搜尋結果： : " UNIVERSITY OF BIRMINGHAMBIRMIN "

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。

is to support the hiring of PCPs, Specialists, and Midlevel Practitioners 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 Midlevel Practitioners, $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 two significant changes made to the program: 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 has been revised 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 should be e-mailed to Kathryn Yurcak at Yurcak-K@iehp.org  and Tiffany Pham at Pham-T2@iehp.org. For any questions regarding this program, please contact Kathryn Yurcak, Business Analyst at Yurcak-K@iehp.org or Tiffany Pham, Business Analyst at Pham-T2@iehp.org. 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. Corona/Temecula/Hemet Cardiac/Thoracic Surgery Cardiology Family Practice General Surgery Genetics Internal Medicine OB/GYN Pain Management Pediatrics Plastic Surgery Psychiatry Surgery Urology   High Desert Allergy and Immunology Cardiac/Thoracic Surgery Cardiology Dermatology Family Practice General Surgery Genetics Internal Medicine Neurology Neurosurgery OB/GYN Otolaryngology Pain Management Pediatric Subspecialties Pediatric Surgery Pediatrics Podiatry Psychiatry Psychology Rheumatology Surgery Urology   Low Desert Allergy and Immunology Cardiology Family Practice General Surgery Internal Medicine OB/GYN Pain Management Pediatric Surgery Pediatrics Psychiatry Pulmonary Medicine Urology   Riverside Allergy and Immunology Dermatology Family Practice General Surgery Genetics Internal Medicine OB/GYN Pain Management Pediatrics Psychiatry Surgery Urology   San Bernardino Proper Dermatology Family Practice Genetics Internal Medicine OB/GYN Pain Management Pediatric Surgery Pediatrics Psychiatry   West San Bernardino Family Practice Genetics Internal Medicine Neurology OB/GYN Pediatric Surgery Pediatrics Plastic Surgery Psychiatry Surgery      

HP) directly contracted provider. Prior to extending a contract, we must receive the following documents. Please completely fill out all required documents. Any delay in receiving the below stated documents will affect the effective date of the contract that will be mailed to you. New Contract Existing Contract (Adding New Provider) Physician Network Form (PDF) Medical-Number (Physicians and Medical Groups should be enrolled in the State's Medi-Cal Program) Physicians and Specialists (PDF) (M.D., D.O., D.P.M., D.C., O.D., S.P., AuD., P.T., etc) Pre-Contractual Letter (PDF) (Only applies to PCPs. Please review and return signed if all outlined criteria is met) Mid Level Practitioners (PDF) (P.A., N.P., and C.N.M.) Supervisor Agreement (PDF) (Only Applies to Physician Assistants) Medical-Number (Physicians and Medical Groups should be enrolled in the State's Medi-Cal Program) All documents should be e-mailed to contract@iehp.org. All documents should be e-mailed to contract@iehp.org. Provider Maintenance Request Form (PCP, OB/GYN, and Mid-Levels ONLY) can be found here (PDF). Contracts Maintenance Request Form (Specialists ONLY) can be found here (PDF). Individual W-9 form can be found here (PDF). Direct Deposit Frequently Asked Questions can be found here (PDF). National Plan & Provider Enumeration System (NPPES) Portal login: https://nppes.cms.hhs.gov/#/. NPI Address Update Instructions can be found here (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.

contracted provider. Prior to extending a contract, we must receive the following documents.  PLEASE NOTE, IEHP is only accepting Vision Providers who meet the following exceptions through October 31, 2022: Providers practicing in any of the CalAIM service area expansion territories effective January 1, 2022 (including formerly voluntary and excluded zip codes) Providers filling positions that have been vacated in an existing practice Providers transitioning from an existing group agreement to their own individual agreement Providers being added to existing Vision groups Please completely fill out all required documents and submit to contract@iehp.org. Any delay in receiving the below stated documents will affect the effective date of the contract that will be mailed to you.  1. Vision Provider Network Participation Form (PDF) 2. Letter of Interest that outlines the following: What Specialty/Services you are interested in contracting for Facility locations(s) National Provider Identifier (NPI) for each facility Medi-Cal Provider information number (PIN) 3. W-9 Form (PDF) A current Taxpayer Identification Number and Certification Form 4. California Participating Physician Application (PDF) 5. Liability Insurance Certificate Professional general liability in the minimum amount of One Million Dollars ($1,000,000) per occurrance; and Three Million Dollars ($3,000,000) aggregate per year for professional liability 6. Facility Business License - Faculty 7. Ownership Information (PDF) Name, Title, and Percent of Ownership Contracts Maintenance Request Form can be found here (PDF). All documents should be e-mailed to contract@iehp.org. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

d Services (CMS) to remove Social Security Numbers (SSN) from all Medicare cards to address the risk of Medicare beneficiary medical identity theft. CMS will mail out new Medicare Cards to Medicare Beneficiaries starting April 2018 through April 2019.  By clicking on the CMS web links below, you will be leaving the IEHP website. For more information regarding the new Medicare cards, please visit https://www.cms.gov/medicare/new-medicare-card/nmc-home.html. For an overview of the new Medicare cards, please visit https://www.cms.gov/medicare/new-medicare-card/nmc-home. New Medicare card resources: New Medicare Card: Information for Partners & Stakeholders (PPT) You're getting a new Medicare card! (PDF) New Card! New Number! (PDF) "10 Things to Know About Your New Medicare Card" (PDF) Your New Medicare Card: Information for People with Medicare (PPT) For additional resources regarding the new Medicare cards, please visit https://www.cms.gov/Medicare/New-Medicare-Card/Partners-and-Employers/Partners-and-Employers.html. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

rug list and addresses MAC appeals for IEHP’s Medicare Line of Business.  Please direct all MAC appeals, regardless of fill date, via email to m5@dsthealth.com; or direct MAC appeals over the phone to DST Pharmacy Solutions at 1-800-522-7487, Monday through Friday, 8:00AM – 5:00PM CST (6:00AM – 3:00PM PST). Click here for more information about previous IEHP MAC Drug Lists and MAC appeals processing. Information on this page is current as of December 20, 2021

得的資訊 語言協助 我方通信 關於給付決定或上訴相關措施的時效性 如何向 IEHP DualChoice (HMO D-SNP) 提出申訴 1.請立即與我們聯繫 ─ 請致電 (877) 273-IEHP (4347) 與 IEHP DualChoice 聯繫，服務時間為每天上午 8 點至晚上 8 點，假日亦提供服務，TTY/TDD 使用者請撥 1-800-718-4347。您可以隨時提出申訴，除非係與 D 部分藥品有關。若申訴內容係與 D 部分藥品有關，您必須在申訴問題發生後 60 個曆日內提出。 如果您不想透過電話提出 (或者您致電過，但未獲得滿意答覆)，您可以將要申訴的問題寫下來，然後郵寄給我們。如果您是透過書面形式提出申訴，我們也會透過書面形式回覆您的申訴。  您可以使用我們的「會員上訴與申訴申請表」。我們的所有醫師診間與服務提供者皆備有該表單，或者我們也可郵寄表單給您。您可以線上提出申訴。您可將填妥的表單提供給我們的計畫提供者，或寄送至下列地址，也可將填妥的表單傳真至下列號碼。此表單適用 IEHP DualChoice 及其他 IEHP 計畫。 IEHP DualChoice  P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 傳真：(909) 890-5877 無論是致電或致函，您都應立即聯繫 IEHP DualChoice 會員服務中心。 2.我們會審核您的申訴，然後給您答覆 我們會盡可能立即回覆您。當您透過電話提出申訴，我們會儘量在當次通話中答覆您。若您的健康狀況需要我們盡快答覆，我們會按照您的要求辦理。 大部分申訴可在 30 個曆日內得到答覆。如果我們需要更多資訊，且認定延遲是基於您的最大利益 (或者您自己要求更多時間)，則我們可將申訴的答覆時間最多延長 14 天 (共 44 天)。 如果我們否決您的部分或全部申訴，或是我們不負責您所申訴的問題，則我們會告知您。我們會在回應時說明拒絕的理由。我們必須回覆是否同意您的申訴。 快速申訴 若您係因我們拒絕您的「快速給付裁決」或「快速上訴」申請而提出申訴，則我們會自動視同「快速」申訴處理。當您提出「快速」申訴時，則表示我們會在 24 小時內給您答覆。 哪些人可以提出申訴？ 您或您指定之人可以提出申訴。您所指定之人即為您的「代表」。 您可以指定親戚、朋友、律師、倡權者、醫師或任何其他人作為您的代表。其他人可能已經獲得法院許可或依據州法可代表您提出申訴。如果您要指定擔任您代表的人士尚未獲得法院許可或不符合州法規定，則您與該人士必須簽署一份聲明並標註日期，以茲授予該人士擔任您代表的權利。如欲進一步瞭解如何指定代表，您可以致電 IEHP DualChoice 會員服務中心。 外部申訴 您可以向 Medicare 提出申訴 您可以將申訴發送給 Medicare。Medicare 申訴表可透過下列網址下載： https://www.medicare.gov/MedicareComplaintForm/home.aspx。 Medicare 會仔細審理您的申訴，並且會運用這項資訊改善 Medicare 計畫的品質。 若您有任何其他意見或疑慮，或者您認為本計畫未解決您的問題，請致電 (800) MEDICARE (800) 633-4227)。TTY/TDD 使用者請撥 (877) 486-2048。此為免付費電話。 您也可以向 Medi-Cal 提出申訴 監察專員辦公室也可從中立角度協助解決問題，以確保我們的會員獲得我們須提供的所有給付服務。監察專員辦公室與我方無關，也與任何保險公司或健康計畫無關。  監察專員辦公室的電話為 1-888-452-8609。這些服務是免費的。 您可以向加州管理式醫療保健部提出您的申訴 加州管理式醫療保健部 (DMHC) 負責管理各項健康計畫。您可以致電 DMHC 協助中心，取得有關 Medi-Cal 服務申訴方面的協助。若您在申訴緊急問題、涉及對您的健康造成立即嚴重危害之問題、您不同意我方計畫對您申訴的裁決，或我方計畫並未於 30 個曆日內解決您的申訴等方面需要協助，您可以聯繫 DMHC。 您可以透過下列兩種方式取得協助中心的協助： 致電 (888) 466-2219，TTY 使用者請撥 (877) 688-9891。此為免付費電話。 造訪管理式醫療保健部網站： http://www.dmhc.ca.gov/ 您可以向民權局提出申訴 如果您認為遭受到不公平對待，您可以向衛生與公眾服務部 (Department of Health and Human Services) 民權局提出申訴。例如，您可以提出無障礙設施或語言協助等相關申訴。民權局的電話為 (800) 368-1019。TTY 使用者請撥 (800) 537-7697。您也可以造訪 https://www.hhs.gov/ocr/index.html 瞭解詳細資訊。 您也可以聯絡當地的民權辦事處，地址是： U.S. Department of Health and Human Services 90 7th Street, Suite 4-100 San Francisco, CA 94103 電話：(800) 368-1019 TDD：(800) 537-7697 傳真：(415) 437-8329 您也受《美國殘障人士法案》(Americans with Disabilities Act) 之保護。您可以聯繫監察專員辦公室取得協助。電話號碼為 (888) 452-8609。 若您的申訴是與照護品質有關 您還有下列兩個選擇： 您可以向品質改善組織 (Quality Improvement Organization) 提出申訴。如果您願意，可以直接向該組織提出與您所獲得照護品質有關的申訴 (而非向我方計畫提出申訴)。如欲搜尋您所在州的品質改善組織名稱、地址與電話號碼，請參閱  IEHP DualChoice 會員手冊第 2 章。若您向該組織提出申訴，我們將與其共同解決您的申訴。 或者，您可以同時向雙方提出申訴。您可以視需求，同時向我們和品質改善組織提出與照護品質相關的申訴。 詳細資訊請參閱 IEHP DualChoice 會員手冊第 9 章。 處理您的 Medi-Cal 福利問題 若您向 IEHP 投保 Medi-Cal，並希望瞭解就 Medi-Cal 給付服務提出上訴與申訴的相關資訊，請致電 IEHP DualChoice 會員服務部，電話為 (877) 273-IEHP (4347)，TTY 使用者請撥 (800) 718-4347。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。 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

表。若您需要填寫表單方面的協助，IEHP 會員服務中心可以提供協助。 您可以線上填寫會員申訴表。 您可以將填寫完成的表單提供給任何 IEHP 提供者，或郵寄至： P.O Box 1800, Rancho Cucamonga, CA 91729-1800 您可以將填寫完成的表單傳真至 (909) 890-5877。您可以線上提出申訴。此表單適用 IEHP DualChoice 及其他 IEHP 計畫。  針對某些類型的問題，您需遵行給付範圍決定和上訴程序。 而針對其他類型的問題則需遵行提出申訴的程序。以上兩種程序皆經 Medicare 核準。為確保問題處理流程的公正性與時效性，每種流程各有一套規定、程序及期限，我方與您都必須確實遵守。 長期服務與支援： 如果您對於照護有任何疑問，請致電 1-888-452-8609 尋求監察專員辦公室協助。  若屬我們簽約社區成人服務 (Community Based Adult Services, CBAS) 據點 或護理機構/亞急性照護機構之資格認定、評估與照護相關的問題與疑慮，請依據下列流程提出。 社區成人服務 (CBAS) 您可以致電 (877) 273-IEHP (4347) 與 IEHP 會員服務中心聯繫，並索取會員申訴表。若您需要填寫表單方面的協助，IEHP 會員服務中心可以提供協助。 您可以將填寫完成的表單提供給任何 IEHP 提供者，或郵寄至： P.O Box 1800 Rancho Cucamonga, CA 91729-1800 您可以將填寫完成的表單傳真至 (909) 890-5877。您可以線上提出申訴。此表單適用 IEHP DualChoice 及其他 IEHP 計畫。 協助處理問題 您可以聯絡 Medicare。您可以透過下列兩種方式直接向 Medicare 索取資訊： 您可以致電 24 小時全年無休專線 (800) MEDICARE (800) 633-4227，TTY 使用者請撥 (877) 486-2048。 您可以造訪 Medicare 網站 點選此連結，您將會離開 IEHP DualChoice 網站。 向獨立政府組織求助 我們非常樂意為您提供服務。不過，在某些情況下，建議您透過與我方無關的人士獲得協助或指導。您可隨時聯繫您的 State Health Insurance Assistance Program (SHIP)。此政府計畫在各州都設有受過訓練的顧問。此計畫與我方無關，也與任何保險公司或健康計畫無關。此計畫的顧問可以協助您瞭解處理問題時應採用的流程。此外，他們也可以解答您的問題、提供更多資訊，以及輔導您進行後續處理。SHIP 顧問的服務並不收費。您可以致電 1-800-434-0222 與 SHIP 聯繫。 向 DHCS 取得協助與相關資訊 電話：(916) 445-4171 MCI，TDD 請撥 (800) 735-2929 MCI，語音電話：(800) 735-2922 Sprint，TDD 請撥 (800) 877-5378 Sprint，語音電話：(800) 877-5379 致函： Department of Health Care Services 1501 Capitol Ave., P.O. Box 997413 Sacramento, CA 95899-7413 網站：www.dhcs.ca.gov 點選此連結，您將會離開 IEHP DualChoice 網站。 向 Medi-Cal 取得協助與相關資訊 監察專員辦公室可以解答您的疑問，並協助您瞭解需要做哪些事才能解決您的問題。監察專員辦公室與我方無關，也與任何保險公司或健康計畫無關。此計畫可協助您瞭解應採用哪項流程。 電話：請於週一至週五上午 9 點至下午 5 點致電 1-888-452-8609 (TTY 711) 造訪其網站：www.healthconsumer.org/ 點選此連結，您將會離開 IEHP DualChoice 網站。 向 Livanta 取得協助與相關資訊 本州有一個名為 Livanta Beneficiary & Family Centered Care (BFCC) 品質改進組織 (Quality Improvement Organization, QIO) 的組織。這是一個由醫生和其他健康照護專業人員組成的團體，他們協助改善 Medicare 患者的護理品質。Livanta 與我們的計畫無關。 電話：(877) 588-1123，TTY 使用者請撥 (855) 887-6668 如欲提出上訴：(855) 694-2929 如欲申請所有其他審核：(844) 420-6672 致函： Livanta BFCC-QIO Program 10820 Guilford Road, Suite 202 Annapolis Junction, Maryland 20701 網站：www.livanta.com 點選此連結，您將會離開 IEHP DualChoice 網站。 如何取得向 IEHP DualChoice (HMO D-SNP) 提出的申訴、上訴與例外處理的總數？ 請致電或寫信至 IEHP DualChoice 會員服務中心。 電話：(877) 273-IEHP (4347)。此為免付費專線。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 使用者請撥：(800) 718-4347。此號碼須使用特殊電話設備。此為免付費專線。 傳真：(909) 890-5877 致函： IEHP DualChoice, P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 電子郵件：memberservices@iehp.org 親自造訪：10801 Sixth Street, Suite 120, Rancho Cucamonga, CA 91730 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

mance and quality measures to help Medicare beneficiaries make informed decisions regarding health and prescription drug plans. As part of this effort, CMS adopted measures for High Risk Medication (HRM) endorsed by the Pharmacy Quality Alliance (PQA) and the National Quality Forum (NQF). The HRM was developed using existing HEDIS measurement “Drugs to be avoided in the elderly”.  The HRM rate analyzes the percentage of Medicare Part D beneficiaries 65 years or older who have received prescriptions for drugs with a high risk of serious side effects in the elderly. 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. Notices 12/10/2021 IEHP Pharmacy Times (PDF) 01/13/2016 IEHP Pharmacy Times (PDF) 06/17/2013 IEHP Pharmacy Times (PDF) 02/11/2013 IEHP Pharmacy Times (PDF)   Reference IEHP High Risk Medication Drug Alternative(s) Reference Guide (PDF) AGS Beers Criteria 2019 (PDF)   Information on this page is current as of December 10, 2021.

康計畫。這項承諾也及於支持 IEHP 宗旨，願意為社區提供高品質、方便取得並以保健為目的的健康照護服務之業務夥伴以及指定代理機構。  我們的法規遵循計畫旨在： 確保我們遵循適用的法令、規則、法規 減少或消除詐欺、浪費與濫用 (FWA) 預防、偵查、矯正不符法規的情形 加強我們對於法規遵循文化的承諾，並為此而努力 建立並實現我們對於誠實、誠信、透明、負責的共同承諾 FDR 資訊 什麼是 FDR？ 第一階、下游或關聯實體 (First Tier, Downstream or Related Entity，FDR) 是指透過分包代表 IEHP 提供健康計畫相關服務的委派實體。  FDR 規定 FDR 必須*遵守 IEHP 的政策和程序、業務行為與道德規範，以及其他合約規定。   FDR 資源 法規遵循計畫規定*手冊/廠商第一階、下游、關聯實體 (FDR) - 本手冊與 IPA 無關。  IEHP 法規遵循計畫說明 IEHP 業務行為與道德規範  禁止報復政策 委任監督提供者手冊 PnP (即將提供) 文件留存 (即將提供) FDR 法規遵循計畫證明 CMS 法規遵循、FWA、HIPAA 訓練教材 ICE FWA 訓練 ICE 綜合法規遵循訓練 *如欲瞭解 IPA 規定，請造訪 提供者資源頁面。  業務行為與道德規範 Inland Empire Health Plan (IEHP) 期望團隊成員以及與 IEHP 有業務往來的業務實體在執行業務活動時符合道德與專業，並促進公眾對於 IEHP 誠信的信任與信心。本規範針對 IEHP 的法規遵循文化，以及每位團隊成員在建立與延續該文化上所扮演的角色提供相關指引，成員包含高階管理人員、高階主管、管理委員會、業務合作夥伴。 IEHP 業務行為與道德規範 法規遵循、詐欺、浪費與濫用 (FWA)、隱私權計畫訓練 IEHP 的法規遵循、FWA 與隱私權訓練計畫著重於成效良好的法規遵循計畫、行為與道德、詐欺、浪費與濫用 (FWA)、隱私權計畫的各部分。 IEHP 要求委派實體在聘僱/開始日期的 90 天內為 其員工、提供者、下游實體、董事會、承包商提供法規遵循訓練。 IEHP 致力於培養法規遵循、道德與誠信文化，法規遵循訓練的目標是賦予所有相關人員能力，展現對於 IEHP 規定的認知，包括與日常工作相關法規遵循有關的法規、政策、程序。 若有疑問或其他建議，請寄電子郵件至 IEHP 法規遵循部門：compliance@iehp.org 綜合法規遵循訓練 法規遵循詐欺、浪費與濫用 (FWA) HIPAA 隱私權與安全 (PDF) 報告資訊 IEHP 提供下列資源，供報告詐欺、浪費或濫用、隱私權問題以及其他法規遵循問題： 法規遵循熱線：(866) 355-9038 傳真：(909) 477-8536 電子郵件：compliance@iehp.org 郵件： IEHP Compliance Officer P.O.Box 1800 Rancho Cucamonga, CA 91729-1800 線上：報告法規遵循問題

、遺傳資訊、婚姻狀況、性別、性別認同或性傾向而非法歧視、排擠或差別對待他人。 IEHP 提供： 免費的援助和服務，以協助殘障人士與我們充分溝通，例如： 合格的手語翻譯員 其他格式的書面資訊（大字列印、語音、無障礙電子格式、其他格式）   針對母語非英語人士的免費語言服務，例如： 合格的口譯員 以其他語言撰寫的資訊 如需此類服務，包括假日在內的每天早上 8 點至下午 5 點（太平洋標準時間）均可撥打 1-800-440-IEHP (4347) 與 IEHP 會員服務中心聯絡。如在聽說方面有困難，請撥打 1-800-718-4347。此文件可應要求以點字、大字列印、盒式錄音磁帶或電子形式提供。如需獲取其他格式的副本，請致電或寫信： Inland Empire Health Plan 10801 6th St., Rancho Cucamonga, CA 91730-5987 1-800-440-4347（TTY：1-800-718-4347/加州轉接 711） 如何提出申訴 如果您認為 IEHP 並未提供此類服務，或因性別、種族、膚色、宗教、血統、國籍、族群認同、年齡、精神殘疾、身體殘疾、醫療狀況、遺傳資訊、婚姻狀況、性別、性別認同或性傾向而以其他方式進行非法歧視，您可以向 IEHP 的民權協調員提出申訴。您可以透過電話、書面、親洽或電子等形式提出申訴： 電話：早上 8 點至下午 5 點（太平洋標準時間）撥打 1- 800-440-4347 與 IEHP 的民權協調員聯絡。或者，如在聽說方面有困難，請撥打 TTY 專線：1-800-718-4347/加州轉接 711。 書面：填寫申訴表或寫信給 - IEHP 民權協調員，地址為 10801 6th St., Rancho Cucamonga, CA 91730-5987 親洽：前往醫師辦公室或 IEHP 並說想要提出申訴。 電子：線上提出申訴。 民權辦公室 - 加州醫療保健服務部 您也可以透過電話、書面或電子等形式向加州醫療保健服務部民權辦公室提交民權申訴： 電話：電話 (916) 440-7370。如在聽說方面有困難，請撥打 711（電信轉接服務）。 書面：填寫申訴表或寄信至 - Deputy Director, Office of Civil Rights Department of Health Care Services Office of Civil Rights, P.O。Box 997413, MS 0009 Sacramento, CA 95899-7413 電子：傳送電子郵件至 CivilRights@dhcs.ca.gov。 民權辦公室 - 美國衛生與公眾服務部 如果認為自己遭遇了基於種族、膚色、國籍、年齡、殘疾或性別的歧視，您也可以透過電話、書面或電子等形式向美國衛生與公眾服務部民權辦公室提出民權申訴： 電話：撥打 1-800-368-1019。如在聽說方面有困難，請撥打 TTY/TDD 專線：1-800- 537-7697。 書面：填寫申訴表或寄信至 - U.S. Department of Health and Human Services, 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 電子：造訪民權申訴辦公室入口網站 https://ocrportal.hhs.gov/ocr/portal/lobby.jsf 語言協助 English ATTENTION:If you need help in your language call 1-800-440-4347 (TTY: 1-800-718-4347).Aids and services for people with disabilities, like documents in braille and large print, are also available.Call 1-800-440-4347 (TTY: 1-800-718-4347).These services are free of charge. الشعار بالعربي ة (Arabic) يُر جى الانتباه:ى إذا احتجت إلى المساعدة بلغتك، فاتصل ب 1-800-440-4347 (TTY: 1-800-718-4347) .ى تتوفر ا ً أيض المساعدات والخدمات للأشخاص ذوي الإعاقة، مث ى ل المستندات المكتوبة بطريقة بريل والخ ى ط الكب ري.ى اتصل ب 1-800-440-4347 (TTY: 1-800-718-4347) . هذه الخدمات مجانيةى. Հայերեն պիտակ (Armenian) ՈՒՇԱԴՐՈՒԹՅՈՒՆ:Եթե Ձեզ օգնություն է հարկավոր Ձեր լեզվով, զանգահարեք 1-800-440-4347 (TTY: 1-800-718-4347)։ Կան նաև օժանդակ միջոցներ ու ծառայություններ հաշմանդամություն ունեցող անձանց համար, օրինակ` Բրայլի գրատիպով ու խոշորատառ տպագրված նյութեր։ Զանգահարեք 1-800-440-4347 (TTY: 1-800-718-4347)։ Այդ ծառայություններն անվճար են։ ឃ្លាសម្គាល់ជាភាសាខ្មែរ (Cambodian) ចំណំ៖ ប ើអ្នក ត្រូវ ការជំនួយ ជាភាសា រ ស់អ្នក សូម ទូរស័ព្ទបៅបេខ 1-800-440-4347 (TTY: 1-800-718-4347)។ ជំនួយ និង បសវាកមម សត្ា ់ ជនព្ិការ ដូចជាឯកសារសរបសរជាអ្កសរផុស សត្ា ់ជនព្ិការភ្ននក ឬឯកសារសរបសរជាអ្កសរព្ុមពធំ ក៏អាចរកបានផងភ្ដរ។ ទូរស័ព្ទមកបេខ 1-800-440-4347 (TTY: 1-800-718-4347)។ បសវាកមមទំងបនេះមិនគិរថ្លៃប ើយ។ 简体中文标语(Chinese) 请注意：如果您需要以您的母语提供帮助，请致电1-800-440-4347 (TTY: 1-800-718-4347)。另外还提供针对残疾人士的帮助和服务，例如盲文和需要较大字体阅读，也是方便取用的。请致电1-800-440-4347 (TTY: 1-800-718-4347)。这些服务都是免费的。 (Farsi) مطلب به زبان فارسی توجه: اگر میخواهید به زبان خود کمک دریافت کنید، با 1-800-440-4347 (TTY: 1-800-718-4347) تماس بگیرید. کمکها و خدمات مخصوص افراد دارای معلولیت، مانند نسخههای خط بریل و چاپ با حروف بزرگ، نیز موجود است. با 1-800-440-4347 (TTY: 1-800-718-4347) تماس بگیرید. این خدمات رایگان ارائه میشوند. ह िंदी टैगलाइन (Hindi) ध्यान दें: अगर आपको अपनी भाषा में सहायता की आवश्यकता है 1-800-440-4347 (TTY: 1-800-718-4347) पर कॉल करें। अशक्तता वाले लोगोों के ललए सहायता और सेवाएों, जैसे ब्रेल और बडे लरोंट में भी दस्तावेज़ उपलब्ध हैं। 1-800-440-4347 (TTY: 1-800-718-4347) पर कॉल करें। ये सेवाएों लन: शुल्क हैं। Nqe Lus Hmoob Cob (Hmong) CEEB TOOM:Yog koj xav tau kev pab txhais koj hom lus hu rau 1-800-440-4347 (TTY: 1-800-718-4347).Muaj cov kev pab txhawb thiab kev pab cuam rau cov neeg xiam oob qhab, xws li puav leej muaj ua cov ntawv su thiab luam tawm ua tus ntawv loj.Hu rau 1-800-440-4347 (TTY: 1-800-718-4347).Cov kev pab cuam no yog pab dawb xwb. 日本語表記 (Japanese) 注意日本語での対応が必要な場合は 1-800-440-4347 (TTY: 1-800-718-4347)へお電話ください。点字の資料や文字の拡大表示など、障がいをお持ちの方のためのサービスも用意しています。1-800-440-4347 (TTY: 1-800-718-4347) へお電話ください。これらのサービスは無料で提供しています。 한국어 태그라인 (Korean) 유의사항: 귀하의 언어로 도움을 받고 싶으시면 1-800-440-4347 (TTY: 1-800-718-4347) 번으로 문의하십시오. 점자나 큰 활자로 된 문서와 같이 장애가 있는 분들을 위한 도움과 서비스도 이용 가능합니다.1-800-440-4347 (TTY: 1-800-718-4347) 번으로 ___________문의하십시오. 이러한 서비스는 무료로 제공됩니다. ແທກໄລພາສາລາວ (Laotian) ປະກາດ: ຖ້າທ່ານຕ້ອງການຄວາມຊ່ວຍເຫ ຼືອໃນພາສາຂອງທ່ານໃຫ້ໂທຫາເບີ 1-800-440-4347 (TTY: 1-800-718-4347). ຍັງມີຄວາມຊ່ວຍເຫ ຼືອແລະການບໍລິການສໍາລັບຄົນພິການ ເຊັ່ນເອກະສານທີ່ເປັນອັກສອນນູນແລະມີໂຕພິມໃຫຍ່ ໃຫ້ໂທຫາເບີ 1-800-440-4347 (TTY: 1-800-718-4347). ການບໍລິການເຫ ົ່ານີ້ບໍ່ຕ້ອງເສຍຄ່າໃຊ້ຈ່າຍໃດໆ. Mien Tagline (Mien) LONGC HNYOUV JANGX LONGX OC:Beiv taux meih qiemx longc mienh tengx faan benx meih nyei waac nor douc waac daaih lorx taux 1-800-440-4347 (TTY: 1-800-718-4347).Liouh lorx jauv-louc tengx aengx caux nzie gong bun taux ninh mbuo wuaaic fangx mienh, beiv taux longc benx nzangc-pokc bun hluo mbiutc aengx caux aamz mborqv benx domh sou se mbenc nzoih bun longc.Douc waac daaih lorx 1-800-440-4347 (TTY: 1-800-718-4347).Naaiv deix nzie weih gong-bou jauv-louc se benx wang-henh tengx mv zuqc cuotv nyaanh oc. ਪੰਜਾਬੀ ਟੈਗਲਾਈਨ (Punjabi) ਧਿਆਨ ਧਿਓ: ਜੇ ਤੁਹਾਨ ੂੰ ਆਪਣੀ ਭਾਸਾ ਧ ਿੱਚ ਮਿਿ ਿੀ ਲੋੜ ਹੈ ਤਾਂ ਕਾਲ 1-800-440-4347 (TTY: 1-800-718-4347). ਅਪਾਹਜ ਲੋਕਾਂ ਲਈ ਸਹਾਇਤਾ ਅਤੇ ਸੇ ਾ ਾਂ, ਧਜ ੇਂ ਧਕ ਬ੍ਰੇਲ ਅਤੇ ਮੋਟੀ ਛਪਾਈ ਧ ਿੱਚ ਿਸਤਾ ੇਜ਼, ੀ ਉਪਲਬ੍ਿ ਹਨ| ਕਾਲ ਕਰੋ 1-800-440-4347 (TTY: 1-800-718-4347). ਇਹ ਸੇ ਾ ਾਂ ਮੁਫਤ ਹਨ| Русский слоган (Russian) ВНИМАНИЕ!Если вам нужна помощь на вашем родном языке, звоните по номеру 1-800-440-4347 (TTY: 1-800-718-4347).Также предоставляются средства и услуги для людей с ограниченными возможностями, например документы крупным шрифтом или шрифтом Брайля.Звоните по номеру 1-800-440-4347 (TTY: 1-800-718-4347).Такие услуги предоставляются бесплатно. Mensaje en español (Spanish) ATENCIÓN: si necesita ayuda en su idioma, llame al 1-800-440-4347 (TTY: 1-800-718-4347).También ofrecemos asistencia y servicios para personas con discapacidades, como documentos en braille y con letras grandes.Llame al 1-800-440-4347 (TTY: 1-800-718-4347).Estos servicios son gratuitos. Tagalog Tagline (Tagalog) ATENSIYON:Kung kailangan mo ng tulong sa iyong wika, tumawag sa 1-800-440-4347 (TTY: 1-800-718-4347).Mayroon ding mga tulong at serbisyo para sa mga taong may kapansanan,tulad ng mga dokumento sa braille at malaking print.Tumawag sa 1-800-440-4347 (TTY: 1-800-718-4347).Libre ang mga serbisyong ito. แท็กไลน์ภาษาไทย (Thai) โปรดทราบ: หากคุณต้องการความช่วยเหลือเป็นภาษาของคุณ กรุณาโทรศัพท์ไปที่หมายเลข 1-800-440-4347 (TTY: 1-800-718-4347)นอกจากนี้ ยังพร้อมให้ความช่วยเหลือและบริการต่าง ๆ สาหรับบุคคลที่มีความพิการ เช่น เอกสารต่าง ๆ ที่เป็นอักษรเบรลล์และเอกสารที่พิมพ์ด้วยตัวอักษรขนาดใหญ่ กรุณาโทรศัพท์ไปที่หมายเลข 1-800-440-4347 (TTY: 1-800-718-4347) ไม่มีค่าใช้จ่ายสาหรับบริการเหล่านี้ Примітка українською (Ukrainian) УВАГА!Якщо вам потрібна допомога вашою рідною мовою, телефонуйте на номер 1-800-440-4347 (TTY: 1-800-718-4347).Люди з обмеженими можливостями також можуть скористатися допоміжними засобами та послугами, наприклад, отримати документи, надруковані шрифтом Брайля та великим шрифтом.Телефонуйте на номер 1-800-440-4347 (TTY: 1-800-718-4347).Ці послуги безкоштовні. Khẩu hiệu tiếng Việt (Vietnamese) CHÚ Ý:Nếu quý vị cần trợ giúp bằng ngôn ngữ của mình, vui lòng gọi số 1-800-440-4347 (TTY: 1-800-718-4347).Chúng tôi cũng hỗ trợ và cung cấp các dịch vụ dành cho người khuyết tật, như tài liệu bằng chữ nổi Braille và chữ khổ lớn (chữ hoa).Vui lòng gọi số 1-800-440-4347 (TTY: 1-800-718-4347).Các dịch vụ này đều miễn phí.    

IEHP GOVERNING YOUR USE OF THE DEVELOPER PORTAL AND THE IEHP APIS (DEFINED BELOW). BY CLICKING “I AGREE” OR ACCESSING THE DEVELOPER PORTAL OR USING IEHPS APIS YOU ARE AGREEING TO BE BOUND BY THE TERMS OF THIS DEVELOPER AGREEMENT AND ANY OTHER APPLICABLE TERMS AND CONDITIONS POSTED ON IEHPS WEBSITE LOCATED AT WWW.IEHP.ORG/EN/ABOUT/PRIVACY-POLICY. IF YOU DO NOT AGREE TO THE TERMS OF THIS AGREEMENT, YOU MAY NOT ACCESS THE DEVELOPER PORTAL OR USE THE IEHP APIs. By entering into this Agreement, you affirm that you are at least 13 years old and of legal age to enter into this Agreement and are authorized to enter into this Agreement on behalf of your Company. No legal partnership or agency relationship is created between IEHP and you or your Company by virtue of this Agreement. We may update this Agreement by posting the updated version(s) on this Website. Updated versions of the Agreement will apply to your use of the IEHP APIs occurring on or after the date of the last update. The "Last Updated" legend above indicates when this Agreement was last changed. You should periodically review this page to determine if this Agreement has been updated. Your continued use of the IEHP APIs following any updates to this Agreement shall constitute notice and acceptance of any such updates. PERMISSIBLE USE OF IEHP APIS We provide access to Our application programming interfaces (“APIs”), including Our Patient Access API, Provider Directory API and Promoting Interoperability API, and their associated documentation and sandbox (collectively, the “IEHP APIs”) on the Developer Portal. We may update, change, discontinue or add IEHP APIs or functionality or features to the IEHP APIs in Our discretion with or without providing notice to you. Subject to the terms of this Agreement, IEHP grants you a limited, non-sublicensable, non-assignable, non- transferable, royalty-free, non-exclusive license only to use: (a) the Patient Access API to retrieve certain health plan information maintained by Inland Empire Health Plan, a local public entity of the State of California, and its subsidiary health plans with the approval and at the direction of the applicable member or their personal representative consistent with applicable law; (b) the Provider Directory API to retrieve certain provider and pharmacy directory information; and (c) the Promoting Interoperability API to retrieve certain health care information with the consent of the applicable patient or their personal representative consistent with applicable law. You may only access the Patient Access API and Promoting Interoperability API by means of an application that has been registered with IEHP to access them. You agree to comply with all applicable laws, regulations, and governmental issuances. RESTRICTIONS You may not: (a) decompile, disassemble, reverse engineer, or otherwise attempt to derive, reconstruct, identify, or discover any source code, underlying ideas, or algorithms of the IEHP APIs by any means, except to the extent that the foregoing restriction is prohibited by applicable law; (b) remove any proprietary notices, labels, or marks from the IEHP APIs; (c) interrupt or attempt to interrupt the operation of the IEHP APIs in any way, including, without limitation, by restricting, inhibiting, or interfering with the ability of any other user to use the IEHP APIs (including by means of hacking or defacing any portion of the IEHP APIs, or by engaging in spamming, flooding, or other disruptive activities); (d) disrupt, interfere with, modify, bypass, or otherwise circumvent IEHP APIs functionality or features, limitations, security measures, technical processes, availability, integrity, or performance (or attempt the same); (e) transmit or attempt to transmit data over a IEHP APIs unless such transmission is authorized and formatted in accordance with applicable specifications in the IEHP APIs implementation guide; (f) transmit or otherwise make available through or in connection with the IEHP APIs any malicious, harmful or invasive code; (g) attempt to exceed IEHP APIs rate limits; (h) conduct security research on or testing against IEHP APIs, services, applications, systems, devices, or networks without prior written approval from IEHP; or (i) use the IEHP APIs (1) for any unlawful purpose or in any manner not authorized or intended in the IEHP APIs implementation guide, (2) in any way that could pose a threat to, disrupt, interfere with, harm, or impair the IEHP APIs, IEHP or other IEHP services, applications, systems, devices, or networks, or Inland Empire Health Plan members’, patients’, customers’, or other users’ use of IEHP APIs, (3) in any manner that, in IEHP’s reasonable determination, constitutes excessive or abusive usage, (4) to gain unauthorized access to any IEHP service, application, system, device, or network, or (5) to transmit malicious code or exploit security flaws, vulnerabilities, or deficiencies. MONITORING Your use of this Website and the IEHP APIs may be monitored by IEHP to ensure compliance with this Agreement. You consent to such monitoring. REPORTING SECURITY ISSUES You agree to promptly report to IEHP any security flaws, vulnerabilities, or deficiencies identified through normal use of IEHP APIs by calling the Inland Empire Compliance Hotline at 1-866-355-9038. You may not publicly disclose security flaws, vulnerabilities, or deficiencies in the IEHP APIs or other IEHP applications, systems, devices, or networks of which you become aware. ACCOUNTS/REGISTRATION You agree to promptly report to IEHP any security flaws, vulnerabilities, or deficiencies identified through normal use of IEHP APIs by calling the Inland Empire Health Plan Compliance Hotline at 1-866-355-9038. You may not publicly disclose security flaws, vulnerabilities, or deficiencies in the IEHP APIs or other IEHP applications, systems, devices, or networks of which you become aware. PROPRIETARY RIGHTS IEHP or its licensors own the IEHP APIs and the content on this Website and all intellectual property rights therein. You may not use any Inland Empire Health Plan entity’s name, trademarks, service marks, tradenames, logos or other distinctive brand features except as necessary to comply with your obligation, above, and agree not to remove any proprietary notices, labels, or marks from the IEHP APIs, and, in any case, you may not use those notices, labels or marks to imply affiliation with or endorsement by Inland Empire Health Plan. You have only those rights to access and use the IEHP APIs as are expressly granted by IEHP under this Agreement and all other rights in the IEHP APIs are reserved to IEHP or its licensors. You acknowledge that these rights are valid and protected in all forms, media, and technologies existing now or hereinafter developed. “Inland Empire Health Plan, a local public entity of the State of California,” means the health care organization doing business as Inland Empire Health Plan including, without limitation, Inland Empire Health Plan, and the subsidiaries, partners, and successors of the foregoing. PUBLIC ENTITY STATUS; BROWN ACT/PUBLIC RECORDS ACT The parties hereby acknowledge and agree that IEHP is a local public entity of the State of California subject to the Brown Act, California Government Code Sections 54950 et seq., and the Public Records Act, California Government Code Sections 6250 et seq. PRIVACY Your submission of information through the Website is governed by our Privacy Policy. RESPONSIBILITY FOR HARDWARE, SOFTWARE, TELECOMMUNICATIONS AND OTHER SERVICES You are responsible for obtaining, maintaining, and paying for all hardware, software, and all telecommunications and other services, needed for you to use the IEHP APIs. DISCLAIMER OF WARRANTY IEHP AND ITS SERVICE PROVIDERS DISCLAIM ALL EXPRESS OR IMPLIED REPRESENTATIONS OR WARRANTIES REGARDING THE IEHP APIS, INFORMATION, CONTENT, SERVICES, FUNCTIONALITY, AND ANY OTHER RESOURCES AVAILABLE ON OR ACCESSIBLE THROUGH THIS WEBSITE, INCLUDING, WITHOUT LIMITATION, ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR NON- INFRINGEMENT. ALL SUCH IEHP APIS, INFORMATION, CONTENT, SERVICES, FUNCTIONALITY AND RESOURCES ARE MADE AVAILABLE "AS IS" AND "AS AVAILABLE", AT YOUR SOLE RISK, WITHOUT WARRANTY OF ANY KIND. IEHP DOES NOT WARRANT THAT THE WEBSITE OR IEHP APIS WILL BE ACCURATE OR OPERATE WITHOUT INTERRUPTION OR ERROR. LIMITATION OF LIABILITY TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, IN NO EVENT SHALL IEHP, INLAND EMPRIE HEALTH PLAN OR THEIR SERVICE PROVIDERS, LICENSORS OR RESPECTIVE EMPLOYEES, OFFICERS, DIRECTORS, AGENTS, AFFILIATES, SUPPLIERS, VENDORS, LICENSORS, CO-BRANDERS OR PARTNERS (COLLECTIVELY, THE “INLAND EMPRIE HEALTH PLAN PARTIES") BE LIABLE FOR ANY DIRECT, INDIRECT, SPECIAL, PUNITIVE, INCIDENTAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES, OR ANY DAMAGES WHATSOEVER RESULTING FROM ANY LOSS OF USE, LOSS OF DATA, LOSS OF PROFITS, BUSINESS INTERRUPTION, LITIGATION, OR ANY OTHER PECUNIARY LOSS, WHETHER BASED ON BREACH OF CONTRACT, TORT (INCLUDING NEGLIGENCE), PRODUCT LIABILITY, OR OTHERWISE ARISING OUT OF OR IN ANY WAY CONNECTED WITH THE USE, OPERATION OR PERFORMANCE OF THE IEHP APIS, WITH THE DELAY OR INABILITY TO USE THE IEHP APIS, ANY DEFECTS IN THE IEHP APIS, OR WITH THE PROVISION OF, OR FAILURE TO MAKE AVAILABLE, ANY INFORMATION, SERVICES, PRODUCTS, MATERIALS, OR OTHER RESOURCES AVAILABLE ON OR ACCESSIBLE THROUGH THE IEHP APIS, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. You acknowledge and agree that the limitations set forth above are fundamental elements of this Agreement. INDEMNIFICATION You agree to indemnify, defend, and hold the Inland Empire Health Plan Parties harmless from any liability, loss, claim, and expense (including reasonable attorneys' fees) actually or allegedly related to or arising out of your use of the IEHP APIs or this Website, your use or disclosure of information obtained through the IEHP APIs, your violation of this Agreement, and/or your violation of the rights of any other person. TERM, TERMINATION, SUSPENSION AND REVOCATION This Agreement is effective until terminated by either party. If you no longer agree to be bound by this Agreement, you must cease your use of the IEHP APIs. If you breach any provision of this Agreement, then you may no longer use the IEHP APIs. IEHP may suspend or revoke your Credentials or access to the IEHP APIs without prior notice for your failure to comply with this Agreement or if IEHP determines that your access to the IEHP APIs would present an unacceptable level of risk to the security of IEHP’s systems. IEHP may terminate this Agreement if you fail to comply with its terms and, to the extent permitted by law, for any or no reason. If this Agreement is terminated for any reason, then: (a) this Agreement will continue to apply and be binding upon you in respect of your prior use of the IEHP APIs (and any unauthorized further use of the IEHP APIs); and (b) any rights granted to us under this Agreement will survive such termination. GENERAL LEGAL TERMS This Agreement constitutes the entire agreement between you and IEHP with respect to its subject matter IEHP’s failure to exercise or enforce any right or provision of this Agreement shall not constitute a waiver of such right or provision. If a court of competent jurisdiction rules that any provision of the Agreement is invalid, then that provision will be removed from the Agreement without affecting the rest of the Agreement and the remaining provisions will continue to be valid and enforceable. There are no third- party beneficiaries to this Agreement. The rights granted in this Agreement may not be assigned or transferred by You without the prior written approval of IEHP. You may not delegate your responsibilities or obligations under this Agreement without the prior written approval of IEHP. This Agreement shall be governed by the laws of the State of California without regard to its conflict of laws provisions. You agree to submit to the exclusive jurisdiction of the courts located within the county of San Bernardino, California to resolve any legal matter arising from this Agreement. IEHP may, notwithstanding this, seek injunctive remedies in any jurisdiction.

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 https://www.gov.ca.gov/wp-content/uploads/2022/03/3.4.22-Russia-Ukraine-Executive-Order.pdf. 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 (https://home.treasury.gov/policy-issues/financial-sanctions/sanctions-programs-and-country-information/ukraine-russia-related-sanctions). Failure to comply may result in the termination of contracts or grants, as applicable. For general inquiries, please email procurement@iehp.org.

中心，電話 1-800-440-IEHP (4347)。TTY 使用者請致電 1-800-718-4347。您也可以發送電子郵件至 MemberServices@iehp.org。 Medicare/Medi-Cal 會員：  如有任何疑問，請於上午 8 點 至晚上 8 點（太平洋標準時間）致電 IEHP DualChoice，電話：1-877-273-IEHP (4347)，每週七天（包括節假日）均提供服務。TTY 使用者請致電 1-800-718-4347。您也可以發送電子郵件至 MemberServices@iehp.org。 若您是提供者： 如需任何資訊，請於週一至週五上午 8 點至下午 5 點致電提供者關係團隊 (Provider Relations Team)，電話 (909) 890-2054。您也可以發送電子郵件至 ProviderServices@iehp.org。 如欲投保 IEHP： 如需投保醫療保健保險，請於週一至週五上午 8 點至下午 5 點致電  1-866-294-4347。TTY 使用者請致電  1-800-720-4347。我們會有親切友善的雙語投保顧問 (Enrollment Advisors) 與您洽談。 如需驗證 IEHP 員工的就業狀況  ，請向 IEHP 人力資源部門 (IEHP Human Resources Department) 提交請求：  電子郵件： Human_Resources@iehp.org。 傳真：909-477-8544 電話：909-890-2000（轉接人力資源部門） 我們的社區 如欲洽詢一般事務，請於週一至週五上午 8 點至下午 5 點致電 (909) 890-2000。TTY 使用者請致電 (909) 890-0731。 潛在供應商  若您有意成為 IEHP 的供應商，請造訪我們的「Procurement」（採購） 頁面。 對於所有記錄處理 請聯絡 IEHP 法務部門 (IEHP Legal Department)。法務部門負責處理牽涉受保護健康資訊 (Protected Health Information) (“PHI”)、傳票、監護權、公共記錄法 (Public Records Act) (“PRA”)，以及加州政府理賠申請的各項事宜。法務部門也是 IEHP 的傳票送達指定代收人。 Inland Empire Health Plan Attn:Legal Department 10801 Sixth Street Rancho Cucamonga, CA 91730 電子郵件：legal@iehp.org 傳真：(909) 477-8578 授權書 (Authorization of Release) (PDF) - 本表授權 IEHP 使用及披露受保護的健康資訊。 若您是媒體/新聞記者  請致電我們的媒體聯絡人： 傳播策略專家 Chelsea Galvez (909) 727-5263 press@iehp.org 我們的地址 10801 Sixth Street Rancho Cucamonga, CA 91730  郵寄地址 P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 傳真：(909) 890-2003 IEHP 直接會員的索賠郵寄地址 Inland Empire Health Plan - Claims P.O. Box 4349 Rancho Cucamonga, CA 91729-4349 IEHP 直接會員的索賠上訴和爭議郵寄地址 Inland Empire Health Plan - Claims Appeals and Disputes P.O. Box 4319 Rancho Cucamonga, CA 91729-4319

nd Empire Health Plan (IEHP) is now responsible for coverage of the Major Organ Transplant (MOT) benefit for adult and pediatric transplant recipients and donors, including related services such as organ procurement and living donor care.   What Transplant Services are Available for Members? Autologous Islet Cell Bone Marrow Cornea Heart Heart-Lung Liver Liver-Heart Liver-Intestinal Liver -Lung Lung Kidney Kidney-Liver Kidney - Pancreas Pancreas (after Kidney)   Centers of Excellence (COE) For transplant care, IEHP has partnered with various, local, Centers of Excellence (COE). A COE is a recognized program within an existing healthcare center that provides a concentration of specialized care,  delivered in a comprehensive, interdisciplinary manner. Their focused care in distinct areas provides exceptional, integrated care that can lead to better Member outcomes.   Bone Marrow - CHLA, City of Hope, LLUMC, UCSD, USC (Norris) Heart - USC (Keck), LLUMC, Rady's Children, Sharp Memorial, UCSD Intestinal - CHLA Kidney-Pancreas - LLUMC, UCI Liver- CHLA, LLUMC, USD, USC (Keck) Lung - UCSD      You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here  

d by APL 19-004, all Providers currently in IEHP's network and those looking to join the network are mandated to enroll in the Medi-Cal Program. This requirement to enroll in the Medi-Cal Program applies to all IEHP Providers, including those participating through an IPA. If a Provider currently active with IEHP fails or declines to complete their enrollment in the Medi-Cal Program, IEHP will be required to terminate their participation from the network.  How to Enroll The Provider Enrollment Division (PED), a unit within the Department of Health Care Services (DHCS), is responsible for the timely enrollment of Providers into the Medi-Cal Program. PED now offers an improved web-based application via their Provider Application and Validation Enrollment (PAVE) portal. Please note the current PAVE release may not support specific Provider types or submissions from new out-of-state Providers. PAVE is being implemented in a series of releases to include Provider types and enrollment actions. Here is a current list of Provider types supported in PAVE. Provider Resources All Plan Letter 19-004 This APL supersedes 17-019, the APL mandating Providers to enroll in the Medi-Cal Program. All Plan Letter 17-019 Access the APL on DHCS's website regarding the screening and enrollment of all Providers rendering services to Medi-Cal beneficiaries.  California Health & Human Services (CHHS) Agency Open Data Portal Utilize the Open Data Portal to identify Providers who have successfully enrolled in the Medi-Cal Program through DHCS. The portal is maintained and updated by PED monthly. Frequently Asked Questions (FAQ) The document contains responses from DHCS to frequently asked questions regarding screening and enrollment requirements. Provider Resources from DHCS Access to PAVE Provider Types, PAVE 101 Training Slides, Provider Job Aides, FAQs, PAVE Support Resources Contact Information Department of Healthcare Services Attn:  Provider Enrollment Division MS4704 PO BOX 997412 Sacramento, CA 95899-7412 PED Message Center (916) 323-1945 After reaching the welcome message, please select Option 4, then Option 1 to speak with a live agent. PAVE Technical Assistance (866) 252-1949 PAVE@dhcs.ca.gov PED Policy Assistance PEDCORR@dhcs.ca.gov IEHP Provider Assistance ProviderNetwork@iehp.org

OS June 30, 2022, payments will run out through June 2023. The Proposition 56 VBP Program provided direct payments incentivizing Providers to meet specific measures aimed at delivering key quality healthcare services that improve the quality of care to Medi-Cal beneficiaries. Targeted areas were behavioral health integration, chronic disease management, prenatal/post-partum care and early childhood prevention. For more information about the VBP Program, please visit the DHCS website at https://www.dhcs.ca.gov/provgovpart/Pages/VBP_Measures_19.aspx. By clicking on this link, you will be leaving the IEHP website.  Value Based Payments Program Guide Value Based Payments (VBP) Program Guide (PDF) - Published: January 01, 2022 Value Based Payments Dispute Forms Value Based Payments Program - Paid Claims Dispute Request (PDF) Published: January 19, 2022 Value Based Payments Program - Encounter Dispute Request (PDF) Published: January 19, 2022 Please e-mail completed forms to ValueBasedPaymentsProgram@iehp.org At-Risk Condition Codes The At-Risk Condition Codes list includes diagnosis codes to identify Serious Mental Illness, Substance Use Disorder or Homelessness Conditions for the VBP Program. These conditions qualify Providers for an additional payment amount for VBP services. Please refer to page 4 of the VBP Program Guide for additional details. At-Risk Condition Codes (PDF) Published: March 25, 2020 You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

h plan operations in compliance with ethical standards, contractual obligations under State and Federal programs, laws, and regulations applicable to Medi-Cal and IEHP DualChoice. This commitment extends to our business associates and delegated entities that support IEHP’s mission to organize and improve the delivery of quality, accessible, and wellness based healthcare services for our community.   Our Compliance Program is designed to: Ensure we comply with applicable laws, rules, and regulations Reduce or eliminate Fraud, Waste, and Abuse (FWA) Prevent, detect, and correct non-compliance Reinforce our commitment to culture of compliance for which we strive Establish and implement our shared commitment to honesty, integrity, transparency, and accountability Code of Business Conduct and Ethics Inland Empire Health Plan (IEHP) expects Team Members and business entities doing business with IEHP to conduct business activities in an ethical and professional manner that promotes public trust and confidence in the integrity of IEHP. The Code is meant to provide guidance about the compliance culture at IEHP and the role that each Team Member, including management, Chief Officers and the Governing Board, plays in building and preserving that culture. IEHP Code of Business Conduct and Ethics (PDF) Compliance, Fraud, Waste, and Abuse (FWA), and Privacy Program Training The IEHP Compliance, FWA, and Privacy Training Program focuses on the elements of an effective Compliance Program, conduct & ethics, and the Fraud, Waste and Abuse and Privacy Programs. IEHP requires delegated entities to provide Compliance Training to their employees, Providers, downstream entities, Board of Directors, and Contractors within 90 days of hire/start, and annually thereafter. IEHP is committed to a culture of compliance, ethics, and integrity. The goal of Compliance Training is to provide all associated parties the ability to demonstrate awareness of IEHP’s requirements, including regulations and policies & procedures associated with Compliance as it relates to daily work. If you have questions or additional suggestions, please e-mail the IEHP Compliance Department at compliance@iehp.org. Compliance Training FWA HIPAA Privacy and Security (PDF) Eligibility to Participate in Federal and State Health Care Programs Inland Empire Health Plan (IEHP) is prohibited from issuing payment for services provided, ordered, or prescribed by an individual or entity that is excluded, ineligible, or terminated from participation in State and Federal health care programs in accordance with regulatory and contractual requirements. IEHP conducts regular reviews of Federal and State exclusionary databases and lists, including but not limited to: Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE list) GSA Excluded Parties List System (EPLS) DHCS Medi-Cal Suspended and Ineligible Provider List CMS Preclusion List Restricted Provider Database (RPD) Exclusion Screening IEHP has implemented a screening process to identify individuals and entities that appear on the DHHS OIG LEIE, the GSA EPLS, the CMS Preclusion List and the DHCS Medi-Cal Suspended and Ineligible Provider List prior to appointment, contracting, and/or employment and monthly thereafter to ensure that none of these individuals or entities are excluded, ineligible or terminated from participation in State and Federal health care programs. Delegated entities must implement a screening program for employees, Board Members, contractors, and business partners to avoid relationships with individuals and/or entities that tend toward inappropriate conduct. This program includes but is not limited to: Prior to contract and monthly thereafter, review of the GSA System for Award Management (SAM), the Department of Health Care Services Medi-Cal Suspended and Ineligible list, and the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) that are excluded from participation in government health care programs (42 CFR §10011901). A monthly review of the Department of Health Care Services Medi-Cal Suspended and Ineligible list. Criminal record checks when appropriate or as required by law. Review of the National Practitioner Databank (NPDB). Review of professional license status for sanctions and/or adverse actions. Reporting results to Compliance Committee, Governing Body, and IEHP as necessary. Fraud, Waste, and Abuse (FWA) IEHP has established a Fraud, Waste, and Abuse Program to detect, correct, and prevent fraud, waste, and abuse on part of Team Members, IEHP Members, Providers, Vendors, delegated entities and any other entity doing business with IEHP. Fraud Prevention Fraud Prevention, it’s a Team Effort In an effort to prevent fraud and abuse, IEHP encourages Providers and their staff to report any suspicious circumstances when they arise. You may want to ask for another form of identification in addition to the IEHP Member identification card. Identification with both a picture and a signature, such as a valid driver’s license or State identification card, are suggested. We are informing Members of this concern and are requesting that they have additional identification available when they come to you. To obtain more compliance guidelines, the Department of Health and Human Services (HHS) offers assistance (by clicking on this link you will be leaving the IEHP website). Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program, or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program. Examples include: Knowingly billing for services or prescriptions not furnished or supplies not provided Knowingly altering claim forms for a higher payment Selling medicine, medical equipment, or other things received through IEHP Waste includes overuse of services, or other practices that, directly or indirectly, result in unnecessary costs. Waste is generally not considered to be caused by criminally negligent actions but rather by the misuse of resources. Examples include: Conducting excessive office visits Writing excessive prescriptions or ordering excessive tests Prescribing more medications than necessary for the treatment of a specific condition Abuse includes actions that may, directly or indirectly, result in unnecessary costs and improper payment or services. Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment. Examples include: Billing for unnecessary medical services or medical equipment Billing for brand name drugs when generics are dispensed Misusing codes on a claim, such as upcoding and unbundling codes. Report potential FWA Click Here (By clicking on this link, you will be leaving the IEHP website). Privacy Incident/Breach IEHP has established a HIPAA Privacy Program to ensure that Member’s health information is properly protected while allowing the flow of health information needed to provide and promote high-quality health care. A privacy breach is defined as unauthorized acquisition, access, use, or disclosure of protected health information (PHI) which compromises the security or privacy of such information. PHI is health information that relates to a Member’s past, present or future physical or mental health or condition, including the provision of his/her health care, or payment for that care and contains personally identifiable information (PII) such as name, SSN, DOB, Member ID, address, or any other unique identifier related to the Member. This generally means that a breach occurs when PHI is accessed, used, or disclosed to an individual or entity that does not have a business reason to know that information. The law does allow information to be accessed, used, or disclosed when it is related to treatment, payment, or healthcare operations directly associated with the work that we do at IEHP on behalf of our Members. Report a Privacy Incident/Breach Click Here (By clicking on this link, you will be leaving the IEHP website). Reporting Information IEHP has the following resources available for reporting fraud, waste or abuse, privacy issues, and other compliance issues: Compliance Hotline: (866) 355-9038 Fax: (909) 477-8536 E-mail: compliance@iehp.org. Mail: IEHP Compliance Officer P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 Online: (By clicking on this link, you will be leaving the IEHP website) Report a Compliance Issue: Click Here Report a Privacy Incident/Breach: Click Here Report potential FWA: Click Here Frequently Asked Questions (FAQs) What are some common examples of fraud? Providers Billing for services not rendered Paying a "kickback" in exchange for a referral for medical services or goods Unbundling Overcharging for services or goods  Using false credentials Members Allowing unauthorized individuals to use ID card to obtain benefits Altering prescriptions Falsifying residence information to obtain benefits Drug seeking or doctor shopping to obtain narcotics What do I do if I suspect an IEHP Member is engaging in possible fraud, waste, or abuse? First, document your suspicions. Then, contact IEHP’s Compliance Department at (866) 355-9038 and make a report with one of our Representatives. At times, IEHP may request additional information that is necessary to investigate. IEHP also has the following resources available for reporting fraud, waste or abuse, privacy issues, and other compliance issues: Compliance Hotline: (866) 355-9038 Fax: (909) 477-8536 E-mail: compliance@iehp.org Mail: IEHP Compliance Officer P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 Online: (By clicking on the following links, you will be leaving the IEHP website) Report a Compliance Issue Click Here Report a Privacy Incident/Breach Click Here Report potential FWA Click Here What do I do if my facility has made some billing errors? If you suspect that errors in billing may have occurred, contact your IEHP Provider Services Representative at (909) 890-2054. What are some other things I can do as a Provider? Periodically perform internal audits of billing practices and compare billing records with payments received. Do not leave prescription pads, which include a Provider's identification and license number, out in the open. For example, do not store prescription pads in exam room cabinets or leave on office counters. IEHP DualChoice (HMO D-SNP) Model of Care Training The Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) and the National Committee for Quality Assurance (NCQA) require that IEHP staff and contracted consultants/vendors, our Medicare IPAs, Hospitals/SNFs, and Providers, receive training on the Plan’s Model of Care for our D-SNP Members: Interdisciplinary Care Team (ICT) Fact Sheet (PDF) IEHP DualChoice (HMO D-SNP) Model of Care Training (PDF) IEHP DualChoice (HMO D-SNP) Model of Care Training (HTML)   *We recommend opening file in: Mozilla Firefox, MS Edge or MS Internet Explorer Contact the OIG The Office of the Inspector General (OIG) is there to assist you and maintains a hotline, which offers a confidential means for reporting vital information. For information on confidentiality, please contact the hotline and ask about their confidential source program. Each caller is encouraged to assist the OIG by providing information on how they can be contacted for additional information but the caller may remain anonymous. Contacting the Office of the Inspector General Phone: (800) HHS-TIPS (447-8477) E-mail: Htips@oc.dhhs.gov Additional Hotlines DHCS Medi-Cal Fraud Hotline Phone: (800) 822-6222 E-mail: fraud@dhcs.ca.gov Web: https://apps.dhcs.ca.gov/stopfraud/Default.aspx  The recorded message may be heard in English and 10 other languages: Spanish, Vietnamese, Cantonese, Armenian, Hmong, Cambodian, Laotian, Farsi, Korean and Russian. The call is free and the caller may remain anonymous.    You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

護的近用以及會員、提供者、社區為第一優先。  提供者招募 IEHP 創新的網路擴展基金 (NEF) 是加州同類型計畫的先驅。成立於 2014 年的 NEF 自特別指定基金中提撥了 3,000 萬美元，以吸引專科認證的初級照護提供者、專科醫師、中階提供者至內陸帝國地區，因應此地區長期缺少提供者的情況，並且為超過 120 萬名 IEHP 會員改善照護近用。至今，本計畫的直接成果之一是招募了超過 280 個提供者。 行為健康整合複合式照護計畫 行為健康整合複合式照護計畫 (BHICCI) 是一項 2019 年 1 月 1 日開始的合作計畫，參與者為 IEHP 以及內陸帝國地區中替加州醫療保健服務部 (California Department of Health Care Services, DHCS) 的健康之家計畫提供服務據點的 30 多間診所。該計畫旨在改善會員的健康狀況，方法是組織提供全面照護管理的複合式照護團隊，以及在河濱郡與聖貝納迪諾郡的多個提供者與健康照護系統之間協調複雜的生理與行為健康需求。BHICCI 照護團隊目前正在轉型為提供健康之家服務的社區照護管理實體 (community-based care management entity, CB-CME)，為健康之家上線做準備。 健康之家計畫 健康之家計畫 (HHP) 是以擁有複雜需求的病患為對象的綜合照護管理計畫，基礎為 IEHP 的行為健康整合複合式照護計畫 (BHICCI)，依照醫療保健服務部 (DHCS) 的立法進行。HHP 會協助擁有嚴重慢性生理與/或心理健康問題的會員，協調生理、行為、社區上的長期服務與支援 (Long-Term Services and Supports, LTSS) 需求。HHP 的主要目標是透過照護協調與複合式照護管理，改善會員的整體健康狀況。自從計畫於 2019 年 1 月啟動以來，已有超過 9,000 名會員在血壓、糖尿病、憂鬱的相關臨床健康狀況上獲得極為正向的結果。按一下這裡進一步瞭解健康之家計畫。  EHR 與健康資訊交換所 IEHP 與聖貝納迪諾郡醫學會 (San Bernardino County Medical Society) 及河濱郡醫學會 (Riverside County Medical Association) 合作，組建了 Inland Empire EHR 資源中心，在選擇及採用電子病歷系統方面協助提供者與診所。此外，IEHP 也是 Inland Empire 健康資訊交換所的一部分，日前已與 CalIndex 健康資訊交換所合併為 Manifest Medex (MX)。MX 是涵蓋加州的健康資訊交換所，在內陸帝國地區的普及率及使用率顯著，透過所有的內陸帝國急症照護醫院與許多醫療團體及醫師提供病患的臨床資料與管理資料。MX 為存取及安全分享病患的電子病歷提供必要技術，造福內陸帝國 440 萬名居民中的絕大多數人。MX 讓醫師、診所、醫院、其他健康照護提供者能用電子方式檢查及存取醫療記錄，為我們社區中的病患提供及時且高品質的健康照護。 線上醫師 (DocOnline) 這項創新計畫為會員提供了另一個選擇，能在下班時間取得醫師的醫療建議。IEHP 會員能透過電話或視訊聊天，輕鬆快速地與專科認證醫師通話。醫師可以存取 IEHP 處方集與 IEHP 網路內藥局，在需要時為 IEHP 會員以電子方式開立處方藥。全面實施之後，本服務將提升會員的近用性與便利性，同時減少不必要的急診室或緊急照護就醫次數。 遠程醫療 IEHP 支持在內陸帝國地區拓展遠程醫療服務，促進有迫切需要的專科照護之近用，在快速診斷及治療方面提供協助。遠程醫療能消除內陸帝國長期存在的一項照護障礙 – 取得健康照護資源的地理距離。有了遠程醫療的資源通訊技術，就能遠程推動疾病或傷害的治療及預防，消除地理距離這項阻礙照護的重大因素。遠程醫療也能用來協助訓練提供者及教育會員。IEHP 目前支援以下特定服務的遠程醫療：行為健康、視網膜檢查、皮膚科、骨科諮詢。未來還將推出多項計畫，根據會員需求拓展至其他服務。 電子諮詢 (eConsult) 電子諮詢是 IEHP、Arrowhead Regional Medical Center、河濱大學保健系統之間的合作計畫，讓 PCP 在病患可能需要專科醫師轉介時，能以電子方式直接聯繫專科醫師。透過隱密安全的系統，PCP 能及時取得專科醫師的臨床建議，得以在初級照護環境中管理大多數病患 (某些病患可能需要親自前往專科醫師處就診)。IEHP 目前為該計畫前 24 個月提供贊助，未來將在河濱郡與聖貝納迪諾郡超過 70 處診所設計、實施、評估電子諮詢。 安全線上會員入口網站與應用程式 IEHP 會員可以在全天候管理自身健康方面扮演積極角色，方法是使用透過 IEHP 網站或行動應用程式存取的安全線上帳戶。會員可以檢視及列印自己的 IEHP 會員卡；檢視檢測內容、疫苗接種卡與授權書；尋找或變更醫師；搜尋提供者目錄；參加健康教育課程；確認資格；以及更多服務。獨立的 Baby-N-Me 產前護理應用程式有助改善孕期的健康狀況，讓孕婦更容易追蹤孕期里程碑，辨識健康問題，利用提醒與有用工具保持健康。 簡訊發送與警示 IEHP 採用雙向簡訊發送與簡訊服務 (SMS) 警示，向會員說明計畫福利以及健康照護系統的操作方式。這些具有針對性的警示會傳達季節性的健康資訊，涵蓋疫苗接種、預防性照護、服藥遵從性、新健康計畫的特色等主題。 長期護理服務與支援 (LTSS) IEHP 長期護理服務與支援 (LTSS) 計畫讓老年人及殘障人士得以在家中以安全可行的方式長時間獨立生活，無法獨立生活時則提供專業護理機構 (SNF) 照護。LTSS 包括 Multipurpose Senior Services Program (MSSP) 與社區成人服務 (CBAS)，以及必要時的 SNF 服務。IEHP 也會幫助協調任何居家支援服務 (IHSS) 的福利。2018 年 5 月以來，IEHP 已幫助 750 名會員轉離長期照護機構，返回社區。與河濱郡社會服務部合作制定的 24 小時居家緊急照護者計畫及個案管理計畫獲得了全國郡縣協會 (National Association of Counties) 頒發的 2017 年與 2018 年成就獎。IEHP 還與加州大學洛杉磯分校合作投入 Geriatric Workforce Enhancement Program，提供病患、家屬、照護者需要的知識與技能，改善健康狀況並提升老年人的照護品質。   

th Care Services (DHCS), California Advancing and Innovating Medi‐Cal (CalAIM) is a long‐term commitment to transform and strengthen Medi‐Cal, offering Californians a more equitable, coordinated, and person‐centered approach to maximizing their health and life trajectory.1 DHCS Goals For CalAIM 2 Identify and manage comprehensive needs through whole person care approaches and social drivers of health. Improve quality outcomes, reduce health disparities, and transform the delivery system through value-based initiatives, modernization, and payment reform. Make Medi‐Cal a more consistent and seamless system for enrollees to navigate by reducing complexity and increasing flexibility. Resource Links DHCS CalAIM page DHCS CalAIM Transformation Infographic (PDF) DHCS Medi-Cal Alignment Primer (PDF) IEHP Enhanced Care Management IEHP Enhanced Care Management (Member Page) IEHP Community Support Services IEHP Community Support Services (Member Page)   1,2https://dhcs.ca.gov/calaim You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.