabajar con sus pediatras en las evaluaciones de desarrollo y las intervenciones tempranas. Aprenda sobre la educación para la salud incluyendo temas esenciales como consultas para un bebé saludable, alimentación, desarrollo del lenguaje, seguridad, actividad física y vacunas. Las evaluaciones de desarrollo están disponibles a petición.
Para solicitar una evaluación del desarrollo de su hijo, envíenos un correo electrónico a screening@iehp.org
Consulte también:
Al hacer clic en los enlaces a continuación usted saldrá del sitio web de IEHP.
Etapas del Desarrollo
Calendario para las Visitas del Niño Saludable
Calendario de Vacunación
Citas preventivas para ninos (PDF)
MediCal - Facility Site Review
th us to offer our members the highest quality care and service they need. Facility Site Reviews are the required standards by the California Department of Health Care Services (DHCS)/Medi-Cal Managed Care Division (MMCD) for all primary care provider (PCP) sites. Below you will find various resources in regards to DHCS information, Physical Accessibility Reviews (PARS), Facility Site Review (FSR), and Medical Record Reviews (MRR) as well as IEHP’s addendum tools for your reference.
Facility Site Review Training Index:
Department of Health Care Services (DHCS)
IEHP Addendum Tools
PARS
Facility Site Review
Medical Record Review
Department of Health Care Services (DHCS)
2022 Facility Site Review Standards (FSR) (PDF)
2022 Facility Site Review Tool (FSR) (PDF)
2022 Medical Record Review Standards (MRR) (PDF)
2022 Medical Record Review Tool (MRR) (PDF)
APL 22-017 - Facility Site Review and Medical Record Review (PDF)
DPL 14-005 - FSR Physical-Accessibility Reviews (PDF)
PL 12-006 - Revised FSR Tool (PDF)
(Back to Index)
IEHP Addendum Tools
Att 06 - IEHP Urgent Care Evaluation Tool (PDF)
IEHP Interim Review (PDF)
(Back to Index)
PARS
APL with PARS C (PDF)
APL with PARS D & CBAS (PDF)
PAR-FSR-C_PARS - Survey (PDF)
PAR-FSR-D_PARS - Ancillary (PDF)
PAR-FSR-E_PARS - CBAS (PDF)
(Back to Index)
Facility Site Review Menu
Click on the following links to jump to that specific section:
Facility Site Review Audit Tool Sections
Additional Documents
Medical Record Review Audit Tool Sections
Additional Documents
(Back to Index)
Access/Safety
Facility Site Review
Emergency Exit Routes Factsheet (PDF)
Evacuation Routes (PDF)
Glucometer Log (PDF)
Hemocue Log (PDF)
Medical Emergency, Earthquake, Fire Protocols (PDF)
Emergency Exit Routes Factsheet (PDF)
Pre-filled Emergency Medications Dosage Chart (PDF)
Sample Oxygen Tank Set (PDF)
Workplace Violence (PDF)
(Back to FSR Menu)
Adult Preventive
Medical Record Review
ACES Screening (PDF)
Adult Health History (PDF)
Adult Sterilization & Special Consent P&P (PDF)
Alcohol Resources (PDF)
AUDIT-C (PDF)
Brief Addiction Monitor (BAM) (PDF)
Comprehensive Pediatric and Adult Health Assessment Forms (PDF)
CRAFFT-2.0 Clinician Interview (PDF)
Hepatitis Risk Assessment Tool (PDF)
Intimate Partner Violence (IPV) Screening Tools (PDF)
Intimate Partner Violence (IPV) and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings (PDF)
PHQ-2 - Sample (PDF)
PHQ-9 - Sample (PDF)
Social Needs Screening Tool (PDF)
TB Risk Assessment Adult (PDF)
(Back to FSR Menu)
Clinical Services
Facility Site Review
Checklist for Safe Vaccine Storage and Handling (PDF)
Clean and Dirty Sign (PDF)
Controlled Substance Distribution Log (PDF)
Controlled Substance Narcotic Log (PDF)
Monthly Expiration Date & Verification Log (PDF)
P&P Distribution of Sample Medications (PDF)
Patient Distribution Log for Samples (PDF)
Plan for Vaccine Protection in Case of Power Outage (PDF)
Radiology - Notice to Employees (PDF)
Sample Radiology Inspection Report (PDF)
Vaccine Information Sheet (VIS) Protocol (PDF)
Vaccine Storage (PDF)
(Back to FSR Menu)
Coordination of Care
Medical Record Review
Adult Progress Note - Sample (PDF)
Missed Appointment Log - Sample (PDF)
Pediatric Progress Note - Sample (PDF)
(Back to FSR Menu)
Documentation
Medical Record Review
Adult General Consent to Treat (PDF)
Advance Health Care Directive Acknowledgement Form (PDF)
CAIR Sharing Request (PDF)
General Consent to Treat Minor (PDF)
Medical Record Release (PDF)
Sample Medication List (PDF)
Signature Page - IEHP (PDF)
(Back to FSR Menu)
Format
Medical Record Review
Acknowledgment of Receipt of Notice of Privacy Practice (PDF)
(Back to FSR Menu)
Infection Control
Facility Site Review
AAP Infection Prevention and Control in Pediatric Ambulatory Settings - COVID (PDF)
Autoclave Log (PDF)
Biohazardous Sign (PDF)
Bloodborne Pathogens & Post Exposure Plan - Fillable (PDF)
Cleaning Schedule (PDF)
Communicable Disease (ISOLATION) Protocol (PDF)
Infection Control, Biohazardous Waste and Disposition of Patients with Contagious Disease (PDF)
Instrument Transportation Log (PDF)
Isolation & Transmissions Based Precautions (PDF)
OSHA Employee Injury Report Form (PDF)
P&P Autoclave (PDF)
P&P Autoclaving Instruments in Peel (PDF)
P&P Chemical Disinfection (PDF)
P&P Cold Sterilization (PDF)
P&P Transport for Reusable Instruments (PDF)
Reusable Sharps Container (PDF)
Safety Needle Fact Sheet (PDF)
Sharps Injury Log Sample (PDF)
Transfer Stations and Treatment Facilities (PDF)
(Back to FSR Menu)
OB/CPSP Preventive
Medical Record Review
CPSP Initial and Trimester Assessment and Care Plan (PDF)
CPSP Postpartum Assessment and Care Plan (PDF)
Edinburgh Postnatal Depression Scale (EPDS) (PDF)
Required Documentation Checklist for OB (PDF)
(Back to FSR Menu)
Office Management
Facility Site Review
Access Standards (PDF)
After Hour Script (PDF)
CLAS Standards (PDF)
Confidentiality Form (PDF)
Fax Sheet (PDF)
Medical Emergency, Earthquake, Fire Protocols (PDF)
Medical Record Release (PDF)
Office Hours Sample Form (PDF)
On-Call Provider Schedule (PDF)
PCP Referral Tracking Log (PDF)
Referral Process (PDF)
Sample Office Hours (PDF)
Wait Time Survey Tool (PDF)
(Back to FSR Menu)
Pediatric Preventive
Medical Record Review
AAP Infection Prevention and Control in Pediatric Ambulatory Settings - COVID (PDF)
AAP Schedule (PDF)
AAP Supplemental Information (PDF)
Alcohol Resources (PDF)
AUDIT-C (PDF)
Brief Addiction Monitor (BAM) (PDF)
CDC BMI Growth Chart - Boys (PDF)
CDC BMI Growth Chart - Girls (PDF)
CDC Growth Chart Head Circumference - Boys (PDF)
CDC Growth Chart Head Circumference - Girls (PDF)
CDC Growth Chart Weight for Age - Boys (PDF)
CDC Growth Chart Weight for Age - Girls (PDF)
Child Health History - English (PDF)
Child Health History - Spanish (PDF)
Comprehensive Pediatric and Adult Health Assessment Forms (PDF)
CRAFFT-2.0 Clinician Interview (PDF)
Edinburgh Postnatal Depression Scale (EPDS) (PDF)
General Consent to Treat Minor (PDF)
Hepatitis Risk Assessment Tool (PDF)
Intimate Partner Violence (IPV) Screening Tools (PDF)
Intimate Partner Violence (IPV) and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings (PDF)
Oral Health Risk Assessment Tool (PDF)
PEARLS Assessment (PDF)
PEARLS Teen Self-Assessment (PDF)
PHQ-2 - Sample (PDF)
PHQ-A - Sample (PDF)
Social Needs Screening Tool (PDF)
TB Risk Assessment Pediatrics (PDF)
What Do You Eat (8-19 years) - English (PDF)
What Do You Eat (8-19 years) - Spanish (PDF)
What Does Your Child Eat (Birth - 8 years) - English (PDF)
What Does Your Child Eat (Birth - 8 years) - Spanish (PDF)
Youth Nutrition and Activity Assessment (8 - 19 years) (PDF)
(Back to FSR Menu)
Personnel
Facility Site Review
Accessibility Obligations of Medical Practices (PDF)
Bloodborne Pathogens & Post Exposure Plan - Fillable (PDF)
Domestic Violence (PDF)
Electronic Resources for Required Employee Training (PDF)
Employee File Checklist (PDF)
IEHP Cultural and Linguistics Training (PDF)
IEHP Evidence of Staff Training (PDF)
IEHP Grievance Resolution Process - English (PDF)
IEHP Grievance Resolution Process - Spanish (PDF)
IEHP P&P Child Abuse Reporting (PDF)
IEHP P&P Elder or Adult Abuse Reporting (PDF)
IEHP P&P Sensitive Services-Access Standards (PDF)
Medical Assistant Letter of Competency - Fillable (PDF)
Medical Assistant Venipuncture Form (PDF)
Medication Administration Procedures (PDF)
Mid-level Supervision of Medical Assistant (PDF)
Notice to Consumer PA Sign - English (PDF)
Notice to Consumer PA Sign - Spanish (PDF)
Notice to Consumer Sign - English (PDF)
Notice to Consumer Sign - Spanish (PDF)
SB697 Practice Agreement (PDF)
SOC 341 (PDF)
Standardized Procedures for Nurse Practitioner (PDF)
Suspected Child Abuse Report (PDF)
(Back to FSR Menu)
Preventive Services
Facility Site Review
Pure Tone Audiometer (PDF)
Visual Acuity Screen Tips (PDF)
(Back to FSR Menu)
Additional Documents
Facility Site Review
IEHP Phone List (PDF)
(Back to FSR Menu)
Additional Documents
Medical Record Review
Online Resources for Medical Record Review (PDF)
(Back to FSR Menu)
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
MediCal - Community Supports
offer in place of services or settings covered under the Medicaid State Plan. These services should be medically appropriate and cost-effective alternatives.
Beginning January 1, 2022, IEHP began offering 11 DHCS Preapproved Community Supports services. Effective July 1, 2023, 3 additional services were added. Please click on the service for additional details.
Asthma Remediation
Community Transition Services/Nursing Facility Transition to a Home
Home Modifications
Housing Deposits
Housing Tenancy and Sustaining Services
Housing Transition Navigation Services
Medically Supportive Food/Meals/Medically Tailored Meals
Nursing Facility Transition/Diversion to Assisted Living Facilities, such as Residential Care
Recuperative Care (Medical Respite)
Short-Term Post-Hospitalization Housing
Sobering Centers (Riverside County)
Day Habilitation
Personal Care and Homemaker Services
Respite Services
Community Supports FAQs (PDF)
Please return the completed Community Supports Service Provider Assessment (PDF) via email to DGCommunitySupportTeam@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.
MediCal - Physician Wellness
th IEHP’s inspiring and compelling Mission to “Heal and Inspire the Human Spirit,” we are mindful of the cost of caring on clinician health and well-being and we want you to know we care about you, stand with you, and want to support you in ways that help you sustain joy in your work. We have provided best-practice and highly respected resources here for provider well-being. May you continue to find purpose and fulfillment in your calling to this very sacred work of health care.
Resources
Standford Well MD
A robust site of resources, courses, publications, self-assessments, research, innovation, conferences, and trainings.
https://wellmd.stanford.edu/
National Academy of Medicine
A compilation of key resources for improving clinician well-being.
https://nam.edu/compendium-of-key-resources-for-improving-clinician-well-being/
American Association of Physician Leadership (AAPL)
Resources, courses, and tools for Physician Wellness, Physician Leadership, and more.
https://www.physicianleaders.org/resources/wellness
Coalition for Physician Wellness
Resources, mobile app, research, podcasts, books and publications.
https://www.forphysicianwellbeing.org/
Healthcare Burnout Symposium
Annual conference that addresses the multiple facets of burnout crisis and how to increase the well-being of physicians, nurses and administrators. Visit website to learn more about conference agenda and how to earn continuing education credits.
https://www.stophealthcareburnout.com/
American Medical Association Alliance (AMA) Steps Forward Program: Improving Physician Resilience
Resources for physicians to enhance their resiliency and prevent burnout. Visit website to learn more about the AMA’s Steps Forward guide and module. Physicians might be able to earn continuing education credits by completing the training.
https://amaalliance.org/physician-burnout/
American College of Physicians
Online learning center with webinar and videos available on physician well-being and professional fulfillment.
https://www.acponline.org/online-learning-center/physician-well-being-and-professional-fulfillment
Los Angeles County Medical Association (LACMA) Interactive
Wellness dashboard and resources for physicians.
https://www.lacmainteractive.com/mdlifeline
National Suicide Prevention Hotline
The lifeline provides 24/7, free and confidential support, prevention and crisis resources for anyone in need and best practices for professionals in the United States.
https://988lifeline.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.
MediCal - Community Supports
atives that MCPs may offer in place of services or settings covered under the California Medicaid State Plan.
Beginning January 1, 2022, IEHP began offering 11 DHCS Preapproved Community Supports services. Effective July 1, 2023,
3 additional services were added. Please click on the service for additional details.
Asthma Remediation
Environmental Asthma Trigger Remediations are physical modifications to a home environment that are necessary to ensure the health, welfare, and safety of the individual, or enable the individual to function in the home and without which acute asthma episodes could result in the need for emergency services and hospitalization.
Community Transition Services/Nursing Facility Transition to a Home
Assist members to live in the community and avoid further institutionalization. These services are non-recurring set-up expenses for individuals who are transitioning from a licensed facility to a living arrangement in a private residence where the person is directly responsible for his or her own living expenses.
Environmental Accessibility Adaptations (Home Modifications)
Environmental Accessibility Adaptations (EAAs also known as Home Modifications) are physical adaptations to a home that are necessary to ensure the health, welfare, and safety of the individual, or enable the individual to function with greater independence in the home: without which the Member would require institutionalization.
Housing Deposits
Housing Deposits assist with identifying, coordinating, securing, or funding one-time services and modifications necessary to enable a person to establish a basic household that do not constitute room and board.
Housing Tenancy & Sustaining Services
This service provides tenancy and sustaining services, with a goal of maintaining safe and stable tenancy once housing is secured.
Housing Transition Navigation Services
Housing transition services assist Members with obtaining housing.
Medically Supportive Food/Meals/Medically Tailored Meals
Malnutrition and poor nutrition can lead to devastating health outcomes, higher utilization, and increased costs, particularly among Members with chronic conditions. Meals help individuals achieve their nutrition goals at critical times to help them regain and maintain their health. Results include improved Member health outcomes, lower hospital readmission rates, a well-maintained nutritional health status, and increased Member satisfaction.
Nursing Facility Transition/Diversion to Assisted Living Facilities
Nursing Facility Transition/Diversion services assist individuals to live in the community and/or avoid institutionalization when possible. The goal is to both facilitate nursing facility transition back into a home-like, community setting and/or prevent skilled nursing admissions for Members with an imminent need for nursing facility level of care (LOC). Individuals have a choice of residing in an assisted living setting as an alternative to long-term placement in a nursing facility when they meet eligibility requirements.
Recuperative Care (Medical Respite)
Recuperative care, also referred to as medical respite care, is short-term residential care for individuals who no longer require hospitalization, but still need to heal from an injury or illness (including behavioral health conditions) and whose condition would be exacerbated by an unstable living environment. An extended stay in a recovery care setting allows individuals to continue their recovery and receive post-discharge treatment while obtaining access to primary care, behavioral health services, case management and other supportive social services, such as transportation, food, and housing.
Short-Term Post-Hospitalization Housing
Short-Term Post-Hospitalization housing provides Members who do not have a residence and who have high medical or behavioral health needs with the opportunity to continue their medical/psychiatric/substance use disorder recovery immediately after exiting an inpatient hospital (either acute or psychiatric or Chemical Dependency and Recovery hospital), residential substance use disorder treatment or recovery facility, residential mental health treatment facility, correctional facility, nursing facility, or recuperative care and avoid further utilization of State plan services.
Sobering Centers (Riverside County)
Sobering centers are alternative destinations for individuals who are found to be publicly intoxicated (due to alcohol and/or other drugs) and would otherwise be transported to the emergency department or jail. Sobering centers provide these individuals, primarily those who are homeless or those with unstable living situations, with a safe, supportive environment to become sober.
Day Habilitation Programs
Effective July 1st - Day Habilitation Programs are provided in a participant’s home or an out-of-home, non-facility setting. The programs are designed to assist the participant in acquiring, retaining, and improving self-help, socialization, and adaptive skills necessary to reside successfully in the person’s natural environment.
Respite Services
Effective July 1st - These are provided to caregivers of participants who require intermittent temporary supervision. The services are provided on a short-term basis because of the absence or need for relief of those persons who normally care for and/or supervise them and are non-medical in nature.
Personal Care and Homemaker Services
Effective July 1st - This service is provided for individuals who need assistance with Activities of Daily Living (ADL), such as bathing, dressing, toileting, ambulation, or feeding. Personal Care Services can also include assistance with Instrumental Activities of Daily Living (IADL), such as meal preparation, grocery shopping, and money management.
IEHP Direct and Delegated Providers can submit referrals for Community Supports via the Provider Portal. For questions on how to submit a referral or more information relating to the above services, Providers can call the Provider Call Center at (909) 890-2054 or (866) 223-4347.
Please continue to direct IEHP Members needing additional information on Community Supports services to IEHP Member Services at (800) 440-4347, Monday - Friday, 8am - 5pm. TTY users should call (800) 718-4347.
If you have programmatic questions, please email DGCommunitySupportTeam@iehp.org
Community Supports Provider Brochure - English (PDF) | Spanish (PDF) | Chinese (PDF) | Vietnamese (PDF)
Community Supports FAQs (PDF)
Medi-Cal Community Supports or In Lieu of Services (ILOS) 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.
Plan Updates - Vaccine Resources
2-2023 influenza season continues to coincide with circulation of COVID-19 virus (SARS-CoV-2). As of August 2022, approximately 94.2 million cases of COVID-19 had been reported in the United States. Influenza vaccination remains an important tool for the prevention of potentially severe respiratory illness, which helps decrease the stress on the U.S. health care system. IEHP DualChoice members who are 18 years of age or older may obtain flu vaccines through the IEHP Pharmacy Vaccine Network.
Vaccine Notice: Access to Pharmacy Vaccine Network (PDF)
Frequently Asked Influenza (Flu) Questions: 2022-2023 Season (CDC Recommendations)
What’s New for 2022-2023
By clicking on these links, you will be leaving the IEHP website.
The composition of flu vaccines has been updated.
For the 2022-2023 flu season, there are three flu vaccines that are preferentially recommended for people 65 years and older. These are Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine and Fluad Quadrivalent adjuvanted flu vaccine.
The recommended timing of vaccination is similar to last season. For most people who need only one dose for the season, September and October are generally good times to get vaccinated. Vaccination in July and August is not recommended for most adults but can be considered for some groups. While ideally it’s recommended to get vaccinated by the end of October, it’s important to know that vaccination after October can still provide protection during the peak of flu season.
The age indication for the cell culture-based inactivated flu vaccine, Flucelvax Quadrivalent (ccIIV4), changed from 2 years and older to 6 months and older.
Pre-filled Afluria Quadrivalent flu shots for children are not expected to be available this season. However, children can receive this vaccine from a multidose vial at the recommended dose.
Mpox Information
Mpox Vaccination Locations
San Bernardino County: Monkeypox (mpox) – Department of Public Health
Riverside County: Mpox Vaccine Locations – Riverside University Health System
Please advise members to call before going in for a vaccination as some locations are only available with appointments. Members may make appointments for the JYNNEOS vaccine at https://myturn.ca.gov/.
Mpox Testing
As of December 8, 2022, no commercial testing is available for the diagnosis of Mpox. Providers may contact CDC in the diagnosis, management of patients with suspected Mpox, and for any additional information regarding Mpox connect with the CDC Emergency Operations Center.
Phone: 1-770-488-7100, Monday through Friday, 8:00 AM to 4:30 PM EST
After Hours Phone: 1-404-639-2888
Treatment
Mpox patients usually recover fully within 2-4 weeks without the need for medical treatment. While there are no treatments specifically for Mpox, the virus that causes Mpox is similar to the smallpox virus and therefore antiviral drugs developed to protect against smallpox may be used. The antiviral drug, tecovirimat (TPOXX), has been approved by the FDA to treat smallpox in adults and children.
If you prescribe tecovirimat to treat members with Mpox the member must sign a consent form stating tecovirimat is an investigational drug that has not yet been approved by the FDA for treatment of Mpox.
More information about tecovirimat visit https://www.cdc.gov/poxvirus/monkeypox/if-sick/treatment.html.
Preventive Services Information
Immunizations
By clicking on these links, you will be leaving the IEHP website.
CDC ACIP Vaccine Recommendations and Guidelines: https://www.cdc.gov/vaccines/hcp/acip-recs/index.html
CDC ACIP Immunization Schedule for Children: https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
CDC ACIP Immunization Schedule for Adults: https://www.cdc.gov/vaccines/schedules/hcp/adult.html
USPSTF Task Force's Immunization Recommendations: https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=immunization
California Immunization Registry Portal (CAIR): https://cair.cdph.ca.gov/CAPRD/portalInfoManager.do
Immunization Timing 2022 (PDF)
Medicare-Medicaid (MMP) Quality Withhold Measures
California Specific Quality Withhold Technical Notes for DY 2 to 8 (PDF)
Core Quality Withhold Technical Notes for DY 2 to 10 (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.
MediCal - Medi-Cal Renewal Process
s the Medi-Cal Renewal process, is currently underway across our state. This initiative is the biggest challenge facing the Medi-Cal program in its history.
Up to 400,000 IEHP Members could potentially lose their Medi-Cal coverage if they don't complete the necessary renewal paperwork on time.
The impact on Providers across the entire healthcare system will be significant, potentially resulting in:
Increased use of the emergency department for primary care
Decreased capacity of bed availability
Delays in hospital discharges while awaiting coverage
Increased length of stay for patients with delayed preventative or chronic care
Increased cost of care
Interruptions of ongoing care
However, with every challenge comes opportunities to help our collective health care mission and partnership grow even stronger.
IEHP takes this challenge seriously and we are committed to helping Members keep their Medi-Cal coverage and Providers keep their assigned Members without interruption.
Resources to Help with the Medi-Cal Renewal Process
The following resources for Providers offer more information about the Medi-Cal Renewal process and tools to help your office proactively engage and encourage Members to renew their Medi-Cal coverage on time.
Medi-Cal Renewal Flyers and Provider Information
IEHP Medi-Cal Renewal Flyer for Members PDF – (English, Spanish, Chinese, Vietnamese)
Annual Eligibility Renewal (AER) FAQs
Medi-Cal Redetermination PowerPoint presentation - (Providers and IPAs)
Department of Health Care Services (DHCS) Toolkits – Medi-Cal Continuous Coverage Requirement
IEHP Eligibility Renewal Support Team
IEHP’s Eligibility Renewal Support team is here to answer calls from Members needing more one-on-one support during the Medical-Renewal process!
We support:
Application print outs
Online submissions via BenefitsCal.com
Assistance in connecting with the appropriate county department
Serving as a centralized eligibility hub for all eligibility-related issues (on hold, disenrolled, out of area, etc.)
Helping Members update contact information (national change of address, undeliverable address, etc.)
Please let your patients and our Members know that additional application support is just a phone call away.
IEHP Eligibility Renewal Support Team Hotline
Phone and Hours of Operation: 1-888-860-1296, Monday-Friday, 8 am - 5 pm (PST)
Additional information for IEHP Members
Additional Communication from IEHP
IEHP’s Medi-Cal Renewal specific Provider Communication is provided here for your convenience as well as here on our Correspondence page:
June 15, 2023 - Medi-Cal Renewal Date Does NOT Override Member's Eligibility Status (PDF)
June 09, 2023 - URGENT: What can I do to help patients keep their Medi-Cal (PDF)
May 04, 2023 - New: Annual Medi-Cal Eligibility Renewal (AER) Roster Now Available to Download Under CSV! (PDF)
April 17, 2023 - Now Live! Annual Medi-Cal Eligibility Renewal (AER) Alerts and Roster! (PDF)
April 06, 2023 - Phone Number CORRECTION: IEHP Eligibility Renewal Support Team First Round of Yellow Medi-Cal Renewal Packets Mailed to Members! (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.
MediCal - Educational Opportunities
isciplinary Care Team (ICT)
DualChoice Medicare CM IPA Training
Alzheimer's and Dementia Care
Specialty Mental Health Care Coordination
National LGBT Health Education Webinars
Online Cultural Competency Training
Interdisciplinary Care Team (ICT) Fact Sheet (PDF)
Healthcare Provider Toolkit: Assisting Patients with Requests for Workplace Accommodations or Leaves of Absence (PDF)
DualChoice Medicare CM IPA Training
2021 Care Management Delegation Oversight Medi-Cal IPA Training (MP4 Video) - December 08, 2021
Discussion Topics:
Health Risk Assessments (HRA)
Individual Care Plans (ICP)
Interdisciplinary Care Team (ICT)
Coordination of Care
Delegated IPA Reporting Requirements
2021 Care Management Delegation Oversight Medi-Cal IPA Training (MP4 Video) - February 16, 2021
Alzheimer's and Dementia Care
Project ECHO Opportunities from the Alzheimer's Association for Inland Empire Primary Care Clinics
Alzheimer’s Association / UCSF Memory and Aging Center Alzheimer’s and Dementia Care ECHO
Faculty Partners: UCSF Memory and Aging Center faculty
When: Thursdays beginning February 16, 2023 until July 20, 2023 from 12:00 pm - 1:00 pm PT via Zoom
Who can be involved: All California based Primary care practice teams (including MD/DO, NP, PA, social work, MA)
UCSF/Inland Empire ECHO 2023 Flyer (PDF)
To register, please contact Kelsey Burnham at kburnham@alz.org
UCLA ADC ECHO
Faculty Partners: UCLA Alzheimer’s and Dementia Care (ADC) program faculty
When: Wednesdays beginning March 29, 2023 until September 6, 2023 from 11:00 am - 12:00 pm PT via Zoom
Who can be involved: Nationwide teams interested in adding to their own knowledge and skills and those interested in learning about or implementing the highly effective UCLA ADC program
ADC ECHO 2023 Flyer (PDF)
To register, please contact Rachel Goldberger at rbgoldberger@alz.org
Specialty Mental Health Care Coordination
The Centers for Medicare and Medicaid Services (CMS) is requiring IEHP and its IPAs to document and report the efforts made to coordinate the care of IEHP DualChoice (HMO D-SNP) Members receiving specialty mental health services through the County Mental Health Plans. As of June 1, 2018, IEHP has put policies and procedures in place to comply with these process and reporting requirements:
On the first (1st) of each month, IEHP will provide IPAs and County MH Clinics a list of IEHP DualChoice (HMO D-SNP) Members known to be receiving specialty mental health services through the County MH Plans.
IPAs are expected to outreach to these Members and their County MH Clinic Provider, as well as, document their outreach attempts and outcomes as outlined in Policy 25C2, “Care Management Requirements – Delegated IPA Responsibilities.”
IPAs are required to provide data elements specific to this measure, as outlined in Policy 25F1, “Encounter Data Reporting - Medicare MMP Reporting Requirements – IEHP DualChoice (HMO D-SNP)" and Attachment, “Medicare Provider Reporting Requirements Schedule” in Section 25.
IEHP, through its Delegation Oversight process, will monitor the IPAs’ compliance with documentation and reporting requirements, as outlined in Policy 25A2, “Delegation Oversight Audit.”
To access the On-Site training material presented to IPAs and County Mental Health Clinics, click here (PDF).
National LGBT Health Education Webinars
IEHP has put together a list of webinars, provided by a third party, to provide educational programs, resources, and consultation to health care organizations with the goal of optimizing quality, cost-effective health care for lesbian, gay, bisexual, transgender, and all sexual and gender minority (LGBT) people.
The National LGBT Health Education Center is part of the Division of Education and Training at The Fenway Institute, Fenway Health. The Fenway Institute (TFI) is an interdisciplinary center for research, training, education, and policy development that works to ensure access to quality, culturally affirming medical and mental health care for traditionally underserved communities, including LGBTQIA+ people and those affected by HIV/AIDS.
The mission of Fenway Health is to enhance the wellbeing of the LGBTQIA+ community as well as people in our neighborhoods and beyond through access to the highest quality health care, education, research, and advocacy. Fenway Health is one of the largest providers of LGBTQIA+ health care and HIV primary care in the country; as such, it is a leader in the field of LGBTQIA+ health and informs much of the promising practices and innovative models that the Education Center disseminates to health centers nationwide.
By clicking on these links, you will be leaving the IEHP website.
The National LGBT Health Education Center Webinars
Courses Include:
HIV Prevention/PrEP at Health Centers: An Overview and Current Best Practices
What’s new in PrEP and STIs? Cases From a Sexual Health Clinic
Insurance Considerations for Navigating Gender-affirming Care
Building Your Family: LGBTQ Reproductive Options
Behavioral Health Assessments and Referral for Gender-Affirming Surgery
Navigating Gender Affirming Care
Collecting Sexual Orientation and Gender Identity (SO/GI) Data In Electronic Health Records
Providing Mental Health Assessments for Gender Affirming Surgery Referral Letters
Online Cultural Competency Training
AHRQ Health Literacy Modules Available for Continuing Education (CE) and Maintenance of Certification (MOC) Credit
Physicians and nurses can earn CE credits while learning about the challenges in caring for patients with low health literacy as well as strategies to improve overall patient communication and care. OptumHealth Education is issuing continuing education credit for taking the AHRQ-developed Health Literacy Knowledge Self-Assessment. No fees are charged for the two CE activities:
By clicking on these links, you will be leaving the IEHP website.
1. An Updated Overview of Health Literacy
Link (optumhealtheducation.com)
2. Improving Health Literacy by Improving Communication Skills
Link (optumhealtheducation.com)
Pediatricians and family physicians can earn credit for re-certification (MOC Part 2) as well as CE by taking the Health Literacy Knowledge Self-Assessment through the American Board of Pediatrics and the American Academy of Family Physicians, respectively.
To learn about AHRQ’s tools to address health literacy, visit Health Literacy Topics at:
https://www.ahrq.gov/health-literacy/index.html
To find out about other free AHRQ continuing education opportunities, go to:
https://www.ahrq.gov/patient-safety/education/continuing-ed/index.html
To contact AHRQ, visit https://www.ahrq.gov/contact/index.html
Office of Minority Health: https://cccm.thinkculturalhealth.hhs.gov/
CDC: www.cdc.gov
U.S. Department of Health and Human Service, Health Resources and Services Administration: www.hrsa.gov
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
MediCal - IPA
p
1668 S. Garfield 2nd Fl.
Alhambra, CA 91801
(877) 282-8272
(626) 943-6329
Dignity Health Medical Network - Inland Empire
3400 Data Drive,
Rancho Cordova, CA 95670
(916) 851-2026
(916) 851-7642
LaSalle Medical Associates
1855 W. Redlands Blvd. 2nd Floor,
Redlands, CA 92373
(888) 554-4562
(626) 943-6369
Optum Care Network - Inland Faculty MG
1860 Colorado Blvd. Ste 200,
Los Angeles, CA 90041
(800) 371-7547
(323) 257-7329
Physicians Health Network
P.O. Box 11429,
San Bernardino, CA 92423
(909) 300-5030
(909) 332-5555
Horizon Valley Medical Group
18564 US Highway 18 Ste 105,
Apple Valley, CA 92307
(760) 813-6950
(760) 813-6947
DualChoice CalMediConnect
CPN - Horizon Valley Medical Group
18564 US Highway 18 Ste. 105,
Apple Valley, CA 92307
(760) 242-7777
(760) 242-0487
Dignity Health Medical Network - Inland Empire
3400 Data Drive,
Rancho Cordova, CA 95670
(916) 851-2026
(916) 851-7642
EPIC Health Plan
1615 Orange Tree Lane,
Redlands, CA 92374
(909) 799-1818
(909) 786-0816
Alliance Desert Physicians, Inc.
Optum, formerly Beaver MG
Chaffey Medical Group
FENIX Medical Group
Optum, formerly Pinnacle MG
Redlands - Yucaipa Medical Group
TriValley Medical Group
Heritage Provider Network
8510 Balboa Blvd. Ste 275,
Northridge, CA 91325
(818) 654-3461
Desert Oasis Healthcare
275 N El Cielo Rd.,
Palm Springs, CA 92262
(760) 320-8814
Regal Medical Group
621 E Carnegie Dr. Ste 140,
San Bernardino, CA 92408
(818) 654-3400
Optum, formerly PrimeCare
3990 Concourse St.,
Ontario, CA 91764
(909) 605-8000
Optum Care Network - Citrus Valley
9130 Anaheim Place Ste 130,
Rancho Cucamonga, CA 91730
(909) 466-8000
(909) 484-6825
Optum Care Network - Corona
2275 Sampson Ave. Ste 111,
Corona, CA 92879
(951) 371-8440
(951) 371-3910
Optum Care Network - Inland Valley
9130 Anaheim Pl. Ste 130,
Rancho Cucamonga, CA 91730
(909) 466-8000
(909) 484-6825
Optum Care Network - Moreno Valley
1467 Ford St. Ste 103,
Redlands, CA 92373
(909) 798-7766
(909) 792-8627
Optum Care Network - Redlands
1520 Barton Rd.,
Redlands, CA 92373
(909) 798-7766
(909) 792-8627
Optum Care Network - Riverside
2275 Sampson Ave. Ste 111,
Corona, CA 92879
(951) 371-8440
(951) 371-3910
Optum Care Network - San Bernardino
1467 Ford St. Ste 103,
Redlands, CA 92373
(909) 798-7766
(909) 792-8627
Optum Care Network - Southwestern Valleys
41391 Kalmia St. Ste 310,
Murrieta, CA 92562
(951) 461-0762
(951) 698-5194
Riverside Medical Clinic
3660 Arlington Ave.,
Riverside, CA 92506
Administración del Tratamiento con Medicamentos - Administración del Tratamiento con Medicamentos
iento con Medicamentos (Medication Therapy Management, MTM) a los Miembros que reúnan los requisitos. MTM es un término que se utiliza para describir una amplia gama de servicios que ofrecen los farmacéuticos de nuestro equipo de atención médica.
El Equipo Clínico de Servicios Farmacéuticos de IEHP revisa sus medicamentos a fin de asegurarse de que usted esté tomando los adecuados para sus condiciones de salud. Si usted es un Miembro que reúne los requisitos para el Programa de MTM, recibirá una carta de nuestra parte. Estará inscrito, a menos que usted decida lo contrario. El programa cuesta $0 para quienes reúnan los requisitos.
¿Quiénes podrían ser elegibles?
Es posible que algunos Miembros que han sido identificados para este programa solo tengan la cobertura de Medi-Cal con IEHP.
O es posible que estén inscritos en el IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan). Deben cumplir los requisitos y recibirán los servicios para el Programa de MTM de Medicare. (Vea la descripción a continuación).
¿Qué son los servicios de MTM?
Los servicios de MTM de IEHP incluyen los siguientes elementos principales:
Revisiones del tratamiento con medicamentos
Educación sobre medicamentos: incluye un plan de acción de medicamentos
Control de enfermedades
Nuestro Equipo Clínico de Servicios Farmacéuticos de IEHP revisa los medicamentos, antecedentes familiares, estatus o fases de enfermedades y objetivos del tratamiento con medicamentos para el Miembro. Este equipo ofrece recomendaciones al Miembro y a los proveedores basándose en una revisión completa.
Un equipo de farmacéuticos y técnicos registrados se coordina con su Doctor (u otro proveedor) y las farmacias para ofrecerle una atención completa. También nos mantenemos en comunicación con nuestros equipos de Coordinación de Atención Médica para ofrecerle una “atención médica integral” a nuestros Miembros.
Programa de MTM de Medicare
La Farmacia Clínica de IEHP ofrece los servicios de MTM sin costo adicional para los Miembros de IEHP DualChoice que:
tengan varios problemas de salud,
estén tomando muchos medicamentos recetados, y
tengan medicamentos de alto costo
Una vez que esté inscrito en el programa, recibirá un paquete por correo con los detalles. También recibirá información sobre cómo cancelar su inscripción, en caso de que elija no participar en el programa. Si decide no participar en el programa, su inscripción y elegibilidad con IEHP DualChoice no cambiará. Esperamos que, si reúne los requisitos, participe en este programa que le ofrecemos sin costo para ayudarle a controlar mejor sus medicamentos.
El programa de MTM incluye una revisión anual completa de medicamentos (Comprehensive Medication Review, CMR) y una revisión específica de medicamentos (Targeted Medication Review, TMR). A continuación, presentamos algunos detalles sobre los servicios de MTM:
Revisión Completa de Medicamentos (CMR)
Un Farmacéutico Clínico de IEHP le proporcionará una revisión anual completa de sus medicamentos por teléfono. El Farmacéutico revisa sus medicamentos para asegurarse de que usted tenga los adecuados para su condición y para que evite interacciones entre medicamentos y más.
Una vez que se realice su CMR, recibirá su Plan de Acción de Medicamentos (Medication Action Plan, MAP) y su Lista Personal de Medicamentos (Personal Medication List, PML) por correo. Puede tener acceso a los documentos de los servicios de MTM, junto con una copia de la Lista Personal de Medicamentos, si llama a Servicios para Miembros y solicita hablar con el Equipo de Farmacia Clínica.
Revisión Específica de Medicamentos (TMR)
El Equipo Farmacéutico Clínico de IEHP también ofrecerá durante el año un servicio llamado: Administración del Tratamiento con Medicamentos (Medication Therapy Management, TMR), el cual permite revisar los inconvenientes de la interacción de los medicamentos que utilizan los Miembros participantes de IEHP DualChoice. El equipo realizará TMR para todos los beneficiarios inscritos cada tres meses. El beneficiario puede recibir recomendaciones de TMR por correo y además su Doctor de Cuidado Primario puede obtener sugerencias vía fax, esto si el Equipo Farmacéutico Clínico de IEHP lo considera necesario.
Para obtener más información, los Miembros de IEHP DualChoice elegibles para los servicios de Revisión Integral de Medicamentos (Comprehensive Medication Review, CMR) o para los servicios de TMR, pueden llamar al 1-877-273-IEHP (4347), de 8am a 8pm (Hora del Pacífico), los 7 días de la semana, incluidos los días festivos. Los usuarios de TTY deben llamar al 1-800-718-4347. Haga clic aquí y obtenga una forma para enlistar sus medicamentos personales.
REQUISITOS DE ELEGIBILIDAD:
Los servicios del Programa de MTM pueden tener criterios de elegibilidad limitados y no se consideran un beneficio. Están disponibles para las siguientes condiciones:
1. El Miembro tiene un mínimo de tres (3) estados de enfermedades:
Enfermedad ósea, artritis, osteoporosis
Enfermedad ósea, artritis, artritis reumatoide
Insuficiencia cardiaca crónica (Chronic Heart Failure, CHF)
Diabetes
Dislipidemia
Enfermedad renal en etapa terminal (End-Stage Renal Disease, ESRD)
Hipertensión
Condiciones de salud mental crónicas/discapacitantes
Enfermedad respiratoria: asma
Enfermedad respiratoria: enfermedad pulmonar obstructiva crónica (Chronic Obstructive Pulmonary Disease, COPD)
2. Al Miembro se le receta un mínimo de cinco (5) medicamentos diferentes para tratar esos estados de enfermedades:
Inhibidores de la enzima convertidora de angiotensina (Angiotensin-Converting Enzyme, ACE)
Bloqueadores de los receptores de la angiotensina II (Angiotensin II Receptor Blockers, ARB)
Antidepresivos
Antihiperlipidémico
Antihipertensivos
Antipsicóticos
Betabloqueadores
Broncodilatadores
Bloqueadores de los canales de calcio
Medicamentos antirreumáticos modificadores de la enfermedad (Disease-Modifying Anti-Rheumatic Drugs, DMARD)
Diuréticos
Insulinas
Hipoglucémicos orales
Inhibidores selectivos de la recaptación de la serotonina (Selective Serotonin Reuptake Inhibitors, SSRI)
Factores de necrosis tumoral (Tumor Necrosis Factors, TNF)
Corticosteroides inhalados
Calcimimético
Glucósido cardiaco
Factores estimulantes de colonias
Péptido similar al glucagón-1
Glucocorticosteroides
Inhibidor de neprilisina
Medicamentos antiinflamatorios no esteroideos (Nonsteroidal Anti-Inflammatory Drugs, NSAID)
Quelantes de fosfato
Análogos de vitamina D
3. Es probable que los costos de los medicamentos asciendan a $ 1,174 (una cuarta parte de $ 4,696) durante los tres meses previos.
Para obtener más información sobre MTM, llame a Servicios para Miembros de IEHP al 1-800-440-IEHP (4347), de lunes a viernes de 7am-7pm, y sábado y domingo de 8am-5pm. Los usuarios de TTY deben llamar al 1-800-718-4347.
La información en esta página es vigente a partir del 8 de octubre de 2021.
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