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Special Programs - Tobacco Cessation Services

acco Cessation Services   Provider Education Resources Smoking Cessation Resources - Help your patients quit Tobacco The CDC's Brief Tobacco Intervention ASK In a caring manner, at each visit, ...if your patients use tobacco If they do not, congratulate them If they do, proceed to next step ADVISE Patients who use tobacco to consider quitting. Tobacco products can lead to health problems such as...  Heart and Lung Disease Diabetes Stroke Ongoing infections and colds Cancer People exposed to secondhand smoke can also experience these health problems REFER If the patient is interested in quitting, connect them to KICK IT CA and any other local resource (below) Prescribe medications (if appropriate) Congratulate your patient on the decision to quit If patient is not ready to quit, user personalized motivational messages to encourage quitting. Let them know you are here when they are ready. Kick it CA How it works:  Patient will receive services from a Coach that has undergone rigorous training & apprenticeships, participates in weekly monitoring and case reviews, and attend continuing education courses on cultural competency. To enroll, patients can call, chat, or complete an online web form. The patient will then receive a Kick-Off call to collect their basic information and find out what they are trying to quit. Right after kick-off, coaching begins. The patient will receive clinically sound motivational interviewing. The coach will help patient put together a quit plan and set a quit date. The patient will then receive check-ins at times they are most susceptible to relapse. The coach will see if their quit-plan is working and help them modify as needed. Phone Number:  English - 1 (800) 300-8086 Spanish - 1 (800) 600-8191 Website: KICKITCA.ORG Text:  For English: Text "Quit Smoking" or "Quit Vaping" to 66819 For Spanish: Mande "Dejar de Fumar" o "No Vapear" to 66819 Other Smoking Cessation Resources: Link to Resources on Member page: Resources in the Inland Empire: Connect IE Information and Training for Providers: Local Tobacco Control Projects: Tobacco Free San Bernardino County: Tobacco Free Riverside County: (Back to Tobacco Cessation Services Menu) Tobacco Cessation Services By clicking on these links, you may be leaving the IEHP website. Training: Comprehensive Tobacco Cessation Services for Medi-Cal Members (PDF) The Smoking Cessation Leadership Center's (SCLC): Recordings Available for CME/CE Credit Kick it CA Education, Training and Technical Assistance: 5 Major Steps to Intervention: Tobacco Cessation CPT Codes for Identification ACA Facts Sheets and Resources (American Lung Association): Helpline: (also available in Spanish, Chinese, Korean, and Vietnamese) Continuing Medical Education California courses offered through UC Schools of Medicine: Tip: Use key word in search: Tobacco Cessation Centers for Disease Control Coverage for Tobacco Use Cessation Treatments: Patients Not Ready to Make a Quit Attempt Now (The “5 R’s”): University of California San Francisco’s Smoking Cessation Leadership Center’s Tools and Resources: USPSTF-Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions: USPSTF-Tobacco Use in Children and Adolescents: Primary Care Interventions: (Back to Tobacco Cessation Services 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.

Special Programs - California Children Services

page. What is CCS? CCS is a statewide program that enables children with qualifying conditions to receive specialized services related to that condition independent from IEHP. The CCS program provides diagnostic and treatment services, and medical case management for those who have qualifying conditions. CCS also provides occupational and physical therapy services through the Medical Therapy Program (MTP). The Medical Therapy Program (MTP) is a special program that provides physical therapy (PT), occupational therapy (OT), for children who have disabling conditions, generally due to neurological or musculoskeletal disorders Who Qualifies? The CCS program services children and young adults under the age of 21 who have eligible medical conditions. Examples of CCS-eligible conditions include, but are not limited to, chronic and acute medical conditions such as cystic fibrosis, hemophilia, cerebral palsy, heart disease, cancer, traumatic injuries, and infectious diseases producing major sequelae. For a more inclusive list of diagnoses and medical criteria of qualifying conditions please reference the below links: Provider Responsibilities Primary Care Physicians (PCPs), Specialty Providers, and IPA/Medical Groups are responsible for performing appropriate baseline health assessments and diagnostic evaluations sufficient to identify children and young adults with potential CCS-qualifying conditions and refer to CCS as needed. PCPs are responsible for all well child and pediatric preventative services as these services are not a covered benefit of CCS. PCPs are also responsible in assisting CCS members with transition from CCS to IEHP authorizations at the age of 21 when members age out of the CCS program. Benefits of CCS Enrollment CCS Clients are not restricted to in area providers but have access to any CCS paneled provider within the state of California when a need for the specialty care has been determined to be CCS eligible. Once a client is determined to be eligible for CCS, the client will continue to be medically eligible for CCS until treatment is complete or age 21 when the CCS program ends. Additional Resources To assist our valued Providers, every Member active with CCS has a distinct red “CCS” widget in the Provider Portal. Opening that widget enables you to view the diagnosis being treated and any Specialists and their treatment authorization range. For any questions about your Member’s CCS care or management, please do not hesitate to contact IEHP’s CCS Team at: (800) 706-4347 or by email at . (By clicking on the links below, you will be leaving the IEHP site) For additional CCS resources please reference the below links: CCS Program Overview: CCS Program Application: CCS Brochure (English/Spanish): How to become a CCS Provider: You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Join Our Network - IPA

p 2589 E Washington Blvd., Pasadena, CA 91107 (626) 817-9217 (626) 817-9207 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.       Beaver Medical Group       Chaffey Medical Group       FENIX Medical Group       Pinnacle Medical Group       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   Heritage Victor Valley Medical Group 12370 Hesperia Rd., Victorville, CA 92395 (760) 245-4747   Regal Medical Group 621 E Carnegie Dr. Ste 140, San Bernardino, CA 92408 (818) 654-3400   PrimeCare, part of Optum Care  3990 Concourse St., Ontario, CA 91764 (909) 605-8000   PrimeCare Chino 15315 Fairfield Ranch Rd. Ste 275, Chino Hills, CA 91709 (909) 465-1397 (909) 465-6629 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 - Hemet Valley 41391 Kalmia St. Ste 310, Murrieta, CA 92562 (951) 461-0762 (951) 698-5194 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 - Sun City 41391 Kalmia St. Ste 310, Murrieta, CA 92562 (951) 461-0762 (951) 698-5194 Optum Care Network - Southwestern Valleys 41391 Kalmia St. Ste 310, Murrieta, CA 92562 (951) 461-0762 (951) 698-5194 Optum Care Network - Valley Physicians  24630 Washington Ave. Ste 203, Murrieta, CA 92562 (951) 704-1900 (877) 397-7682 Riverside Medical Clinic 3660 Arlington Ave., Riverside, CA 92506    

Provider Resources - Clinical Practice Guidelines

assist primary care providers in delivering care in accordance with IEHP standards. Resources are reviewed regularly and updated to reflect changes from a regulatory and clinical standpoint. Preventive Care Guidelines American College of Obstetricians and Gynecologists (ACOG) American Academy of Pediatricians (AAP) / Bright Futures Comprehensive Perinatal Services Program (CPSP) Clinical Practice Guidelines Library The guidelines contained on this page are recommended by IEHP with the intent to enhance Member care. IEHP’s Clinical Practice Guidelines topics are organized using the following categories: United States Preventive Services Task Force (USPSTF); IEHP Internal Library; Healthcare Effectiveness Data Information Set (HEDIS); and Managed Care Accountability Set (MCAS) Links or documents embedded within the Internal Library category indicate literature that has been published by leading, formal organizations and have been endorsed/approved by IEHP’s Medical Directors and Quality Committee. IEHP produced information relevant to the topic will also be listed in this category. We have also indicated any HEDIS/ MCAS measures that are pertinent to the topic. Additionally, IEHP accepts USPSTF guidelines to help primary care clinicians identify clinical preventive services that are appropriate for their patients. IF there is a USPSTF guideline relevant to the topic, we have identified it below.  Library Catalog Click on a letter to jump to that specific section: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z A Asthma USPSTF N/A IEHP Internal Library Global Strategy for Asthma Management and Prevention (PDF) HEDIS Asthma Medication Ratio (AMR) Medication Management for People with Asthma (MMA) MCAS Asthma Medication Ratio (AMR) (Back to Library Catalog) B Breast Cancer USPSTF Breast Cancer Screening Use of Medications to Prevent Breast Cancer BRCA Testing IEHP Internal Library N/A HEDIS Breast Cancer Screening (BCS) MCAS Breast Cancer Screening (BCS) (Back to Library Catalog) C Cervical Cancer USPSTF Cervical Cancer Screening IEHP Internal Library N/A HEDIS Cervical Cancer Screening (CCS) MCAS Cervical Cancer Screening (CCS) (Back to Library Catalog) Chlamydia USPSTF Chlamydia and Gonorrhea Screening IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS Chlamydia Screening in Women (CHL) MCAS Chlamydia Screening in women (CHL) (Back to Library Catalog) Cholesterol USPSTF Statin Therapy for Primary Prevention of CVD Healthful Diet and Physical Activity for CVD Prevention in Adults with CVD Risks IEHP Internal Library American Heart Association – Blood Cholesterol Management (PDF) American Heart Association – Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (PDF) HEDIS Statin Therapy for Patients with Cardiovascular Disease-Adherence (SPC) Statin Therapy for Patients with Cardiovascular Disease – Statin Therapy (SPC) MCAS N/A (Back to Library Catalog) Chronic Obstructive Pulmonary Disorder USPSTF N/A IEHP Internal Library Global Initiative for Chronic Obstructive Lung Disease – COPD (PDF) HEDIS Pharmacology Management of COPD Exacerbation – Systemic Corticosteroids (PCE) Pharmacology Management of COPD Exacerbations – Bronchodilators (PCE) Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR) MCAS N/A (Back to Library Catalog) Colorectal Cancer USPSTF Colorectal Cancer Screening IEHP Internal Library N/A HEDIS Colorectal Cancer Screening (COL) MCAS N/A (Back to Library Catalog) D Depression USPSTF Screening for Depression in Adolescents Screening for Depression in Adults including Pregnant Women Screening for Perinatal Depression IEHP Internal Library American Academy of Pediatrics – Adolescent Depression in Primary Care (PDF) American Psychiatric Association – Major Depressive Disorder (PDF) HEDIS Antidepressant Medication Management Acute Phase (AMM) Antidepressant Medication Management Continuation Phase (AMM) MCAS Antidepressant Medication Management Acute (AMM-Acute) Antidepressant Medication Management Continuation (AMM-Cont) (Back to Library Catalog) Diabetes USPSTF Gestational Diabetes Screening Prediabetes and Type 2 Diabetes: Screening IEHP Internal Library American Diabetes Association – Diabetes Care (PDF) National Kidney Foundation – Diabetes and Chronic Kidney Disease (PDF) HEDIS Statin Therapy for Patients with Diabetes – Adherence (SPD) Statin Therapy for Patients with Diabetes – Statin Therapy (SPD) Comprehensive Diabetes Care – HbA1C Testing (CDC) Comprehensive Diabetes Care - HbA1C Control (<=9) (CDC) Comprehensive Diabetes Care (<8) (CDC) Comprehensive Diabetes Care - Eye Exam (CDC) Comprehensive Diabetes Care – Monitoring for Nephropathy (CDC) Comprehensive Diabetes Care – Blood Pressure Control (<140/90) (CDC) MCAS Comprehensive Diabetes Care HbA1C Testing (CDC HT) Comprehensive Diabetes Care HbA1C Testing >9%) (CDC H9) (Back to Library Catalog) E (Back to Library Catalog)   F (Back to Library Catalog)   G Gonorrhea USPSTF Chlamydia and Gonorrhea Screening IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS N/A MCAS N/A (Back to Library Catalog) H Hepatitis C USPSTF Hepatitis C Virus Infection in Adolescents and Adults: Screening IEHP Internal Library American Association for the Study of Liver Diseases – Hepatitis C (PDF) HEDIS N/A MCAS N/A (Back to Library Catalog) Human Immunodeficiency Virus (HIV) USPSTF HIV Screening in Pregnant Persons HIV Screening in Adults and Adolescents HIV Prevention – Preexposure Prophylaxis IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS N/A MCAS N/A (Back to Library Catalog) Hypertension USPSTF Screening for Hypertension in Adults IEHP Internal Library Joint National Committee – Hypertension Guidelines (PDF) HEDIS Controlling high blood pressure (CBP) MCAS Controlling high blood pressure (CBP) (Back to Library Catalog) I (Back to Library Catalog)   J (Back to Library Catalog)   K (Back to Library Catalog) L (Back to Library Catalog)   M (Back to Library Catalog)   N (Back to Library Catalog)   O Obesity USPSTF Weight Loss to Prevent Obesity Related Morbidity and Mortality in Adults - Counseling Screening for Obesity in Children and Adolescents Behavioral Health Counseling for Adults that are Overweight or Obese and Have Other CVD Risk Factors IEHP Internal Library N/A HEDIS Weight Assessment and Counseling (WCC-BMI) Adult Body Mass Index (ABA) MCAS Weight Assessment and Counseling (WCC-BMI) Adult Body Mass Index (ABA) (Back to Library Catalog) Osteoporosis USPSTF Osteoporosis to Prevent Fractures: Screening IEHP Internal Library N/A HEDIS Osteoporosis management in women who have had a fracture (OMW) MCAS N/A (Back to Library Catalog) P (Back to Library Catalog) Q (Back to Library Catalog) R (Back to Library Catalog) S Sexually Transmitted Infections USPSTF Syphilis Screening in Pregnant Women Syphilis Screening for those at Increased Risk for Infection Chlamydia and Gonorrhea Screening HIV Screening in Pregnant Persons HIV Screening in Adults and Adolescents HIV Prevention – Preexposure Prophylaxis IEHP Internal Library Centers for Disease Control Public Health Media Library – STD Treatment You may also refer to individual topics as they appear in this library: Chlamydia Gonorrhea HIV Syphilis HEDIS Chlamydia Screening in women (CHL) MCAS Chlamydia Screening in women (CHL) (Back to Library Catalog) Skin Cancer Behavioral Counseling USPSTF Skin Cancer Prevention: Counseling IEHP Internal Library N/A HEDIS N/A MCAS N/A   (Back to Library Catalog) Smoking Cessation/Tobacco Usage USPSTF Smoking Cessation Smoking Cessation – Pharmacotherapy Lung Cancer Screening Tobacco Use in Children and Adolescents – Primary Care Interventions IEHP Internal Library N/A HEDIS N/A MCAS N/A (Back to Library Catalog) Syphilis USPSTF Syphilis Screening in Pregnant Women Syphilis Screening for Those at Increased Risk for Infection IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS N/A MCAS N/A (Back to Library Catalog) T Tuberculosis USPSTF Latent Tuberculosis Screening IEHP Internal Library N/A HEDIS N/A MCAS N/A (Back to Library Catalog) U (Back to Library Catalog) V (Back to Library Catalog) W (Back to Library Catalog) X (Back to Library Catalog) Y (Back to Library Catalog) Z (Back to Library Catalog) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Provider Resources - 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

有用資訊與資源 - 緊急安全

備方面的協助 (例如輪椅、呼吸機、氧氣監測儀等),可於週一至週五上午 8 點至下午 5 點 (太平洋標準時間) 致電 IEHP  會員服務中心,電話  1-800-440-IEHP (4347)。TTY 使用者請撥  1-800-718-4347。如果您需要續取藥物,請前往藥局申請續領。 如何為緊急情況預作準備。 公共安全停電警報 我們鼓勵您註冊警報,以便能夠掌握「公共安全停電」可能發生的時間,以及電力何時能夠恢復。  按一下此處進行註冊。  用藥安全 有些藥物可能需要存放於冰箱中才能維持其藥效,包括許多藥水。如果停電一天或更長時間,除非藥物標籤另有指示,否則請丟棄應該冷藏的任何藥物。如果需要依賴冷藏藥物 (例如胰島素) 維繫生命,請僅在取得新藥品前使用。請儘快更換所有冷藏藥物。 資源 冷藏藥物儲存 (PDF) 緊急情況下的胰島素儲存與藥物轉換 (PDF) 胰島素比較 (PDF) 耐用醫療設備安全性 使用下面的核對清單以便為停電預作準備。 經常檢查您的備用電力設備,確保其在緊急情況期間能夠正常運作。 事先打電話給電力與自來水公司說明您在維生設備方面的需要 (居家透析、抽痰機、呼吸機等) 以免災難發生時措手不及。 將氧氣設備的關閉開關放在您手邊,以便在發生緊急情況時可以快速操作。 發電機使用者應在開闊區域操作發電機,以確保良好的空氣循環。 經常測試發電機以確保它在需要時能夠運作。 制定在停電時如何為電池充電的計畫。 當電力恢復時,請確定醫療設備的設定沒有被更改。 資源 耐用醫療設備的緊急電力規劃核對清單 (PDF) 如何為需要電力的醫療設備做好停電時的準備和處理 - FDA 心理健康 如果您受到火災的影響並且需要與壓力或悲傷有關的心理健康照護,可於週一至週五上午 8 點至下午 5 點 (太平洋標準時間) 致電 IEHP 會員服務中心,電話  1-800-440-IEHP (4347)。TTY 使用者請撥  1-800-718-4347。 其他提示 準備或補充您的緊急補給箱,裡面放置的物品包括食物、飲用水、手電筒、收音機、全新電池、急救用品以及現金。 確定手機的備用充電方法。 學會如何手動打開車庫門。 如果您擁有備用發電機,請確保它能夠安全運作。 擬定火災行動計畫,包括住家、家人與寵物的疏散規劃。 資源 緊急疏散準備:為您的安全負責,身心障礙以及其他活動受限者的指南 緊急健康資訊:Savvy Health Care Consumer 系列 身心障礙以及活動受限者的緊急補給箱 需要過夜的緊急旅遊安全提示 行動裝置緊急使用提示 針對使用依賴電力和電池輔助技術與醫療設備人員進行的緊急電力規劃  

歡迎加入 IEHP!

使命始終是幫助會員取得 高品質的醫療、行為健康和保健服務。 IEHP 簡介 IEHP 是管理式照護健保計畫。我們成立於 1996 年,當時有 62,000 位 Medi-Cal 會員。 時至今日,我們已擴大為前 10 大 Medi-Cal 健保計畫。IEHP 的網絡有超過 8,000 個醫 療服務提供者以及超過 2,000 位員工,為 Riverside 和 San Bernardino 郡逾 140 萬居民 服務。我們與您當地的醫師、醫院和其他健 康照護服務提供者合作,向會員提供更理想 的健康照護協調及高品質照護。 身為 IEHP 會員, 我可以取得哪些福利? 加入 IEHP,您也可以使用: 由超過 8,000 個醫師、專科醫師和其 他健康照護服務提供者組成的網絡 照護協調  24 小時護士諮詢專線 視力服務 緊急照護中心 養成健康生活習慣的課程和方案 還有更多其他福利! 如需更多關於 IEHP 福利和服務的資訊, 請前往我們的網站,網址, 或聯絡 IEHP 會員服務部。 我成為 IEHP 會員後還 可以保有 MEDI-CAL 嗎? 可以的,您仍可保有 Medi-Cal 以及您原本 即有的全部福利和服務,例如無月費及醫 生看診、藥物和住院零費用。唯一的不同是 您的健康照護服務現在將透過 IEHP 協調。 其他 Medi-Cal 服務包括預防照護,例如疫 苗和精神健康、發展和物質濫用失調篩檢。 您可透過 Medi-Cal 牙科方案取得按服務收 費的 Medi-Cal 牙科服務。 我加入 IEHP 後還可以繼續去看 同樣的醫師嗎? 只要醫師在 IEHP 的醫療服務提供者網絡 中,您就可以繼續向同一位醫師接受照護。 您可以致電 IEHP 會員服務部查詢,電話 1-800-440-IEHP (4347),週一至週五,太 平洋標準時間 (PST) 上午 8 時至下午 5 時。 聽語障專線使用者請撥 1-800-718-4347。 如果您也有 Medicare,只要醫師服務是由 Medicare 提供,您便能繼續去看這些醫師。 認識我們 我們的使命 我們要療癒和鼓舞人心。 我們的期許 我們的努力永不停止,因為我們要讓服務的 社區都享有最佳照護,讓民眾活躍而健康。 我們的價值 我們做正確的事,例如: 將會員視為我們的核心利益。 揮灑創意、發揮勇氣以增進民眾健康與 福址。 始終以負責的態度專注於我們的工作。 對於我們與會員、醫療服務提供者、合作 夥伴及彼此間的承諾,絕不妥協。 我們很樂意回答您的問題,幫助您開始踏出 邁向健康的旅程!  

Medi-Cal 於加州提供的醫療福利與給付範圍

需支付任何費用。「具醫療必要性」係指為保護生命、避免您患重大疾病或殘障,或協助您減少確診疾病、病痛或傷害帶來的痛苦,此項醫療合理且必要。 若要進一步瞭解 IEHP 的各項福利與服務,請參閱 IEHP Medi-Cal 會員手冊 (PDF) 第 4 章或聯繫 IEHP 會員服務中心,電話 (800) 440-IEHP (4347),TTY 使用者請撥 (800) 718-4347。 IEHP 提供以下類型的服務: 門診 (非住院) 服務* 急診服務 跨性別服務* 臨終關懷與安寧照護* 住院治療* 產婦與新生兒照護 心理健康服務 處方藥 康復與復健服務及設備* 實驗室與放射線服務,如 X 光* 預防與健康服務以及慢性疾病管理 敏感性服務 物質使用障礙治療服務 兒科服務 視力服務* 非緊急醫療交通 (Non-Emergency Medical Transportation, NEMT) 非醫療交通 (Non-Medical Transportation, NMT) 長期服務與援助 (Long-Term Services and Supports, LTSS) 遠程醫療服務 上述部分服務僅於預先取得 IEHP 或您的 IPA 核准之情況下方適用。標示星號 (*) 的是可能需預先取得IEHP、您的IPA或醫療組的核准后,計劃所承保的服務。 視力服務 計劃承保範圍: 每 24 個月提供一次例行性視力檢查;IEHP 可能在具醫療必要性之範圍內預先核准 (預先授權)  其他服務。 每隔 24 個月配製一副眼鏡 (含鏡框與鏡片);在醫療狀況需要的情況下,可配製隱形眼鏡,譬如無晶體狀態、無虹膜畸形以及圓錐角膜  限制規定 僅限單光鏡片。 未滿 18 歲會員可自動獲配聚碳酸酯鏡片。 僅在具醫療必要性之情況下方可配製隱形眼鏡。 牙科服務 Medi-Cal Dental Program 承保部分牙科服務,如:  診斷性與預防性口腔衛生 (例如:檢查、X 光以及牙齒清潔) 為止痛而提供的緊急服務 拔牙 補牙 根管治療 義齒裝置 符合條件的兒童齒顎矯正 會員可通過注冊加入Medi-Cal Dental Program的牙科服務提供者獲得牙科服務。提供者將向您建議最佳治療方法,以及可獲得治療的時間。 若要進一步瞭解牙科服務,請與 Medi-Cal Dental Program 聯繫,電話 1-800-440-IEHP (4347)/TTY 使用者請撥 (800) 718-4347。您也可造訪 Denti-Cal 網站。 交通服務 您的Medi-Cal福利包括聖貝納迪諾郡和河濱郡内計劃承保的健康服務、以及Medi-Cal 承保服務所需的往返交通。例如心理健康,藥物濫用與牙科服務。 計畫承保範圍: 造訪您基本保健醫生、專科醫生與緊急照護診所。 造訪牙科、心理健康、藥物濫用與其他服務。 除外項目與限制規定 IEHP 不承保: 單程行程與非醫療訪視。 造訪社會安全局、勞工賠償索賠、人身傷害案例、法院、假釋或緩刑或社會服務辦事處。 IEHP 提供兩種交通方式: 適用非醫療交通 (Non-Medical Transportation, NMT) 的公車票*:當您未出現任何不允許您搭乘公車、汽車、計程車或其他公共交通工具的身體或醫療問題時,可核准此方式。 適用非醫療交通 (NMT) 的 Uber:當您所在區域不提供公車交通或您需要跨郡活動時,可核准此方式。對於此類交通方式,您必須在路邊等候預約的車輛。 非緊急醫療交通 (Non-Emergent Medical Transportation, NEMT): 當您的身體或心理狀況不允許您搭乘公車、汽車、計程車或其他公共交通工具時,可核准此方式。對於此類交通方式,您的醫師必須線上提交醫師證明書。 自 2020 年 3 月 1 日起,例行性看診的交通安排,包括行為健康與藥物濫用,都必須在約診日期前五個工作日預訂。欲安排交通相關事宜,請於週一至週五上午 8 點至下午 5 點致電 IEHP 運輸部,電話 1-800-440-4347 (撥通後請按 2)。TTY 使用者請撥 1-800-718-4347 (撥通後請按 2)。 *對於公車票,請致電 Call the Car (CTC),電話 855-673-3195 (撥通後請按 1)。在您取得公車票之後,即可用於您的健康照護看診。 您需使用 Adobe Acrobat Reader 6.0 或更高版本,才能閲讀PDF 文檔。請點選 Adobe Acrobat Reader 下載免費版本。  產後護理擴展計劃 產後護理擴展計劃旨在為 Medi-Cal 會員於懷孕期間和妊娠終止後提供延長承保。 IEHP 將產後護理擴展計劃的承保範圍延長為妊娠終止後最多 12 個月,不論會員的收入,公民身分或移民身分為何,也不需要採取額外行動。 快速全基因組測序 快速全基因組測序 (Rapid Whole Genome Sequencing, rWGS) (包括個別定測序,父母其中一方或父母雙方和其寶寶的三重測序以及超快速測序) 是一項承保福利,適用於一歲以下且在加護病房接受住院服務的任何 Medi-Cal 會員。rWGS 是一種用於即時診斷疾病的新方法,可對加護病房 (Intensive Care Unit, ICU) 中一歲以下兒童的護理服務產生影響。如果您的孩子符合加州兒童服務 (California Children’s Services, CCS) 的資格,CCS 可能需負責承保住院和 rWGS。 轉介 對於某些類型的照護,您的 PCP 或專科醫生在為您提供照護之前,需要取得 IEHP 許可。這稱為取得事先授權、事先核准或預先核准。這表明IEHP 必須從照護與服務的適當性及承保範圍等方面,確保照護具醫療必要性或有需要提供。若相關照護係為保護您的生命、避免您患重大疾病或殘障,或協助您減少確診疾病、病痛或傷害帶來的痛苦,而合理且必要,則「具醫療必要性」。 對於部分服務,您需要取得事先核准 (事先授權)。依據《衛生安全法》(Health and Safety Code) 第 1367.01(h)(2) 條規定,IEHP在收到合理的資訊后,5個工作日内將做出例行性事先核准的決定。 如果您的醫療服務提供者指出等待標準的回復時間可能會嚴重傷害您的生命,健康或取得、維持、恢復最大功能的能力,經過IEHP確定后,IEHP 將加快 (快速) 事先核准決定。IEHP 將依據您的健康狀況儘快發出通知,最晚不會超過收到申請後 72 小時。 若 IEHP 未核准申請,IEHP 將發送行動通知 (Notice of Action, NOA) 信函給您。NOA 信函將說明在您不同意相關決定時,如何提起申訴。若 IEHP 需要更多時間或更多資訊才能審核您的申請,IEHP 將與您聯繫。 照護持續性  若您目前的醫療服務提供者並非 IEHP網絡内的醫生(指網絡外),則在特定情況下,您可持續接受照護,時間最長為 12 個月。若您的醫療服務提供者未於前述 12 個月後加入 IEHP 網絡,您將需要換成 IEHP 網絡内的提供者。若您是新會員且在加入 IEHP 之前已取得網絡外提供者的照護服務,您可要求繼續獲得該提供者的醫療服務。IEHP 將決定由網絡外提供者進行治療是否具醫療適當性。照護持續性並不適用耐用醫療設備、交通、輔助服務、本計劃外Medi-Cal所承保的服務、或者Medical不承保的服務。 若要進一步瞭解照護持續性與資格條件,請致電 1-800-440-IEHP (4347) 與 IEHP 會員服務中心聯繫。 處方藥 大多數處方藥均由 Medi-Cal Rx 承保,可能有部分藥物由 IEHP 承保。您的醫療服務提供者會開立在 Medi-Cal Rx 合約藥物清單上的藥物處方。 如欲查詢藥物是否有在合約藥物清單中或要索取合約藥物清單,請撥打 Medi-Cal Rx 電話 1-800-977-2273 (聽語障專線 1-800-977-2273,接通後按 5,或 711),也可以瀏覽 Medi-Cal Rx 網站,或致電 IEHP 會員服務部,電話 1-800-440-IEHP (4347),服務時間週一至週五,上午 8 時至下午 5 時。聽語障專線使用者請撥 1-800-718-4347 或 711。 藥局 如果要領取或補充處方藥,您必須憑處方向與 Medi-Cal Rx 合作的藥房取得藥物。您可以在 Medi-Cal Rx 藥房名錄中找到與 Medi-Cal Rx 合作的藥房名單,請上網。您也可以致電查詢您附近的藥房,Medi-Cal Rx 電話 1-800-977-2273 (聽語障專線 1-800-977-2273,接通後按 5,或 711)。或請致電 IEHP 會員服務部,電話 1-800-440-IEHP (4347),服務時間週一至週五,上午 8 時至下午 5 時。聽語障專線使用者請撥 1-800-718-4347 或 711。    


ndation is focused on connecting the diverse communities of the Inland Empire with access to a better, more joyful life through programs and initiatives aimed at resolving the root causes of illness, health equity and core needs, including food, shelter and safety. The Foundation was established in July 2022 by Inland Empire Health Plan (IEHP) to ensure all communities throughout the region have access to Vibrant Health, which entails going beyond traditional healthcare services and reaching the region’s most vulnerable populations. Efforts include supporting pilot programs, identifying innovative solutions that improve health outcomes, acting as a convener, collaborator and partner with community and faith-based organizations and much more. Foundation Leadership Angelica Baltazar, MSW, serves as the IEHP Foundation President and has more than 20 years of experience in the public health and human services sectors. She holds a bachelor’s in social work from Cal Poly Pomona and a master’s in policy planning and administration from Loma Linda University. Baltazar is a board member of the Greater Ontario Business Council, Promise Scholars and Partners for Better Health. IEHP Foundation Board of Directors The Foundation is guided by an esteemed, experienced and passionate group of individuals who comprise the Board of Directors: Chair Stephen Bennett, Caravanserai Project Board Chair and Co-Founder Vice Chair Karen Scott, First 5 San Bernardino Executive Director Secretary Regina Weatherspoon-Bell, Founder DVL Project/A Better Way/Victor Valley Domestic, Inc. Treasurer Conrado Bárzaga, MD, Desert Healthcare District & Foundation Chief Executive Officer Josh Candelaria, Viewpoint Advocacy Principal Edward Juhn, MD, MBA, MPH, IEHP Chief Quality Officer Geoffrey Leung, MD, County of Riverside Public Health Officer Jarrod McNaughton, MBA, FACHE, IEHP Chief Executive Officer Combined with their sincere and heartfelt desire to make a difference for all the communities in the region, the board is committed to long-term sustainable change for overall community health improvement. Follow Along on Our Journey Join us as we meet with local communities and organizations to listen to their needs and gain an in-depth understanding of the Inland Empire non-profit landscape. Follow us on Instagram @IEHPFoundation and connect with us on LinkedIn We aspire to significantly transform this region but to make a definitive and long-lasting impact, we are committed to in-depth and ongoing collaborative discussions about the needs and desires of the communities we hope to serve. If you would like to connect, please email us at Press Releases IEHP Announces Angelica Baltazar as New Foundation President IEHP Foundation Launches to Serve Most Vulnerable Communities IEHP Foundation is a 501(c)(3) nonprofit

最新消息 - IEHP 名列提供者滿意度第 99 位

在全美提供者滿意度排行中名列第 99 位。能在滿意度方面得到高分固然令人振奮,但本計畫更關注 能進一步支援提供者的領域和機會。  這項調查每年由第三方透過電話進行,調查對象是本健康計畫的提供者網路,旨在評估提供者對從 IEHP 獲得的服務與支援的滿意度。調查內容包括初級照護醫師、專科醫師以及行為健康提供者的回答。 IEHP 營運長 Susie White 說道:「透過提供者滿意度調查分享的資訊相當重要,今年尤其如此。我們的提供者就代表著我們,他們最早知道哪些事情可行、哪些事情不可行。為了確保我們的會員能得到他們所需的照護與服務,我們必須確保提供者確實能夠對我們提供的工具和資源運用自如。」 為了對健康計畫提供者網路進行有效的調查,本項調查著重於提供者滿意度的主要驅動因素,其中包括:照護管理師的普及性,健康計畫客服中心職員在替患者爭取轉介時是否幫得上忙,以及能否及時取得預先認證、轉介或授權資訊。 在回答調查問卷的提供者當中,98.7% 的提供者表示他們會向其他醫師院所推薦 IEHP。若依類別細分,IEHP 在「提供者關係」、健康計畫客服中心職員、藥局、使用率和品質控管,以及照護協調等項目的排名落在第 99 位。本健康計畫的財務類別分數也排在第 98 位。 本健康計畫在調查中的遠程醫療服務方面得到很好的分數,但 IEHP 確實發現了一個機會,有助於提升對使用遠程醫療服務的資源與資訊的普及程度。 White 補充說道:「今年對我們的提供者來說非常難熬,得到好評難免激勵人心,但我們也非常渴望知道我們還能做些什麼,才能支援提供者繼續為我們的會員和社區提供照護。」 「我們會繼續與提供者一起度過難關,同時也希望提供者知道,我們承諾作為他們的後盾,這一點從未動搖,」White 表示,「我們是社區型健康計畫,有責任因應他們的需求並繼續調整、改善和傾聽,讓我們的會員和社區都能享有最完善的照護,保持健康活力。」 />

投保 IEHP DualChoice

HMO D-SNP) 計畫的資格。我們的 IEHP DualChoice 計畫可協助您獲得所需的護理,帶給您最佳健康。 以 0 美元獲得的給付福利包括: 就醫,如例行檢查和生病就醫 來自 IEHP DualChoice 處方集的處方藥 醫院護理,如急診室服務和急需服務等,目前有資格運用 Medi-Cal,而且  專科病例 加上額外福利,如: 視力照護:每兩年以 350 美元為限的隱形眼鏡與一般眼鏡(含鏡框與鏡片)費用 為承保的公用事業提供 40 美元的公用事業津貼。您必須符合該福利的資格。 誰有資格投保 IEHP DualChoice (HMO D-SNP)? IEHP DualChoice 同時適用 Medicare (A 與 B 部分) 與 Medi-Cal 會員。下列資訊說明哪些人符合 IEHP DualChoice (HMO D-SNP) 的資格。 適用族群: 強制投保 Medi-Cal 福利,包括長期服務與支援 (LTSS) 福利,以及 Medicare 福利。 若您符合下列條件,則您可以加入我們的計畫: 居住在我們的服務區域內(被監禁者即使實際位於該地理服務區域,也不被視為居住於該服務區域),以及 投保時年滿 21 歲,且  擁有 Medicare A 部分和 Medicare B 部分;且 目前符合獲得 Medi-Cal 的資格,且 您是全福利的雙重合格受益人,並且為您的 Medicare 福利投保 IEHP DualChoice,為您的 Medi-Cal 福利投保 Inland Empire Health Plan (IEHP)。這被稱為獨家一致投保 (Exclusively Aligned Enrollment),且 為美國公民或在美國合法居留 如需投保,請於太平洋標準時間每天上午 8 點至晚上 8 點致電 1-800-741-IEHP (4347) 聯繫 IEHP DualChoice Medicare 團隊,假日亦提供服務。TTY 使用者請致電 1-800-718-4347。 IEHP DualChoice 投保表單 IEHP DualChoice (HMO D-SNP) 是與 Medicare 簽約的 HMO 計畫。投保 IEHP DualChoice (HMO D-SNP) 取決於合約續訂。 此頁面資訊為截至 2022 年 10 月 1 日的最新資訊。 H8894_DSNP_23_3241532_M Pending Accepted


CCM) 方案旨在為生病的會員提供協助。其中包括嚴重疾病 ,如心臟病、肺病、腎臟病、愛滋病 (AIDS)、C 型肝炎、脊椎受傷或任何其他未獲得控制的慢性病況。 IEHP 的照護管理團隊將會與您和醫生合作,以確保您取得所需的照護。我們可協助您管理您的疾病和藥物、協調照護、與您的醫療服務提供者合作並協助您取得任何必要的醫療器材。我們還會提供並邀請您善用跨科照護團隊 (Interdisciplinary Care Team, ICT) 來協助您擬定個人照護計畫。此團隊是由您的基本保健醫生、複雜照護經理以及為您健康照護需求提供支援的其他人士所組成。 您可能可透過下列選項獲得複雜照護管理 (CCM) 方案的轉介:  醫療管理方案轉介  出院規劃師轉介  執業人員轉介  照顧者轉介 自我轉介  如何加入複雜照護管理 (CCM) 方案 首先,我們將需要您填寫一份健康問卷調查以評估您的需求。該問卷調查將可協助判定您是否符合加入此方案的資格。如果您符合此方案的資格並想加入,您將會自動加入。 如果您不符合複雜照護管理 (CCM) 方案的資格,但您想取得有關您可使用之其他照護管理服務的進一步資訊,請致電 1-800-440-4347 與 IEHP 會員服務部聯絡。 在加入複雜照護管理 (CCM) 方案後,我們將會指派一位主要個案經理給您。個案經理將會至少每 30 天與您聯絡一次,以討論您的健康目標。個案經理也會協助您擬定計畫以達到這些目標。 如欲開始使用服務,請致電 1-800-440-IEHP (4347) 與 IEHP 會員服務部聯絡,服務時間為週一至週五,上午 7 時至晚上 7 時及週六至週日,上午 8 時至下午 5 時。TTY 使用者請致電 1-800-718-4347。 如何退出複雜照護管理 (CCM) 方案 在加入此方案後,您可隨時退出此方案。您只需致電 1-800-440-4347 與 IEHP 會員服務部聯絡,並告知對方您不想再參加此方案即可。請務必也通知您的個案經理。   

有用資訊與資源 - 假日排程

January 2, 2023 Martin Luther King, Jr. Day - Monday, January 16, 2023 President's Day - Monday, February 20, 2023 Memorial Day - Monday, May 29, 2023 Juneteeth - Monday, June 19, 2023 Day before Independence Day - Monday, July 3, 2023 Independence Day - Tuesday, July 4, 2023 Labor Day - Monday, September 4, 2023 In observance of Veteran's Day - Friday, November 10, 2023 Thanksgiving Day - Thursday, November 23, 2023 Day after Thanksgiving - Friday, November 24, 2023 Christmas Day - Monday, December 25, 2023    

會員諮詢委員會 - 公共政策參與委員會

工作人員與會員共聚一堂,為會員提供公開討論的平台。 在會議進行期間,會員們將有機會針對有關會員資料以及他們在接受 IEHP 照護時的整體體驗提供反饋意見。我們同時還會討論 IEHP 文化和語言 (Cultural and Linguistic, C&L) 服務計畫。 經過遴選參與計畫的會員每次出席會議將可獲得 75 美元的補助。  如果您有興趣在公共政策委員會服務,請按一下此處。 2022 會議排程:  2023 年 3 月 16 日 2023 年 6 月 15 日 2023 年 9 月 21 日 2023 年 12 月 21 日  

有用資訊與資源 - 簡訊發送計畫

下事項向您發送重要的醫療保健通知: 通知您如何透過 IEHP 接受照護與服務 提醒您有關關鍵預防性照護看診,協助您維持健康 告知您符合資格的健康教育與保健計畫 以及更多其他福利 若要註冊,會員需要發送短信 “Healthy” 至 90902。可能需要收取短信與數據費用。 如需協助,請發送短信 HELP 至 90902 或是發送電子郵件至。會員可隨時回覆 STOP 取消注冊。短信頻率會有所不同。 此簡訊發送計畫適用於以下電訊公司訂閱者的會員:Boost、AT&T、T-Mobile®、Dobson、Verizon Wireless、U.S. Cellular、C Spire Wireless、Metro PCS、Cricket Communications、Virgin Mobile 及其他無線運營商。運營商對延遲或未送達的訊息不承擔任何責任。會員必須年滿 13 歲方可使用此服務。 您亦同意 IEHP 無線簡訊條款與條件。  我們尊重您的隱私。您可以在此找到我們的隱私權政策。 聯絡資訊: 10801 Sixth Street Rancho Cucamonga, CA 91730 1-800-440-IEHP (4347) 1-800-718-IEHP (4347)(TTY 使用者) 太平洋標準時間上午 8 點到下午 5 點 *此短代碼計畫由 mPulse 管理。  

Rx Prior Authorization Drug Treatment Criteria - Prior Authorization Drug Treatment

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) Spinraza (nusinersen) (PDF) Synagis (PDF) Xolair (omalizumab) (PDF)  Drug Class Prior Authorization Criteria Adult Enteral Nutritional Supplement (PDF) Antineoplastic Agents (PDF) Erythorpoieses-Stimulating Agents (PDF) Growth Hormones (PDF) Hepatitis C (PDF) Hereditary Angioedema (PDF) Immuno Globulins (PDF) Nutritional Supplement Infant Formula (PDF) Opioid Analgesics (PDF) Pediatric Enteral Nutritional Supplement (PDF) Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitor (PDF) Testosterone Hormone Replacement (PDF) Therapeutic Agents in Rheumatic And Inflammatory Diseases (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 January 1, 2022.

COVID-19 - 新冠病毒

打噴嚏在空氣中產生的飛沫進行傳染 (與普通的感冒或流感一樣)。州長 Newsom 於 2020 年 3 月 19 日發佈了一項適用全加州的命令,要求所有居民「待在家裡」,以最大限度地降低病毒傳播的風險,但有必要運作的實體除外。 COVID-19 的症狀有哪些? 大部分罹患 COVID-19 的人都感覺像是得了流感。老年人,尤其是患病或有其他疾病 (如糖尿病) 者,比較容易因為此病毒而產生重症。 症狀從輕微到嚴重都有,包括發燒、咳嗽、呼吸問題、感覺冷、反复打冷顫、肌肉酸痛、頭痛、喉嚨痛以及失去味覺或嗅覺。 如果您出現了上述症狀,應該怎麼做? 如果您認為自己可能感染了 COVID-19,請待在家中並先打電話給您的醫師診間。將您的症狀告訴他們,或告知他們您周遭是否有人的檢驗結果呈陽性。您的醫生可能會為您提供遠程醫療服務,或是告訴您接下來怎麼做。 如果您沒有辦法看醫生或者現在已經是下班時間,您可以致電 IEHP 的 24 小時護理師諮詢專線 1-888-244-4347,TTY 使用者請撥 711,此專線全年全天候 24 小時提供服務。我們訓練有素的護理師可提供醫療建議,同時如有需要,將會透過電話或是視訊聊天讓您與醫師連線。 何時應尋求緊急醫療照護 COVID-19 有幾個必須注意的緊急警訊 。若某人出現下列任何跡象,請立即尋求緊急醫療照護: 呼吸困難 胸部持續疼痛或胸悶 新的困惑情況 無法醒來或無法睡著 嘴唇或臉部發青 *此清單並未包含所有可能的症狀。如有任何其他嚴重症狀或您有所疑慮,請致電您的醫師。 COVID-19 檢測需要花費多少錢? IEHP承保標準*COVID-19檢測及由服務提供者訂購的檢測。會員無需為此類檢測付費。IEHP將支付由服務提供者訂購的檢測,包括聚合酶鍊式反應 (Polymerase Chain Reaction, PCR) 檢測、快速檢測及居家快速檢測等。如果您的醫生為您訂購了檢測,IEHP將承保該檢測費用。您的服務提供者必須直接向IEHP發送這些檢測的帳單。 IEHP不會對任何選擇支付COVID檢測費用的會員進行補償。其中包括可以在當天出結果的快速COVID-19檢測。 *標準COVID-19檢測的檢測結果通常在兩天內得出。

Clinical Information - 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 $1,174 (one-fourth of $4,696) for the previous three months are likely to be incurred.   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 Cal MediConnect Plan (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 October 2022. H5355_CMC_20_1900233_Accepted 

Pharmacy Pain Management - Pharmacy Pain Management

ively manage members on multiple opioid therapies to prevent overutilization, identify unsafe and inappropriate opioid use, and address potential fraud, waste, and abuse. Identified members at risk of opioid overutilization will be evaluation through our Pharmacy Pain Management Program (PPM). A clinical team will be reviewing member therapy and reaching out to the primary provider to discuss the existence of multiple prescribing providers, member's total opioid utilization, appropriate level of opioid use for the member, and considerations for implementation of a member-level claim edit. After review and consultation with the prescribing provider, if the member's therapy is determined to be appropriate and medically necessary, no further action will be taken.  Results of consultation with provider and findings will be documented. After review and consultation with the prescribing provider, if the member's therapy is determined to be inappropriate, and the provider recommends member-level point of sale claim edit, the member will be mailed a notification letter-that entrails the provider's recommendation.  Medicare members will receive the notice 30 days in advance of the point of sale claim edit implementation. Member may also be referred for evaluation and monitoring by a pain management specialist.   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. Resources and Tools: Pain Management CPG (PDF) Pain Quick Reference Guide (PDF) For convenience, the URL link to the State of California Department of Justice's Controlled Substance Utilization Review and Evaluation Systems (CURES), California Prescription Drug Monitoring Program (PDMP) site. By clicking on this link, you will be leaving the IEHP website.   Information on this page is current as of January 1, 2022  

Pharmacy Services - Pharmacy Network Lists

here to download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website.   To view IEHP’s current Pharmacy Network under IEHP DualChoice (HMO D-SNP) - Medicare-Medicaid Plan, please use this link: Under “How to Access Care” tab, click on “2022 IEHP DualChoice Provider and Pharmacy Directory (PDF)".   To view IEHP’s future Pharmacy Network under IEHP DualChoice (HMO D-SNP), please use this link: Under “How to Access Care” tab, click on “2023 IEHP DualChoice Provider and Pharmacy Directory (PDF)".   Information on this page is current as of November 02, 2022.