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Plan Updates - Coronavirus (COVID-19) Advisory

Control and Prevention (CDC) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus that was first detected in China and which has now been detected in almost 70 locations internationally, including in the United States. The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19"). IEHP will continually update you on the latest recommendations, news, and resources on COVID-19 as it becomes available. COVID-19 Symptoms and Members Care For a complete list of COVID-19 symptoms and step-by-step Member direction, visit our COVID-19 Member page. COVID-19 Therapeutics Available for Members In an effort to provide the most up-to-date treatments against COVID-19, IEHP continues to maintain a list of providers, including but not limited to infusion clinics, ancillary, hospital and non-hospital based infusion centers offering COVID-19 infusion therapy treatment. Under all Member coverage, outpatient COVID therapeutics will be offered immediately after a Member is determined to be clinically eligible under and Emergency Use Authorization (EUA). For more information, Providers can utilize the COVID-19 Therapeutics Clinical Consult Line to connect with other clinicians for a free and confidential consultation on COVID-19 testing and treatment: 1-866-268-4322 (1-866-COVID-CA). List of Infusion Sites COVID-19 Infusion Treatments by Organization (PDF) Test-To-Treat COVID-19 Vaccine Reimbursement for Medi-Cal Providers DHCS has carved out the COVID-19 vaccine from Medi-Cal managed care health plans and will reimburse providers under the Fee-for-Service (FFS) delivery system for both medical and pharmacy claims. Medi-Cal will reimburse the associated COVID-19 vaccine administration fee at the allowable Medicare rate for all claims (medical, outpatient, and pharmacy), based on the number of required doses for all Medi-Cal beneficiaries. For further information: June 13, 2022 - DHCS COVID-19 Vaccine Administration Provider FAQs   How Vaccines Build Immunity While the COVID-19 vaccines are relatively new - the technology and science behind the vaccines have been in development for decades. In the video below, we demonstrate how years of vaccine research and advanced technology allowed researchers and scientists worldwide to be prepared to develop an mRNA vaccine that could help fight the spread of a global infectious disease. FIND A TESTING AND VACCINATION SITE NEAR YOU TODAY! RIVERSIDE Riverside County Public Health COVID Testing Site Vaccine Information Vaccine Locations & Registration Registrations encouraged but not required for: The CDC recommends everyone ages 6 months and older get vaccinated against COVID-19 as well as a booster for everyone 5 years and older, if eligible. For more information, visit the Riverside Country Vaccine webpage. Teenagers 5 to 17 years old must register for a vaccination clinic that offers the Pfizer vaccine and be accompanied by a parent/legal guardian or present a signed written consent from a parent/legal guardian and be accompanied by an adult. Pfizer Minor Consent Form (PDF) | Spanish  The Moderna and Johnson & Johnson vaccines can only be given to individuals age 18 years and older. Johnson & Johnson Fact Sheet (PDF) | Spanish - Published April 26, 2021  SAN BERNARDINO San Bernardino County Public Health COVID Testing Site Vaccine Locations & Registration Additional Dose and Boosters Information COVID-19 Vaccine Consent Form (PDF) | Spanish   The CDC recommends everyone ages 6 months and older get vaccinated against COVID-19 as well as a booster for everyone 5 years and older, if eligible. For more information, visit the San Bernardino County Pediatric COVID-19 Vaccination web page Walk-ins are now available at County-operated vaccination sites. Walk-in individuals will not need to bring any additional information to the site, however be prepared to register on site, which will include answering health screening questions. Walk-ins may experience longer wait times and availability may vary based on site demand.  Centers for Disease Control and Prevention (CDC) Clinical Care Guidance Vaccines Vaccination Plans January 10, 2022 - Continued Coverage of COVID-19 Diagnostic Testing (PDF) CalVax CalVax is a state-wide centralized system for health care Providers enrolled or interested in participating in the California COVID-19 Vaccination Program, developed by the California Department of Public Health (CDPH). The new CalVax platform will provide a system to manage vaccine enrollment, ordering, inventory, administration, reporting and data analytics. Training materials such as job aids, videos, and recorded demos will be available to support all system users as they navigate through the new CalVax platform (  CA Notify • CA Notify Flyer in English (PDF) and Spanish(PDF) • CA Notify Shareable Tools for web and social media • CA Notify Website  Financial Assistance Resources Riverside County Medical Association - COVID-19 Financial Toolkit for Medical Practice U.S. Department of Health & Human Services (HHS) CARES Provider Relief Fund Learn more about the Provider Relief Fund (PRF) Provider Relief Fund (PRF) Portal U.S. Small Business Administration. Borrowers may be eligible for Paycheck Protection Program (PPP) loan forgiveness. See if you're eligible here. Guidance Regarding Monoclonal Antibody Treatment for COVID-19 Even with decreasing cases and hospitalizations, those with high-risk conditions who have tested positive for COVID-19 are encouraged to get monoclonal antibody treatment at Riverside University Health System (RUHS) – Medical Center. In January, the U.S. Food and Drug Administration (FDA) limited the use of certain monoclonal antibody therapies that were ineffective against the omicron variant. In response, RUHS – Medical Center is administering sotrovimab, an IV infusion shown to be effective against omicron and other variants. January 14, 2022 - RUHS-Medical Center Offers Monoclonal Antibodies Treatment Quest Diagnostic For more information, please visit Quest Diagnostics FAQs COVID-19 Specimen Collection Instructions (Watch Video Here)                        Fact Sheet for Healthcare Providers for COVID-19 Testing (View PDF Here)   LabCorp For more information, please visit LabCorp's COVID-19 page. Which COVID-19 Test is Right For You? COVID-19 FAQs If you do not have the ability to collect specimens for COVID-19, please refer to your County Public Health resources for guidance on directing Members for testing.   Telehealth IEHP is strongly encouraging the utilization of telehealth for visits that can be conducted over the phone or via other audiovisual telecommunications.  IEHP has published a telehealth FAQ which is available here: Telehealth Services Due to Limiting Exposure to COVID-19 (PDF)- October 17, 2022 Remember: IEHP Provider Telehealth Information (PDF) IEHP expects that Providers will offer telehealth services and support to their Members during their published business hours.  Existing authorizations are valid and do not need to be changed even if services are being provided via telehealth You can request a POS 02 or POS 10 on your authorization however if you do not, you can still utilize the authorization for telehealth services even if a different POS was approved. When billing the claim for the service, you will utilize a POS 02 or POS 10. ONLY Services that are deemed clinically appropriate to provide via telehealth should be provided via telehealth. If there are treatments, exams, procedures or other services that cannot be provided via telehealth, those are not eligible to be provided via telehealth.  Provider Resources for Combatting COVID-19 Fatigue ACEs Aware - Support for those on the front lines as California addresses stress and anxiety related to COVID-19   Department of Health Care Services (DHCS) and California Department of Public Health (CDPH) COVID 19 Response Department of Health Care Services (DHCS) California Department of Public Health (CDPH)   The California Department of HealthCare Services (DHCS) has published a COVID-19 response page with guidance for Providers and Partners, Home and Community Based Services and Behavioral Health. Found Here: DHCS COVID‑19 Response | DHCS COVID-19 Medi-Cal FAQs The California Department of Public Health (CDPH) also has a page with new guidance documents and additional resources and news releases. Found Here: CDHP COVID-19 Updates Centers for Medicare & Medicaid Services (CMS) CMS Health Care Provider Toolkit - Help link to COVID-19 related questions   San Bernardino Medical Society The San Bernardino County Medical Society promotes the science and art of medicine, the care and well-being of patients, the protection of the public health and to promote the betterment of the medical profession. The latest news, research and developments on the COVID-19 outbreak for physicians can be found here: SBCMS COVID-19. January 07, 2021 - COVID-19 Vaccines For All Practicing Physicians and Staff – San Bernardino County (PDF) 2-1-1 San Bernardino County Resource & Information Guide   2-1-1 San Bernardino County has curated a COVID-19 Resource & Information Guide and will update this page regularly as the situation changes. For more information, please click here.   Correspondences May 2, 2022 - Webinar - IWIN COVID and the Community April 13, 2022 - COVID-19 “Test to Treat” Initiative April 8, 2022 - 2nd Round of Free At-Home COVID-19 Test Kits Available February 23, 2022 - COVID-19 Oral Antiviral Drugs – Coverage and Dispensing Pharmacies  January 28, 2022 - Free OTC COVID-19 Antigen Kits Available January 26, 2022 - Free At-Home COVID-19 Tests Available by Request January 5, 2022 - Extending SNF COVID-19 Per Diem Rate December 22, 2021 - COVID-19 Vaccine Billing for Medicare Advantage Enrollees Effective DOS January 1, 2022 December 16, 2021- COVID-19 Vaccine Incentive Program – Program Guide December 16, 2021 - REMINDER: COVID Vaccine Enrollment Survey - Your Response is Requested December 10, 2021 - REMINDER: COVID Vaccine Enrollment Survey - Your Response is Requested December 10, 2021 - COVID-19 Vaccine Billing for Medicare Advantage Enrollees December 3, 2021- COVID-19 Vaccine Enrollment Survey December 1, 2021- CDC Encourages COVID Booster Due to Omicron Variant November 17, 2021- UPDATE! COVID-19 Vaccine FQHC, RHC and IHF Incentive Program November 9, 2021- Three Upcoming Webinars on Building COVID-19 Vaccine Trust October 22, 2021- 2021 COVID-19 Vaccination Member Incentive October 22, 2021- NEW!!! COVID-19 Vaccine FQHC and RHC Incentive Program October 19, 2021- COVID-19 Treatment – RUHS Monoclonal Antibody Treatment Center October 12, 2021- Reminder - NEW COVID-19 Vaccine PCP Incentive Program - Kickoff Meeting October 6, 2021- NEW COVID-19 Vaccine PCP Incentive Program- Kickoff Meetings October 4, 2021- New COVID-19 Vaccine PCP Incentive Program September 8, 2021- CDPH Webinar: How to Have Crucial Conversations About COVID-19 Vaccines – Thursday, September 9th August 18, 2021 - Riverside County Public Townhall on COVID-19 Vaccines For additional resources regarding COVID-19, please visit: Centers for Disease Control and Prevention (CDC) Riverside County Public Health San Bernardino Public Health You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

COVID-19 - 新冠病毒

嗽 呼吸急促或呼吸困難 疲勞 肌肉或身體酸痛 頭痛 新的味覺或嗅覺喪失 咽喉痛 鼻塞或流鼻涕 噁心或嘔吐 腹瀉 如有嚴重的新冠病毒症狀,應立即就醫求治,包括: 呼吸困難 胸部持續疼痛或有壓力 新的意識紊亂 無法醒來或保持清醒 蒼白、灰色或藍色的皮膚、嘴唇或甲床,具體取決於膚色 生病時應做之事 有任何這些症狀時應考慮: 做新冠病毒檢測,完全免費。IEHP 還會為標準和醫囑新冠病毒檢測付費,無論是何種。醫師需就這些檢測向 IEHP 直接收費。 應在出現症狀後 24 小時內就醫,親自去或遠距看主治醫師或緊急照護中心都可。 如果主治醫師找不到或已下班,可致電 IEHP 24 小時護士諮詢熱線: 1-888-244-4347 ,聽障專線: 711 ,服務時間:每週 7 天、每天 24 小時。護士訓練有素,能提供醫治建議,或酌情幫忙找醫師電話或視訊交談。   新冠病毒治療方法事實 大多數新冠病毒治療方法都用在家自服的藥物,在加州免費提供,無需保險,也不要求是美國公民。 如在症狀出現後前 5-7 天內盡快開始服用,新冠病毒藥物效果最佳。如已感染,不要等待症狀惡化。 新冠病毒藥物能安全有效地阻止病情惡化,可將因新冠病毒而患重病、住院和死亡的風險降低一半或更多。 新冠病毒藥物可助更快得到陰性檢測,並降低出現 長期新冠病毒 症狀的風險。* 如已年滿 12 歲且有某些病況或其他增加風險的常見因素,則建議使用新冠病毒藥物。醫師可告知是否有資格接受新冠病毒藥物治療及最佳藥物。 無論是否已接種疫苗,新冠病毒藥物都有效。 如果新冠病毒檢測呈陽性、有症狀並符合以下條件,即應就醫求治: 年滿 50 歲,或者 未接種或未接種最新的新冠病毒疫苗,或者 有某種病況或其他增加風險的因素,包括肥胖、哮喘、糖尿病、缺少鍛煉、吸煙、精神健康狀況(如抑鬱症)、少數民族等。 詳細了解 可能增加患新冠病毒重病的病況。 點擊此處詳細了解 心理健康和情緒狀況。 * 早期證據表明,新冠病毒藥物帕昔洛韋 (Paxlovid) 或能降低出現長期新冠病毒症狀的風險。感染新冠病毒後,這些症狀可能持續數週、數月或數年。 做新冠病毒檢測 務必知曉做新冠病毒檢測的時間和方法。做檢測可讓自己心安,獲得做出健康決定所需相關資訊,並有助於減緩病毒在社區中的傳播。 新冠病毒檢測地點 造訪這個連結: 新冠病毒檢測呈陽性時應做之事 自我隔離,不要將病毒傳播給他人。 點擊此處 了解新冠病毒病患隔離和預防措施相關提示 立即求治 求治方法 聯絡醫師 聯絡藥房 造訪 檢測治療地點

IEHP DualChoice - 重要資源

HP DualChoice 網站) IEHP DualChoice 隱私權通知說明您的醫療資訊的使用與披露方式,以及您如何取得此資訊。 IEHP DualChoice 隱私權通知 (PDF) Medicare 暨 Medicaid 服務中心 下列連結會將您帶往 Medicaid 暨 Medicare 服務中心網站,且您可透過下列連結檢視 CMS 最佳證據政策 (CMS Best Available Evidence Policy):CMS 最佳證據政策。點選此連結,您將會離開 IEHP DualChoice 網站。 您需使用 Adobe Acrobat Reader  6.0 或更高版本,才能檢視 PDF 檔案。點選此處下載免費版本。點選此連結,您將會離開 IEHP DualChoice 網站。 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

線上完成 Medi-Cal 續保。

本郡自動續保,或者您所在的郡政府需要更多信息。 請務必閱讀該信函並按照說明行事。  郡政府會要求提供哪些信息? 填寫完成的續保表格  驗證資料(例如您的工資單副本) 更新您的聯絡方式 如果您所在的郡政府要求提供更多信息,您必須在截止日期前提供。 如果您在截止日期前沒有回复,您的 Medi-Cal 福利可能會終止。  如何提交這些資訊? 您的資訊可以綫上提交、郵寄、當面提交或電話提交。 綫上辦理: 立即訪問 並選擇「創建帳戶」鏈接,創建您的在線帳戶。要了解更多信息,請觀看視頻:「BenefitsCal 網站:如何建立帳戶」 如果您已經擁有 BenefitsCal 網站帳戶,則可以按照此視頻中的步驟進行提交:「如何在 BenefitsCal 上提交 Medi-Cal 續保」 將全套文件郵寄回您所在的郡政府。 親自造訪您所在郡政府辦公室。 致電您所在郡政府辦公室: 河濱郡:1-877-410-8827,週一至週五上午 8 點至下午 5 點 聖貝納迪諾郡:1-877-410-8829,週一至週五上午 7 點至下午 5 點 如果錯過了截止日期怎麼辦? 聯繫縣政府,詢問您是否仍可以提交資料。 如果有問題,應該與誰聯係? 如果您需要更多幫助,請在周一至週五上午 8 點至下午 5 點  致電 1-888-860-1296 聯繫 IEHP,聯係或您所在縣的 Medi-Cal 辦公室: 河濱郡: 1-877-410-8827,週一至週五上午 8 點至下午 5 點 聖貝納迪諾郡: 1-877-410-8829,週一至週五上午 7 點至下午 5 點 填寫並提交信息後會發生什麼? 您的文件完成審查后,您將收到一封來自縣政府的信函。 您最近搬家了?您需要向縣政府提供那些資訊? 請聯繫縣政府辦公室,確保他們掌握您和您家人的最新信息。 包括: 姓名 地址 電話號碼 電子郵件地址 縣政府需要它來聯繫您並提供有關您的 Medi-Cal 的重要資訊。

Provider Resources - Educational Opportunities

isciplinary Care Team (ICT) Dual Choice 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) Dual Choice 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  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 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 ( 2. Improving Health Literacy by Improving Communication Skills Link ( 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: To find out about other free AHRQ continuing education opportunities, go to: To contact AHRQ, visit   Office of Minority Health - CDC - U.S. Department of Health and Human Service, Health Resources and Services Administration - You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

IEHP DualChoice - 2023 計畫福利

用 住院病患醫院照護:0 美元 居家健康機構照護:0 美元 救護車服務:0 美元 交通:0 美元。包括公車票。請致電 (866) 880-3654 與 American Logistics Company (ALC) 聯繫,TTY 使用者請撥打 711 與轉接服務或加州轉接服務聯繫。如須預約,請於週一至週五上午 7 點至下午 6 點 (太平洋標準時間) 期間致電聯繫。請至少提前 5 天預約。 診斷檢測、X 光與實驗室服務:0 美元 耐用醫療設備:0 美元 居家與社區服務 (HCBS):0 美元 社區成人服務 (CBAS):0 美元 長期照護,包括監護式照護與機構:0 美元 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。 您不須就一個月或長期供應的藥品支付任何費用 對於 IEHP DualChoice,只要遵守計畫規則,不須就給付藥品支付任何費用。 第 1 層藥物為:學名藥、原廠藥和生物相似藥。其共付額為 0 美元。 在您的 IEHP DualChoice 保險生效之後,您必須透過 IEHP DualChoice 網路取得醫療服務與處方藥服務。 如欲深入瞭解此計畫的相關福利、費用分攤、適用條件與限制,請參閱 IEHP DualChoice 會員手冊。 2023 福利摘要 (PDF) 2023 年度更改通知 (PDF) 2023 年 IEHP DualChoice 會員手冊 (PDF) 您需使用 Adobe Acrobat Reader 6.0 或更高版本,才能檢視 PDF 檔案。按一下此處,免費下載 Adobe Acrobat Reader。點選此連結,您將會離開 IEHP DualChoice 網站。  計畫保費 IEHP DualChoice 的每月保費為 $0-$38.90。 您可能有資格獲得「額外補助」,有助於降低您的每月保費。 計畫自付額 IEHP DualChoice 不須支付計畫自付額。 因為您符合 Medi-Cal 投保資格,所以有權並將會獲得 Medi-Cal 為您支付處方藥計畫費用提供的「額外協助」。您不需辦理其他手續即可獲得額外協助。  您可能可以獲得額外協助,用以支付您的處方藥保費和費用。若要瞭解您是否符合獲得額外協助的資格,請致電: 1-800-MEDICARE (1-800-633-4227) ,TTY 使用者請撥 (877) 486-2048,此專線全年全天候提供服務 致電 (800) 772-1213 聯繫社會安全局,服務時間是週一至週五上午 7 點至晚上 7 點,TTY 使用者請撥 (800) 325-0778;或 聯絡您當地的州 Medicaid 辦公室 如何獲取照護協調 您在獲取所需照護方面,是否需要任何協助?我們的照護團隊可以協助您。照護團隊可能包括您的醫師、照護協調員或您選擇的其他健康人員。照護協調員是指經過訓練,可協助您管理所需照護之人。投保 IEHP DualChoice,即可擁有專屬照護協調員。若 IEHP DualChoice 無法提供您所需的服務,照護協調員還會為您轉介社區資源。 如欲與照護協調員交流,請於太平洋標準時間每天上午 8 點至晚上 8 點致電 (877) 273-IEHP (4347) 聯繫 IEHP 會員服務部,假日亦提供服務。TTY 使用者請致電 1-800-718-4347。 事先授權與網路外給付  在未向您的 IEHP DualChoice (HMO D-SNP) 初級保健提供者 (PCP) 取得事先核准的情況下,您可享有哪些類型的醫療照護與其他服務?在未事先獲得初級照護提供者 (PCP) 核准的情況下,您可獲得如下所列的服務。 例行性女性健康照護,包括乳房檢查、檢測性乳房攝影服務、子宮頸抺片檢查及骨盆腔檢查 (需由網路內提供者提供服務)。 疫苗注射,需由網路內提供者提供服務。 網路內提供者或網路外提供者提供的緊急服務。 網路內提供者或網路外提供者 (當網路內提供者暫時無法提供服務或無法到達時,如您暫時身處本計畫服務區域外時) 提供的急症所需照護。 暫時身處本計畫服務區域外時,在 Medicare 認證的透析機構接受的腎臟透析服務。(如果可能的話,請在您離開服務區域之前致電 IEHP DualChoice 會員服務中心,以便我們為您安排您離開期間的維護性透析服務。) 如何取得專科醫師及其他網路內提供者的照護 專科醫師是指針對特定疾病或身體部位提供健康照護服務的醫師。專科醫師有很多種,以下列舉幾個範例: 腫瘤科醫師為癌症患者提供照護。 心臟科醫師為心臟病患者提供照護。 骨科醫師為患有特定骨骼、關節或肌肉疾病的患者提供照護。 對於您的大部分例行性健康照護需求,如身體檢查、免疫接種等,通常需要先找您的 PCP 看診。若 PCP 認為您需要專科治療或藥品,他/她將需要向您的計畫及/或醫療小組取得事先授權 (亦即:事先核准),這稱為轉介。您的 PCP 會發送轉介資料給您的計畫或醫療小組。最重要的是,您必須在前往計畫專科醫師或特定其他提供者看診前,向您的 PCP 取得轉介 (事先核准)。若您未在向專科醫師取得服務之前取得轉介 (事先核准),您可能需要自行支付服務費用。PCP 通常會與特定醫院及專科醫師合作。當您選擇 PCP 時,也決定了您可以看診的醫院與專科醫師。  若專科醫師或其他網路內提供者退出本計畫時該怎麼辦? 有時候,您所看診的專科醫師、診所、醫院或其他網路提供者可能會退出本計畫。當提供者退出網路時,我們會發一封郵件給您,告知您新提供者的相關資訊。若您想選擇其他提供者,請致電 IEHP DualChoice 會員服務中心,我們將協助您找尋與選擇其他提供者。 如何取得網路外提供者的照護 若您的醫師推薦我們網路無法提供的服務,您可透過網路外提供者取得該等服務。為取得網路外服務,您的初級照護提供者 (PCP) 或專科醫師必須向您的計畫或醫療小組提交一份轉介申請。所有網路外服務申請都須在接受服務之前取得您的醫療小組核准。 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。此清單並非完整清單。  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

建議書徵求文件 (RFP) 與標案 - 採購

Procurement department is continuously looking for suppliers of the varied goods and services it procures.  IEHP procures goods and services through the solicitation process, and in the case of repetitively purchased items, establishes long-term contracts. With the exception of Public Works (construction type bids) and a few specialty bids, most bids for goods and services procured are completed using a third-party solicitation website called Bonfire. Vendors have the option to view IEHP’s open solicitations on the Bonfire website. IEHP invites all vendors to register with Bonfire and participate in IEHP’s fair and open solicitation process for goods and services. Mission Statement The Procurement department is committed to supporting the mission of IEHP, which is “to organize and improve the delivery of quality, accessible and wellness based healthcare services for our community”. As a community-developed health plan, we are accountable to the public. IEHP’s Procurement professionals possess the necessary skill set, knowledge base, and negotiating skills to assist IEHP with the acquisition of materials, equipment and contractual services. Utilizing this expertise, our best procurement practices, and the highest standards of professional ethics and integrity, we ensure that procurement decisions made are in the best interest of IEHP and in compliance with all applicable laws, regulations and policies. Compliance with Economic Sanctions Imposed in Response to Russia’s Actions in Ukraine On March 4, 2022, Governor Gavin Newsom issued Executive Order N-6-22 (EO) regarding sanctions in response to Russian aggression in Ukraine. The EO is located at This serves as a notice under the EO that as a vendor, contractor or grantee, compliance with the economic sanctions imposed in response to Russia’s actions in Ukraine is required, including with respect to, but not limited to, the federal executive orders identified in the EO and the sanctions identified on the U.S. Department of the Treasury website ( Failure to comply may result in the termination of contracts or grants, as applicable. For general inquiries, please email Code of Ethics Policy Click to Download Our Code of Ethics Policy

健康生活 - 冠狀病毒

或治愈方法。此即為健康篩檢的用處。  健康篩檢對所有人(從新生兒到年長者)都至關重要。這類檢測旨在篩查您可能患某些疾病的徵兆。即便您沒有出現任何症狀,篩檢仍有助於在早期階段發現健康問題。  癌症篩檢類型 乳癌 乳房 X 光攝影即為乳房 X 光檢查。可以在早期篩查出乳癌,乳癌在這階段最容易治療,且治愈幾率十分高。女性和男性都有可能患乳癌,應當從 50 歲開始每兩年做一次篩檢。對於患癌風險較高或希望盡早開始做篩檢的人士,可以與醫生討論從 40 歲開始做篩檢。 子宮頸癌(宮頸抹片檢查)  巴氏塗片檢查也稱為宮頸抹片檢查,可以盡早發現子宮頸上的異常細胞,從而在其發展成癌症之前進行治療。建議 21 至 65 歲女性每 3 到 5 年做一次篩檢,具體視患癌風險和篩檢類型而定。如欲預約做篩檢,請諮詢您的醫生。  結腸直腸癌   結腸直腸癌對結腸和直腸造成影響。篩檢有助於發現並清除這些部位的增生,避免其發展為癌症。45 至 75 歲人士應當每 1 到 10 年做一次結腸直腸癌篩檢,具體視患癌風險和所選檢測類型而定。請諮詢您的醫生,瞭解哪種檢測最適合您。   肺癌 利用造影技術(電腦斷層 (Computerized Tomography, CT) 掃描)對在過去 15 年內吸菸或戒菸者進行肺癌篩檢,有助於在早期階段篩查癌症。盡早篩檢有助於保持健康。建議年齡介於 50 至 80 歲,且在過去 15 年內吸菸或戒菸的人士每年都進行篩檢。  如果您是時候做篩檢,請即刻致電聯繫您的醫生以進行預約。即刻開始管理您的健康!   如需幫助,請致電 1-800-440-4347 聯繫 IEHP 會員服務處,服務時間為週一至週五,上午 7 點至晚上 7 點,以及週六至週日上午 8 點至下午 5 點。  


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.  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

Join Our Network - 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, Inland Empire Health Plan (IEHP) is offering 11 of the 14 DHCS Preapproved Community Supports services: 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) Upcoming Services Beginning July 1, 2023, three new Community Supports services will be offered: 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   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 - Provider Network Expansion Fund

d is to support the hiring of PCPs, Specialists, and Advanced Practice Providers that will serve the Medi-Cal population in the Inland Empire. Entities that hire qualified candidates are eligible to receive a subsidy up to $75,000 for Advanced Practice Providers, $100,000 for PCPs, and $150,000 for Specialists. All candidates must be a new access point in IEHP's network and not have prior history in the Inland Empire. Please take note of the following: The NEF Program will be targeting specific Provider types. The Provider types and corresponding regions displayed below comprise the list of positions that are currently eligible to receive a subsidy through the NEF Program.   The funding disbursement schedule is as follows:  50% when the qualified candidate completes credentialing 25% when the candidate completes six (6) months of service 25% when the candidate completes one (1) year of service Entities that are interested in receiving support through the NEF Program must submit a complete application to be considered for the funding opportunity. Completed applications and questions should be e-mailed to NEF Program Description (PDF) NEF Application (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here. Click on the following links to jump to that specific section: Corona/Temecula/Hemet High Desert Low Desert Mohave Valley Palo Verde Valley Riverside San Bernardino Proper West San Bernardino Corona/Temecula/Hemet Family Practice Internal Medicine Pediatrics Cardiac/Thoracic Surgery General Surgery Genetics OB/GYN Pulmonary Medicine Plastic Surgery Psychiatry Urology   High Desert Family Practice Internal Medicine Pediatrics Allergy and Immunology Cardiac/Thoracic Surgery Cardiology Dermatology General Surgery Genetics Neurology Neurosurgery OB/GYN Oncology/Hematology Orthopedic Surgery Otolaryngology Pain Management Pediatric Subspecialties Physical Therapy Podiatry Psychiatry Psychology Pulmonary Medicine Rheumatology Speech Therapy Urology   Low Desert Family Practice Internal Medicine Pediatrics Allergy and Immunology Cardiology General Surgery OB/GYN Pain Management Pediatric Surgery Physical Therapy Psychiatry Pulmonary Medicine Rheumatology Urology   Mohave Valley Family Practice Internal Medicine Pediatrics Allergy and Immunology Cardiology Dermatology Gastroenterology General Surgery Nephrology Neurology OB/GYN Oncology/Hematology Ophthalmology Otolaryngology Pain Management Psychiatry Pulmonary Medicine Rheumatology   Palo Verde Valley Family Practice Internal Medicine Pediatrics Allergy and Immunology Cardiology Dermatology Endocrinology Gastroenterology General Surgery Neurology OB/GYN Ophthalmology Otolaryngology Pain Management Physical Therapy Podiatry Psychiatry Pulmonary Medicine Speech Therapy Urology   Riverside Family Practice Internal Medicine Pediatrics Cardiology Dermatology General Surgery Genetics OB/GYN Occupational Therapy Ophthalmology Pain Management Podiatry Psychiatry Speech Therapy Urology   San Bernardino Proper Family Practice Internal Medicine Pediatrics Allergy and Immunology Dermatology OB/GYN Pain Management Pediatric Surgery Psychiatry Pulmonary Medicine   West San Bernardino Family Practice Internal Medicine Pediatrics Genetics OB/GYN Pediatric Surgery Plastic Surgery Psychiatry   Updated May 5, 2023    

Provider Resources - 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 - 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You can download a free copy by clicking here.

Medi-Cal 加州醫療保險規定

居住在我們服務區域的民眾 (加州河濱郡與聖貝納迪諾郡的大部分居民) 成人 (無論是否撫養子女)、未成年人、老年人及殘障人士 符合收入標準和其他計劃要求者 50 歲以上的無證成年人 我要負擔多少費用? 成人無須就 Medi-Cal 保險繳交任何月保險費。依據 Children’s Health Insurance Program (CHIP) 享有 Medi-Cal 保險的未成年人,僅須繳交少量月保險費。  我透過 IEHP 可以獲得 Medi-Cal 的哪些照護? 您的計劃承保範圍包括:  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。 如何申請 Medi-Cal:  請於週一至週五上午 8 點至下午 5 點致電 (866) 294-4347,與 IEHP 投保顧問聯繫。TTY 使用者請撥 (800) 720-4347。  您也可以致電 1-800-430-4263 與 Health Care Options 聯繫,或上網。TTY 使用者請撥 1-800-430-7077。 IEHP Medi-Cal 會員重要注意事項 Medi-Cal 會員手冊 (PDF) - 說明如何取得 IEHP 照護及計劃承保的福利。 IEHP 會員手冊 Medi-Cal 福利指南 (PDF) - 本指南可協助您在IEHP會員手冊找到各項福利與服務的重要資訊。 Medi-Cal 提供者目錄 (PDF):條列我們不斷壯大的醫療網絡,以及可快速取得所需照護的選項 – 全天無休。  您需使用 Adobe Acrobat Reader 6.0 或更高版本,才能閲讀PDF 文檔。點選 Adobe Acrobat Reader 下載免費版本。     

IEHP DualChoice - 如何獲得照護

通常是您暫時身處本計畫服務區域外)、區域外透析服務,以及 IEHP DualChoice (HMO D-SNP) 授權使用網絡外提供者的情況。 何謂網路內提供者? 網路內提供者係指與我們簽訂合約,且接受我們的付款 為全額付款之醫師與其他健康照護專家、醫療團體、醫院與其他健康照護機構。我們安排這些提供者為本計畫會員提供給付的服務。 所有參與本計畫的提供者還會與我們簽訂合約,提供給付的 Medi-Cal 福利。 尋找醫師 請使用下列 IEHP DualChoice 提供者與藥局目錄,尋找網路內提供者: 2023 年 IEHP DualChoice 提供者與藥局目錄 (PDF) 初級照護提供者 (PCP) 是誰?他們在您的計畫中扮演什麼角色? PCP 是指您的初級照護提供者。您的大部分例行性健康照護需求,都必須先找您的 PCP 看診。您的 PCP 也會協助您安排或協調您身為本計畫會員所享有的其他給付服務。「協調」您的服務包括與其他計畫提供者確認或諮詢您的照護內容與狀況。包括: X 光 實驗室檢測、治療 專科醫師提供的照護 醫院住院及後續照護 初級照護提供者 (PCP) 通常與特定醫院有所關聯。您在選擇 PCP 時,請記住下列事項: 您必須從提供者與藥局目錄選擇您的 PCP。若您在選擇或更換 PCP 時需要任何協助,請致電 IEHP DualChoice 會員服務中心。 選擇距離您的住家 10 英哩或 15 分鐘車程內的 PCP。 您所選擇的 PCP 只能夠為您辦理入住特定醫院。請儘量選擇距離您的住家 30 英哩或 45 分鐘車程內,且能夠讓您入住欲就診醫院的 PCP。 部分醫院設有「住院專科醫師」,負責於病患住院期間提供照護。若您入住任何此等醫院,「住院專科醫師」可能會在您入住期間擔任您的照護提供者。當您出院後,您的健康照護需求將恢復由您的 PCP 負責。 若您因任何原因需要變更 PCP,您的醫院與專科醫師也可能會變動。您的 PCP 應能夠講您的語言。然而,您的 PCP 也可在必要時隨時撥打語言專線服務,取得口譯人員的協助。 若您在加入 IEHP DualChoice 時未選擇 PCP,我們將為您選擇。我們會將您的 ID 卡與您的 PCP 資訊寄送給您。請記住,您可以隨時變更 PCP。 您可以基於任何原因更換您的 醫師 (及醫院) (每個月一次)。若  IEHP 在當月 25 日之前收到您的變更申請,則變更將從次月一日開始生效;若  IEHP 在當月 25 日之後收到您的變更申請,則變更將從下下個月一日開始生效 (部分提供者可能要求您提供 PCP 的轉介)。  如何取得專科醫師的照護 對於您的大部分例行性健康照護需求,如身體檢查、免疫接種等,通常需要先找您的初級照護提供者 (PCP) 看診。若 PCP 認為您需要專科治療或藥品,他/她將需要向您的計畫及/或醫療小組取得事先授權 (亦即:事先核准)。這稱為轉介。您的 PCP 會發送轉介資料給您的計畫或醫療小組。 最重要的是,您必須在前往計畫專科醫師或特定其他提供者看診前,向您的 PCP 取得轉介 (事先核准)。若您未在向專科醫師取得服務之前取得轉介 (事先核准),您可能需要自行支付服務費用。 需要急症所需照護時,若您身處本計畫服務區域外該怎麼辦? 假設您身處本計畫服務區域外,但仍在美國境內。若您需要急症所需照護,您可能無法找到或取得本計畫網路內的提供者。在此等情況下 (當您身處服務區域外且無法取得網路內提供者提供的照護時),本計畫會給付任何提供者為您提供的急症所需照護。 若您在美國以外地區接受照護,本計畫將無法給付該等急症所需服務或任何其他照護。 變更您的初級照護提供者 (PCP) 您可以隨時基於任何原因變更 PCP。此外,您的 PCP 可能會退出本計畫的提供者網路,屆時您必須尋找新的 PCP。在此等情況下,您將必須更換為本計畫網路內的另一個提供者。若您的 PCP 退出本計畫,我們將會通知並協助您選擇其他 PCP,以便您持續享有給付的服務。IEHP DualChoice 會員服務中心可協助您找尋與選擇其他提供者。您可以致電 IEHP DualChoice 會員服務中心更換您的醫師。請於 (太平洋標準時間) 每天上午 8 點至晚上 8 點致電 (877) 273-IEHP (4347) 聯繫 IEHP DualChoice 會員服務中心,假日亦提供服務。TTY 使用者請撥 (800) 718-4347。 如需進一步瞭解網路內提供者的相關資訊,請參閱 IEHP DualChoice 會員手冊第 1 章。 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。此清單並非完整清單。  您需使用 Adobe Acrobat Reader 6.0 或更高版本,才能檢視 PDF 檔案。點選 Adobe Acrobat Reader 下載免費版本。  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

MediCal Open Access Program - Open Access Program

題通常未獲得處理。Open Access Program 可透過加快獲得醫師看診的過程,讓您的子女更容易獲得持續醫療照護。無論您居住在加州內陸帝國的任何地方,您的子女都能夠約診網路內的任何 醫師。 此外,我們的計畫還能為您的子女提供一般 Medi-Cal 系統無法提供的許多服務。 Open Access 計畫如何使您的子女更容易獲得健康照護: 您的子女可預約我們龐大醫師網路內的任何 PCP 。 您可以隨時因任何原因更換醫師。IEHP 將協助您找到合適的醫師。請致電 1-800-440-IEHP (4347)/TTY 使用者請撥 (800) 718-4347。 此計畫會將您子女的健康記錄 (疫苗注射、用藥、檢查) 提供給醫師,以使其在看診時不須猜測。 若您忘了帶 IEHP 會員 ID 卡或保險受益人身份卡 (Beneficiary Identification Card, BIC),Open Access 醫師可上網快速確認您子女的資格。 您與您的子女可免費獲取額外服務: 免費為您的子女提供 哮喘或糖尿病等健康項目。  讓您的子女保持安全與健康,並可享有父母專屬的額外福利,例如嬰兒汽車安全座椅、 兒童維他命及自行車安全帽。 我們設有專屬團隊,可協助您照護患有慢性疾病的子女。我們與您子女的醫師合作,致電給 您,確保您的子女獲得適當的照護。如果醫師看診、實驗室檢測或藥品配製工作塞車時,我們也可伸出援手。 重要資源 Open Access 提供者目錄 (PDF) 如欲深入瞭解 Open Access Program,請於週一至週五上午 8 點至下午 5 點致電 (800) 706-4347,與 IEHP 寄養照護專科醫師聯繫。 您需使用 Adobe Acrobat Reader 6.0 或更高版本,才能檢視 PDF 檔案。免費下載版本。點選 Adobe Acrobat Reader。 

社區支持 - 靈活的護理選擇:社區支持

可以幫助您保持健康,減少疾病併發症,並避免於醫院、護理設施和急診室的不必要停留。 您可能會發現 IEHP 的社區支持可於住房或護理過渡期間提供協助。如果您需要協助管理您的健康,IEHP 的社區支持可能是正確的選擇。 當您需要額外照護時 IEHP 的社區支持向任何需要支持性護理的 Medi-Cal 或 IEHP DualChoice Cal MediConnect Plan(Medicare-Medicaid 計畫)會員開放。社區支持可以培養您的整體健康—照護您的身心。 可以從社區支持中受益的成員可能: 面臨無房時期 努力為親人獲取食物 有哮喘問題,需要改變他們的生活空間 您的護理團隊如何協助您 如果您可以得到社區支持的協助,一個護理團隊可能會協助確定您的需求。然後,他們將協調免費服務,包括尋找住房資源、出院後的護理以及在家處理哮喘。 誰可能是您的護理團隊的成員: 護理師護理管理者 行為保健管理者 照護協調員 社區健康工作者 在您需要時提供支持 您的護理團隊可以透過電話或面對面為您提供協助,他們甚至可以在您所在的位置與您會面。有了 IEHP 的社區支持,您並不孤單。 提供哪些社區支持? 哮喘補救措施:環境哮喘誘因補救措施是指對居家環境進行必要的物理調整,以確保個人的健康、福利和安全,或使個人能夠在家中正常活動,如果沒有這些安排,急性哮喘發作可能導致需要急救服務和住院治療。 社區過渡服務/護理設施過渡到居家環境:協助會員在社區生活,避免進一步的設施收容。這些服務是臨時性的安排開支項,提供給安排從有執照的設施過渡到私人住宅生活的個人,由該個人直接負責自身的生活開銷。 環境無障礙改造(居家改造):環境無障礙改造 (Environmental Accessibility Adaptations, EAA) 也被稱為居家調整,是對居家環境的物理改造,屬於為了確保個人的健康、福利和安全或者使個人得以在家庭中更獨立地活動而必須進行的改造:如果沒有這些改造,會員將需要進入設施生活。 住房存款:住房存款協助確定、協調、確保或資助一次性服務和必要的調整,使個人能夠建立一個基本的家庭,但不包括食宿。 住房租賃和維持服務:提供住房租賃和維持服務,目標是在會員獲得住房後維持安全穩定的租賃。 住房過渡導引服務:住房過渡服務協助會員獲得住房。 醫療輔助食品/餐食/醫療訂製餐:營養失調和營養不良會導致毀滅性的健康後果、導致更高的設施利用率和成本增加,對於患有慢性病的會員尤其明顯。餐食協助個人在關鍵時刻達成營養目標,幫助他們恢復和維持健康。結果包括改善會員健康、降低再入院率、保持良好的營養健康狀況以及提高會員滿意度。 護理設施過渡/轉移到生活輔助設施:護理設施過渡/轉移服務協助個人在社區生活和/或盡可能避免住院。目標是促進從護理設施回歸類似家庭的社區環境,和/或避免會員因迫切需要護理設施級別的照護 (level of care, LOC) 而入院接受專業護理的必要。當個人符合資格要求時,可以選擇居住於輔助生活環境,以替代長期安置於護理設施。 康復護理(醫療暫休):康復護理,也稱為醫療暫休護理,是針對不再需要住院,但仍需要從受傷或疾病(包括行為健康狀況)中恢復並且其病情會因不穩定的生活環境而惡化的個人的短期住宿護理。長期居住於康復護理設施中使個人能夠繼續康復並接受出院後治療,同時獲得初級保健、行為健康服務、個案管理和其他支持性社會服務,例如交通、食物和住房。 短期出院後住房:短期出院後住房為沒有住所且有高度醫療或行為健康需求的會員提供機會,讓他們在離開住院醫院(無論是急症醫院、精神科醫院或藥物依賴和康復醫院)、住院藥物使用障礙治療或康復設施、住院精神健康治療設施、矯正設施、護理設施或康復護理後立即繼續其醫療/精神/藥物使用障礙的康復,避免進一步使用州計畫服務。 戒癮中心:戒癮中心是被發現公開醉酒(由於酒精和/或其他藥物導致)的個人的安置地點,以代替將他們送往急診室或監獄。戒癮中心為這些個人,主要是那些無家可歸或生活狀況不穩定的個人提供安全、支持性的環境,讓他們清醒。 如需瞭解有關社區支持的更多資訊,請於週一至週五上午 8 點至下午 5 點(太平洋標準時間)致電 1-800-440-IEHP (4347) 聯絡 IEHP 會員服務部。TTY 使用者請致電 1-800-718-4347。

Pharmacy Services - Formulary

most appropriate, high quality and cost-effective drug therapies.   The Inland Empire Health Plan Pharmacy and Therapeutics (P & T) Subcommittee develops and monitors the Formulary. The P & T is composed of the IEHP Chief Medical Officer, Medical Directors, Director of Pharmaceutical Services, physicians from various medical specialties, local communities, and clinical pharmacists. This panel reviews the medications in all therapeutic categories based on safety, clinical efficacy, and cost-effectiveness and selects the most appropriate drugs in each class.   Formulary development and maintenance is a dynamic process. The IEHP P & T Subcommittee is responsible for developing, managing, updating and administering the Formulary. The Subcommittee also ensures that the IEHP Formulary remains responsive to the needs of our members and providers.   You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Click here to download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website.   IEHP Medi-Cal Formulary Items: DHCS Noncapitated Physician Administered Drugs (PADs) Medi-Cal Medical Benefit PA (PDF) Medi-Cal Medical Benefit Formulary (PDF) Referral Form for Medi-Cal Benefit (PDF) Exceptions to criteria or requests for coverage of drugs not on the Medi-Cal Drug Benefit Formulary may be submitted by prescribers on the Referral Form for Medi-Cal Benefit. Starting January 1, 2022, all IEHP Medi-Cal pharmacy services will be transitioned from managed care (MC) to fee for service (FFS). The Medi-Cal pharmacy benefits and services administered by the Department of Health Care Services (DHCS) will be identified collectively as "Medi-Cal Rx." Magellan Medicaid Administration, Inc. (MMA) will assume operations for Medi-Cal Rx on behalf of DHCS. For further information on Medi-Cal Rx, please visit: For more information on the Medi-Cal Rx Covered Drug List (CDL), please visit:   IEHP DualChoice (HMO D-SNP) - Medicare-Medicaid Plan Items: IEHP DualChoice (HMO D-SNP) Formulary Book (PDF) Grievance Coverage Determination and Appeals Process IEHP DualChoice (HMO D-SNP) Formulary Search Tool        10 Reasons Why You Should Be E-prescribing Brochure (PDF) E-prescribing Tips (PDF)   Information on this page is current as of May 31, 2023

IEHP DualChoice - 處方藥

alChoice 網路內提供者須遵守加州政府所規定藥局實務之最低標準。 IEHP DualChoice 給付哪些處方藥? IEHP DualChoice (HMO D-SNP) 訂有給付藥品清單(處方集)。處方集說明 IEHP DualChoice 給付哪些 D 部分處方藥。這份清單上的藥品為本計畫在醫師及藥劑師協助下選定的。清單項目必須符合 Medicare 的規定。Medicare 已核准 IEHP DualChoice 處方集。  您可自下列資料找尋給付藥品: 2023 年處方集 (PDF) 處方集變更 (PDF) 2023 年分階段療法 (PDF) 2023 年須事先授權之藥品 (PDF) IEHP DualChoice 與哪些藥局簽約? 我們的 IEHP DualChoice (HMO D-SNP) 提供者與藥局目錄列出完整的網絡內藥局清單 – 亦即清單上註明同意為本計畫會員提供給付處方藥的所有藥局。 通常情況下,您必須向計畫提供者取得所有例行性照護,並使用網路內藥局獲得您的處方藥福利,除非在非常規的情況下,而且有數量上限和使用限制。  此清單並非完整清單。相關福利資訊僅為概要資料,並非福利的完整說明。可能適用限制條款、共付額和限制條件。處方藥的共付額可能依您取得的「額外協助」等級而異。福利與共付額可能在每年的 1 月 1 日改動。給付藥品清單以及藥局與提供者網路在年度期間可能有所變化。在進行對您有影響的變更之前,我們會向您發送通知。如需詳細資訊,請致電 IEHP DualChoice 會員服務中心或參閱 IEHP DualChoice 會員手冊。  2023 年 IEHP DualChoice 提供者與藥局目錄 (PDF) 您需使用 Adobe Acrobat Reader 6.0 或更高版本,才能檢視 PDF 檔案。點選此處下載免費版本。點選此連結,您將會離開 IEHP DualChoice 網站。  若您沒有 IEHP DualChoice 提供者與藥局目錄,可向 IEHP DualChoice 會員服務中心索取副本。您可隨時致電 IEHP DualChoice 會員服務中心,取得網路內藥局變更事項的最新資訊。致電 1-877-273-IEHP (4347) 聯繫 IEHP DualChoice,服務時間為太平洋標準時間每天上午 8 點至晚上 8 點,假日亦提供服務。TTY 使用者請致電 1-800-718-4347。 網路外給付 通常,IEHP DualChoice (HMO D-SNP) 只在您無法使用網絡內藥局時,方會給付在網絡外藥局領取的藥品。在下列情況於網路外藥局領取的處方藥均屬給付範圍: 如果我因為緊急醫療情況而需要處方藥,應該怎麼辦? 若處方藥是為了緊急醫療情況或急症照護,而於網路外藥局領取,我們將給付該等處方藥的費用。在此情況下,您在領取處方藥時須付清全額費用 (而非僅支付共付額部分)。您可提交書面理賠表,要求我們將我們應付的分攤費用退款給您。如欲進一步瞭解如何提交書面理賠,請參閱下面的書面理賠程序。 在您旅遊或不在計畫服務區域內時取得給付 若您定期領取處方藥,而且您即將外出旅行,請記得在出發前檢查您的藥品數量。只要可行,請隨身攜帶您需要的所有藥品。您可以透過我們的網路內郵購藥局服務,或透過提供「延長藥量」的零售網路藥局,事先訂購您的處方藥。 若您是在美國境內旅行,但不在計畫服務區域內,並且您生病、遺失處方藥或處方藥用完了,則若您遵守本文規定的所有其他給付規定,且附近無法找到網路內藥局,我們將會給付由網路外藥局提供的處方藥。在此情況下,您在領取處方藥時須付清全額費用 (而非僅支付共付額部分)。您可提交理賠表,要求我們將我們應付的分攤費用退款給您。如欲進一步瞭解如何提交書面理賠,請參閱下面的書面理賠程序。 在向網路外藥局領取處方藥之前,請致電 IEHP DualChoice 會員服務中心,瞭解您旅行所在區域是否有網路內藥局。若當地沒有網路內藥局,IEHP DualChoice 會員服務中心可以安排您向網路外藥局領取處方藥。 我們不支付由美國境外藥局所提供的任何處方藥,即使是基於緊急醫療情況而提供。 需要急症所需照護時,若您身處本計畫服務區域外該怎麼辦? 身處服務區域外且無法取得網路內提供者提供的照護時,本計畫會給付任何提供者為您提供的急症所需照護。若您在美國以外地區接受照護,本計畫將無法給付該等急症所需服務或任何其他照護。 我們給付您向網路外藥局取得之處方藥的情況 在至少符合下列任一條件時,我們將會給付您向網路外藥局取得之處方藥: 若您因在合理交通範圍內無法找到提供 24 小時服務之網路內藥局,而無法在我們的服務區域內及時取得給付藥品。 若您試圖取得的給付處方藥並非合格網路內零售藥局或郵購藥局定期會進貨的藥品 (此等藥品包括孤兒藥或其他專科醫師用藥)。如有上述情況,請先向 IEHP DualChoice 會員服務中心確認附近是否有網路內藥局。  如何向本計畫申請退款?  如果您必須使用網路外藥局,通常必須在領取處方藥時付清全額費用 (而非平常所付的分攤費用)。您可以要求我們退還 IEHP DualChoice 應付的分攤費用。請將您的付款要求及帳單和所有付款單據郵寄給我們。建議您影印帳單及收據作為記錄。請將您的付款要求附上帳單或收據郵寄給我們,地址為:  IEHP DualChoice P.O. Box 4259 Rancho Cucamonga, CA 91729-4259  您必須在取得服務、用品或藥品之日起 1 年內提出理賠。如有任何疑問,請聯繫 IEHP DualChoice 會員服務中心。如果您不知道您應付的款項,或者您收到了帳單但不知道該如何處理,我們可以提供協助。如果您已經將付款要求寄給我們,但想提供更多資訊,也歡迎您致電與我們聯絡。請參閱 IEHP DualChoice 會員手冊 第 7 章及第 9 章,瞭解如何向本計畫申請退款。 IEHP DualChoice 處方集變動 IEHP DualChoice 處方集包括多種被視為第一線治療的藥物 (應首先用於適應症的藥品)。IEHP DualChoice 會審核新藥的療效 (治療效果) 與安全性 (安全程度)、比較新藥與既有藥品以及依據臨床證據編制臨床實務指南,以持續編制與維護處方集。 IEHP DualChoice 會 (在福利年度內) 不定時依據新臨床證據及市場上產品的供應狀況,修改 (新增或移除藥品) 處方集。 所有變動皆係由目前執業之提供者與藥局所組成的專案小組,負責審閱與核准。 IEHP DualChoice 會在將 D 部分藥品自 D 部分處方集移除之前,通知 IEHP DualChoice 會員。若發生任何事先授權、數量限制、分階段療法變動,或任何藥品移往更高費用分攤層級之情況,我們也將通知會員。 若 IEHP DualChoice 移除給付的 D 部分藥品,或對 IEHP DualChoice 處方集進行任何變動,我們會在 IEHP DualChoice 處方集變動生效日期前至少三十 (30) 天,將處方集變動內容公佈在 IEHP DualChoice 網站,並將通知受影響的會員。然而,如果食品藥物管理局 (FDA) 認為我們處方集的藥品不安全,或是藥品的製造商從市場撤除該藥品,我們將立即將該藥品從處方集中移除。 藥品清單的部分變動將會立即生效。例如: 市場上可取得新學名藥。有時會出現全新且更便宜,但效果與藥品清單所列藥品一樣好的藥品。在這種情況下,我們可能會將既有藥品移除,不過您就新藥品所分攤的費用將維持不變或減少。我們在新增學名藥時,還可能決定保留清單上既有的藥品,但會變更其給付規定或限制。 我們可能不會在進行上述變更之前通知您,不過我們會將相關變動資訊發送給您。 您或您的提供者可以申請這些變更的「例外處理」。我們會發送通知給您,向您說明申請「例外處理」的步驟。有關「例外處理」的詳細資訊,請參閱會員手冊第 9 章 (若您有問題或欲提出申訴 [給付決定、上訴、申訴] 時的處理方式)。 藥品從市場下架。若食品藥物管理局 (FDA) 認定您所服用的藥品不安全,或藥品製造商將藥品從市場下架,我們會將藥品從藥品清單中移除。若您正在服用該藥品,我們將會通知您。您的提供者也會接到這項變動通知。他或她將與您合作尋找其他可治療您的病情的藥物。 我們可能會做出影響您所服藥品的其他變動。 我們會事先通知您有關藥品清單的所有其他變動。此等變動可能因下列情況而發生: FDA 發佈藥品的新指南,或藥品出現全新的臨床指南。 我們新增市場已有的學名藥,且: 取代藥品清單上已有的原廠藥;或 變更原廠藥的給付規定或限制。 在進行此等變動時,我們會在變更藥品清單前或在您再次領藥前至少 30 天通知您,如此您就有時間與您的醫師或其他開立處方者進行溝通。他或她能協助您判斷是否能改服藥品清單中的類似藥品,或是否需要申請例外處理。接著,您可以: 在藥品清單變更生效前領取 31 天的藥品;或 申請這些變更的例外處理。如需進一步瞭解如何申請例外處理,請參閱會員手冊第 9 章 (若您有問題或欲提出申訴 [給付決定、上訴、申訴] 時的處理方式)。 再次強調,如果藥品因不安全或其他原因而突然被召回,本計畫將立即將該藥品從處方集中移除。我們會立即告知您此變動。 您的醫師也將瞭解此變動,並與您合作尋找其他可治療您的病情的藥物。 如何查詢您的藥品給付是否發生變化? 若 IEHP DualChoice 移除給付的 D 部分藥品,或對 IEHP DualChoice 處方集進行任何變動,IEHP DualChoice 會在 IEHP DualChoice 處方集變動生效日期前至少三十 (30) 天,將處方集變動內容公佈在 IEHP DualChoice 網站,並將通知受影響的會員。然而,如果食品藥物管理局 (FDA) 認為我們處方集的藥品不安全,或是藥品的製造商從市場撤除該藥品,我們將立即將該藥品從處方集中移除。 取得計畫核准 針對特定藥品,您或提供者必須先取得計畫核准,我們才會同意給付該藥品。這稱為「事先授權」。有時候,事先取得核准的要求有助於導引特定藥品的適當使用。如果您未取得事先授權,本計畫可能不會予以給付。如需進一步瞭解分階段療法與數量限制的相關資訊,請參閱   IEHP DualChoice 會員手冊第 5 章。使用 IEHP Medicare 處方藥給付裁決表單取得事先授權。 申請 Medicare 處方藥給付裁定 (PDF) 標準格式說明 此表單亦可透過 CMS 網站取得:  Medicare 處方藥裁定申請表 (適用於投保人與提供者)。  點選此連結,您將會離開 IEHP DualChoice 網站。 適用條件與限制 只要您遵守 IEHP DualChoice 會員手冊 第 6 章所列給付規定,且藥品具醫療必要性,亦即為治療您的傷害或疾病所合理必要,我們通常會給付本計畫的處方集藥品。另外還必須是獲允許可治療您的病況的藥品。 關於 Medicare 藥品計畫依 D 部分規定不予給付的藥品,請參閱下列三項一般規定: 本計畫的 D 部分藥品給付範圍不包括 Medicare A 部分或 B 部分所給付的藥品。 本計畫無法給付在美國領土境外購買的藥品。 我們的計畫通常不給付仿單標示外使用。「仿單標示外使用」係指將該藥品用於任何非食品藥物管理局核准的用途 (相關用途標示於藥品仿單上)。 詳細資訊請參閱  IEHP DualChoice 會員手冊第 6 章。 取得臨時藥量 在某些情況下,若藥品不在藥品清單上或受到某些規定限制,我們可能會為您提供臨時藥量。這樣一來您就有時間與提供者討論是否可以改用其他藥品,或要求我們給付藥品。 若要取得臨時藥量,您必須符合以下兩條規定: 您一直以來服用的藥品: 不再列於我們的藥品清單上;或 從來不曾列於我們的藥品清單上,或 現在受到某些規定限制。 您必須符合以下任一種情況: 您去年為本計畫會員。 您是本計畫的新會員。 您加入本計畫已超過 90 天,居住在長期照護機構且立刻需要藥品。 當您取得藥品的臨時藥量時,應與提供者討論這次藥量用盡時該怎麼做。以下為您的可選方案: 您可以更換其他藥品。 本計畫可能有適合您的其他給付藥品。您可以致電會員服務中心以索取可治療相同病症的給付藥品清單。該清單可協助您的提供者找到可能適合您的給付藥品。 或者 您可以提出例外申請。 您與您的提供者可要求我們做出例外處理。例如,您可以要求我們給付未列於藥品清單上的藥品。或可要求我們給付藥品,而不加諸任何限制。若您的提供者認為您有適用例外情況的合理醫療理由,則可協助您提出申請。 若明年您所服用的藥品將從藥品清單中移除,或受到某些規定限制,我們將允許您在明年之前申請例外處理。 我們將告訴您明年的藥品給付變動。您可以向我們申請例外處理,並且按照您所希望的方式給付該藥品。 我們將在接到您的申請 (或您的開立處方者的佐證聲明後) 72 小時內答覆您的申請。 Medicare 處方藥給付及您的權利通知 - 會員藥品給付權利公告: Medicare 要求藥局在每次會員的給付請求被駁回或不同意費用分攤資訊時,通知會員。 若您不同意藥劑師所提供之資訊,您有權上訴或提出處方集例外處理要求。 閱讀您的 Medicare 會員藥品給付權利。   藥品使用管理 我們會審查會員的藥品使用情況,協助確保會員獲得安全且適當的照護。此等審查對採用多個提供者開立處方藥品的會員來說特別重要。 IEHP DualChoice (HMO D-SNP) 設有辨識與降低用藥錯誤情況的流程。每次您調配處方藥時,我們都會進行審查。我們也會定期審查我們的記錄。審查時,我們會尋找潛在的問題,如: 可能的用藥錯誤。 藥品可能非必要,因為您正在服用另一種治療相同醫學病症的藥品。 因您的年齡或性別對您不安全或不適當的藥品。 若同時服用,可能危害您健康的特定藥品組合。 處方箋中的藥品含有您會過敏的成分。 可能的服用藥量 (劑量) 錯誤。 過量使用與用量不足 臨床濫用/不當使用 若我們認為您的藥品使用情況可能存在問題,我們會與您的醫師合作改正問題。IEHP DualChoice 還會向 Medicare 暨 Medicaid 服務中心 (CMS) 提供資訊,說明其依據 CMS 規定的準則所採取的品質保證措施。 此頁面資訊為截至 2022 年 10 月 1 日的最新資訊 DSNP_23_3241532_M Pending Accepted

Special Programs - 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 will be offering 11 of the 14 DHCS Preapproved Community Supports services. 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 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 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 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 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.

兒童與青少年 - 疫苗接種

當暴露於疾病中時,身體將會知道如何對抗與殺死病菌,以預防病菌造成健康問題。這稱為對疾病具免疫力。 為什麼疫苗有這麼多種? 人生的所有階段都需要接種疫苗。許多疫苗是對嬰兒與幼童施打,以在成長過程中發育良好。疫苗可保護人體罹患下列疾病: 流感 麻疹、腮腺炎、風疹 小兒麻痺症 破傷風 水痘 百日咳 有關疫苗接種的完整清單,請參閱  0-18 歲疫苗接種建議時程表 (PDF) 及 疫苗接種手冊 (PDF)。 接種疫苗不須負擔任何費用 投保 IEHP,您就可以免費接種疫苗。您亦可參閱 IEHP 會員手冊,瞭解疫苗接種與檢查時程表。向您的醫師索取疫苗接種記錄卡,或登入您的  IEHP 健康帳戶 列印,並在每次檢查時隨身攜帶。