Correspondences

Please see the following PDF links below.

For Pharmacy Correspondences please click here.

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Coronavirus (COVID-19) Advisory

Last Updated: July 6, 2020

The Centers for Disease 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.

Provider Relations

If you have any questions, please do not hesitate to contact the IEHP Provider Relations Team at (909) 890-2054 or email at providerservices@iehp.org. By clicking on the links below, you will be leaving the IEHP website.

Guidance Regarding Testing for COVID-19

If your Members are assigned under LabCorp or Quest Diagnostics and you have the swabs and ability to collect the specimens to send to these labs for COVID-19 testing, please do so and refer to the lab pages for these vendors for the most up to date procedures. Remember, do not send your Members directly to these labs for testing.   Please follow appropriate protocol to send specimens to the labs.

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.

Testing Available at Multiple Locations

RIVERSIDE COUNTY

For more information, please visit the Riverside County Public Health website. Testing sites with (*) require appointments.

 

SAN BERNARDINO COUNTY

For more information, please visit the San Bernardino County website. Testing sites with (*) require appointments. Some testing sites open appointment registrations weekly.

 

Testing Instructions from Local County Public Health Departments

PPE Available through Local Medical Societies

IEHP has received numerous calls from Providers asking for supplies including disinfectant, gloves, masks, etc. Unfortunately, IEHP is not a supplier or provider of these materials and is unable to provide these resources to offices. IEHP is happy to announce that our local medical societies are assisting in providing PPE to Providers. Please refers to the information posted below:

• June 26, 2020 - NorthStar PPE Solutions (PDF)
• May 18, 2020 - PPE Resources for Practices (PDF) 
• May 06, 2020 - PPE Gowns Available for Physician Practices - Free of Charge (PDF)
• May 05, 2020 - PPEs Available to RCMA Members (PDF)

Coronavirus California: Governor Newsom Updates 

•  April 24, 2020 - Gov. Newsom Announces Plans to Resume Delayed Health Care that was Deferred as Hospitals Prepared for COVID-19 Surge (PDF)

Technology Security Guidance for Providers

•  AA20-099A: COVID-19 Exploited by Malicious Cyber Actors

Physician Volunteers Needed

• April 20, 2020 - Volunteers Needed - Riverside County Health Corps (PDF)
• April 03, 2020 - COVID-19 Physician Volunteers Program (PDF)

COVID-19 Webinars

•  Reopening Colleges and Universities During COVID-19 - Keeping Students and Communities Healthy (PDF) - Wednesday, July 8, 5-6:30 p.m. EDT
• Supporting Individuals with Dementia and their Caregivers (PDF) - Tuesday, June 23, 12:00 P.M. - 1:30 P.M. EDT
• Telehealth Annual Wellness Visits (PDF) - Thursday, June 18, 12:15 PM PST
• An Update on COVID-19 Testing & Contact Tracing in Riverside County (PDF) - Tuesday, June 9, 12:15 PM PST
• Do You Know if Your Patients Have Tested Positive for COVID-19? (PDF) - Tuesday, June 2, 12:15 PM PST
• A Guide to Telehealth Workflows (PDF) - Wednesday, May 27, 7:00 AM PST | 12:15 PM PST
• Reopening a Medical Practice: Pediatrics (PDF) - Tuesday, May 19, 12:15 PM - 1:15 PM PST
• COVID-19 Flexibilities for Medical Staffs and Hospital-Based Physicians (PDF) - Thursday, May 21, 12:15 PM - 1:15 PM PST
• A Practical Guide for Re-Opening Your Practice (PDF) - Tuesday, May 5, 7:00 AM PST | Thursday, May 7, 12:15 PM PST
• (UPDATED) Weekly Inland Empire COVID-19 Care Coordination Post-Acute Care (PAC) Calls (PDF) - Wednesdays, 1:00-2:00 PM PST
• ACEs Aware Webinar Building Trauma-Informed Connections via Telehealth During COVID-19 (PDF) - Wednesday, April 29, 2020, 12:00-1:00 PM PST
• Supporting Family Caregivers of Older Adults through Times of Stress and Isolation (PDF) - Thursday, April 30, 2020, 12:00 PM - 1:30 PM EDT
• Bi-Weekly Public Health Department Calls (PDF) - April 8, 2020

Provider Loans: Paycheck Protection Program Forgivable Loans

The Small Business Association (SBA) is offering forgivable loans that help businesses keep their workforce employed during the Coronavirus (COVID-19) crisis.The SBA's Paycheck Protection Program authorizes up to $349 billion in forgivable loans to small businesses to pay their employees during the COVID-19 crisis. The loan application period opens on Friday, April 3, 2020.

For more information, please visit the Riverside County Medical Association website here.

Limited funds are available. APPLY TODAY!

• Download Fact Sheet
• Download Application

• April 03, 2020 - Instruction to Submit Application: Paycheck Protection Program (PDF)
• April 03, 2020 - Financial Resources for Businesses Impacted by COVID 19 (PDF)

Postponing/Rescheduling Routine/Non-Urgent/Elective Procedures

IEHP understands at this time that Providers will be rescheduling and postponing non-urgent visits and elective procedures.  We encourage Providers to exercise their best clinical judgment to minimize in-person visits that are not of a critical or emergent nature. 

Healthcare facilities and clinicians should prioritize urgent and emergency visits and procedures now and for the coming several weeks. The following actions can preserve staff, personal protective equipment, and patient care supplies; ensure staff and patient safety; and expand available hospital capacity during the COVID-19 pandemic:

• Delay all elective ambulatory provider visits
• Reschedule elective and non-urgent admissions
• Delay inpatient and outpatient elective surgical and procedural cases
• Postpone routine dental and eyecare visits

• April 07, 2020 - CMS - Non-Emergent, Elective Medical Services, and Treatment Recommendations (PDF)
• April 01, 2020 - California Optometric Association guidance to Optometrists re: Postponing Routine Eye Care Visits
• March 31, 2020 - Routine Childhood Immunizations during COVID-19 Pandemic (PDF)
• March 31, 2020 - MEMORANDUM: Important Covid-19 Update for Referring Providers to RUHS Specialty Clinics (PDF)

Vision Provider Guidance

• May 11, 2020 - Express Lens Lab - UPDATE (PDF)
• May 05, 2020 - Express Lens Lab and Unique Optical – Current Availability (PDF)
• April 07, 2020 - Express Lens Lab (PDF)

Global Quality P4P Guidance during COVID-19

• April 02, 2020 - URGENT- COVID-19 and Impacts to GP P4P Program (PDF)

Screening Questions for Providers to ask Patients calling in regarding Suspected COVID-19

Here is a list of questions Providers should ask their patients when screening for potential COVID-19 exposure (source: History that needs to be presented to Department of Public Health to evaluate a case – Riverside University Health System – Public Health communication.) 

• What are your symptoms (fever, cough, other lower respiratory symptoms)?
• What was the date the symptoms began?
• Have you traveled and what were the specific cities or regions visited and when?
• Have you been exposed to anyone who may have COVID-19 with focus on household contacts?

Please continue to refer to the Centers for Diease Control and Prevention (CDC), San Bernardino County's Public Health and Riverside County Public Health System for updated guidance as this situation evolves. 

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: (UPDATED) Telehealth Services Due to Limiting Exposure to COVID-19 (PDF) - April 09, 2020

• June 30, 2020 - (UPDATED) COVID-19 Impact to 2020 Well-Child Visit (Preventive Services) (PDF)
• May 15, 2020 - FCC - COVID-19 Telehealth Program (PDF)
• April 22, 2020 - COVID-19 Impact to 2020 Well-Child Visit (Preventive Services) (PDF)
• April 21, 2020 - P4P Dual Choice Annual Visit - Services Currently May Be Performed via Telehealth (PDF)
• March 27, 2020 - ESRD Provider Telehealth and Telemedicine Tool Kit (PDF)
• March 27, 2020 - General Provider Telehealth and Telemedicine Tool Kit (PDF)
• March 23, 2020 - COVID-19 Strategies for Implementing Telehealth in Your Practice on Wednesday, March 25, 2020 at 7:00 AM, 12:30 PM, and 7:00 PM (PDF)
• March 18, 2020 - DHCS - Medi-Cal Payment for Telehealth and Virtual/Telephonic Communications Relative to the 2019-Novel Coronavirus (COVID-19) (PDF)

Remember:

• 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 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.
• 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.

UPDATED:  Rates for Services provided through Telehealth

Per DHCS’s Emergency Telehealth Guidance to Medi-Cal Managed Care Health Plans published on March 18, 2020, services are to be paid at the same rate, whether a service is provided in-person or through telehealth, if the service is the same regardless of the modality of delivery.  This direction pertains specifically and only to reimbursement for services provided to Medi-Cal Members.

Per CMS’s Medicare Telehealth FAQs published on March 17, 2020, the following Q and A was provided for payment rates for telehealth:

Q: How much does Medicare pay for telehealth services?

A: Medicare pays the same amount for telehealth services as it would if the service were furnished in person. For services that have different rates in the office versus the facility (the site of service payment differential), Medicare uses the facility payment rate when services are furnished via telehealth.

The CMS telehealth FAQ is being utilized by the plan to guide the processing of payments for telehealth services for CMC Medicare Members and can be found here.

Drug Enforcement Agency (DEA)

Under normal circumstances, DEA would not consider the initiation of treatment with a controlled substance based on a mere phone call to be consistent with the framework of the Controlled Substances Act (CSA) given that doing so creates a high risk of diversion. However, in light of the extraordinary circumstances presented by the COVID-19 public health emergency, and being mindful of the exemption issued by the Substance Abuse and Mental Health Services Administration (SAMHSA), DEA likewise advises that, only for the duration of the public health emergency (unless DEA specifies an earlier date), opioid treatment programs (OTPs) should feel free to dispense, and Drug Addiction Treatment Act (DATA)-waived practitioners should feel free to prescribe, buprenorphine to new patients with opioid use disorder (OUD)  for maintenance treatment or detoxification treatment following an evaluation via telephone voice calls, without first performing an in-person or telemedicine evaluation.

• March 31, 2020 - Prescribing buprenorphine via telephone as part of the COVID-19 Public Health Response (PDF)

Concerns Regarding Possible Provider Office Closures

IEHP has been contacted by a few Provider offices inquiring as to whether they should close their offices.  We recommend that Providers adhere to County Public Health and CDC guidance re: how to protect their office staff.  We want to remind Providers that you are responsible to provide coverage for your patients and should use telehealth whenever possible to support the needs of your patients.  It is not appropriate to rely on Urgent Cares or the Emergency Department for coverage for your office.

If you have to close your office, please contact IEHP and advise on what your coverage and direction for Members will be to ensure that Members do not have a gap in care.  Some Providers are rescheduling (or transitioning to telehealth) non-urgent or routine services for the next few weeks but it is up to each Provider to determine the appropriate protocol following CDC and public health guidance. 

Centers for Medicare & Medicaid Services (CMS)

• June 16, 2020 - (UPDATED) COVID-19 Emergency Declaration Waivers for Health Care Providers (PDF)
• May 15, 2020 - COVID-19 Guidance for Infection Control & Prevention in Home Health Agencies (PDF)
• May 14, 2020 - Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes (PDF)
• May 08, 2020 - 2019 Novel Coronavirus (COVID-19) Long Term Care Transfer Scenarios (PDF)
• April 24, 2020 - Trump Administration Announces New Nursing Homes COVID-19 Transparency Effort Guidance Memo (PDF)
• April 22, 2020 - CMS Issues Recommendation for Re-Opening Facilities to Provide Non-Emergent Non-COVID-19 Healthcare: Phase I (PDF)
• April 13, 2020 - Trump Administration Acts to Ensure U.S. Healthcare Facilities Can Maximize Frontline Workforces to Confront COVID-19 Crisis (PDF)
• April 13, 2020 - COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers (PDF)
• April 07, 2020 - CMS - Non-Emergent, Elective Medical Services, and Treatment Recommendations (PDF)
• March 31, 2020 - Updated CMS Rules and Waivers of Federal Requirements (issued March 30, 2020) to Address Patient Needs During the COVID-19 Pandemic (PDF)
• March 13, 2020 - Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes (PDF)

 

Riverside County Medical Association (RCMA) COVID-19 Resources

The Riverside County Medical Association has published a COVID-19 Resource guide and documents.  Here you will  find links to their Telehealth guide, Telehealth billing document, a resource document for the new wage, unemployment and employer compensation, and a resource document on financial resources for the medical practice.  

Found Here: RCMA COVID-19 Resources

• May 07, 2020 - Physician Wellness Check-Up (PDF)
• May 01, 2020 - COVID 19: Re-Opening Your Medical Practice Checklist (PDF)
• May 01, 2020 - Telehealth Vendor Options (PDF)
• RCMA's Daily COVID-19 Round Up
• April 10, 2020 - RCMA's COVID-19 Self Isolation Recommendations (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.

Pharmacy Times

• March 25, 2020 - URGENT NOTICE: Hydroxychloroquine Formulary Change (PDF)

Additional Resources

• June 25, 2020 - Cultural Formation Interview (PDF)
• June 25, 2020 - National Standards for Culturally and Linguistically Appropriate Services (PDF)
• June 25, 2020 - Center for Peace and Conflict (PDF)
• June 25, 2020 - SAMHSA - Substance Abuse and Mental Health Services Administration (PDF)
• June 25, 2020 - Human Rights Campaign (PDF)
• June 25, 2020 - Youth LGBTQ (PDF)
• June 25, 2020 - Incidents of Coronavirus Discrimination Report (PDF)
• June 25, 2020 - AAPA (PDF)
• June 25, 2020 - Latinx Cultural Humility (PDF)

Correspondences

• June 22, 2020 - COVID-19 Roster (PDF)
• June 11, 2020 - CMA New Medicaid Targeted Distribution (PDF)
• May 18, 2020 - Initial Health Assessment (IHA) Roster (PDF)
• May 07, 2020 - RadNet - We are Open! (PDF)
• April 09, 2020 Claims Processing Timeframes
• April 01, 2020 - Telehealth Services Due to Limiting Exposure to COVID-19
• March 17, 2020 - COVID-19 Update - Supply Requests and Protocols Q&As
• March 12, 2020 - Public Health Advisory - Community Transmission of COVID-19 in the Coachella Valley and Countywide Testing Availability (PDF)
• March 12, 2020 - San Bernardino County Public Health Guidance on COVID-19 (PDF)
• March 11, 2020 - Reminder: Pharmacy Mail Order Services
• March 05, 2020 - Public Health Advisory - Status Update on COVID-19 Coronavirus (PDF)
• March 04, 2020 - CORONAVIRUS: How To Protect Yourself (PDF)
• March 03, 2020 - CORONAVIRUS (COVID-19) Webinar for Clinicians (PDF)

For additional resources regarding COVID-19, please visit:

• Centers for Diease 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.

2020

Medicare Beneficiary Identifier (MBI)

The MACRA Act of 2015, mandates Centers for Medicare & Medicaid 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.

Newsletters

Don't miss out on the latest news! The Heartbeat, IEHP's Provider Newsletter; ScrubTalk, Provider Staff Newsletter; keep you in the know about our newest programs, incentive opportunities, study results, and more. 

Proposition 56 

Proposition 56, the California Healthcare, Research and Prevention Tobacco Tax Act of 2016, now includes proposed supplemental payments for physicians participating in Medi-Cal Fee-For-Service (FFS) and Medi-Cal Managed Care.

• Proposition 56 Extension Notice SFY 19/20 (PDF) Published: February 18, 2020
• Proposition 56 FAQs SFY 19/20 (PDF) Published: February 18, 2020
• Proposition 56 Extension Notice SFY 18/19 (PDF) Published: October 23, 2018
• Proposition 56 FAQs SFY 18/19 (PDF) Published: October 23, 2018

Electronic Payments

With the current public health situation that our country is experiencing, it is necessary for IEHP to take additional precautions to ensure the health and well-being of our community. These precautions are being reviewed, and discussed daily, by our Executive leadership team and will be implemented as deemed necessary.  Future COVID-19 precautions may include reduced on-site staffing and prioritization of electronic payments over printed checks.

To minimize any disruption or delay in payment, we recommend that you sign up for electronic payments as soon as possible if you have not done so already. Our team is available to assist you with the necessary paperwork required to make this change or to answer any questions you may have. The team can be reached by e-mailing vendormaintenance@iehp.org or by calling (909) 294-3928 and selecting Option 1.

Our priority remains keeping our Members, Providers, Vendors, and Team Members safe while doing what we can to minimize the potential spread of the virus. We will continue to work hard to provide you with the level of service you have come to expect during this uncertain time.

Adverse Childhood Experiences Screening (ACES) Services

• Proposition 56 Adverse Childhood Experience Screening (ACES) Services (PDF) Published: May 15, 2020
• FAQs on Proposition 56 Payment Adverse Childhood Experience Screening (ACES) Services (PDF) Published: May 15, 2020

Developmental Screening Services

• Proposition 56 Developmental Screening Services (PDF) Published: March 19, 2020
• FAQs on Proposition 56 Developmental Screening Services (PDF) Published: March 19, 2020

Family Planning Services

• Proposition 56 - Family Planning Services (PDF) Published: June 02, 2020
• FAQs on Proposition 56 - Family Planning Screening Services (PDF) Published: June 02, 2020

Ground Emergency Medical Transport (GEMT) Payment

The Department of Health Care Services (DHCS) has established a Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) program. In accordance with 42 USC Section 1396u-2(b)(2)(D), Title 42 of the Code of Federal Regulations part 438.114(c), and WIC Sections 14129-14129.7, Medi-Cal Managed Care Health Plans must provide increased reimbursement rates for specified GEMT services to non-contracted GEMT providers. SPA 18-004 implements a one-year QAF program and reimbursement add-on for GEMT provided by emergency medical transportation providers effective for State Fiscal Year (SFY) 2018-19 from July 1, 2018, to June 30, 2019.

• GEMT Dispute Request Form (PDF)

Please email completed forms to Prop56Inquiry@iehp.org or fax to (909) 296-3550.

HYDE

• Proposition 56 HYDE Services (PDF) Published: May 15, 2020
• FAQs on Proposition 56 HYDE Services (PDF) Published: May 15, 2020

Proposition 56 Payment Schedule

• Proposition 56 Supplemental Payment Schedule FY 19/20 (PDF) Published: June 17, 2020

Proposition 56 Payment Dispute Process

• Proposition 56 - Paid Claims Dispute Request Form (PDF)
• Proposition 56 - Encounter Dispute Request Form (PDF)

Please email completed forms to Prop56Inquiry@iehp.org or fax to (909) 296-3550.

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Proposition 56 - Value Based Payments (VBP) Program

The Proposition 56 VBP Program provides directed payment to incentivize Providers for meeting specific measures aimed at delivering key quality healthcare services that improve the quality of care to Medi-Cal beneficiaries. Targeted areas are 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

• IEHP DHCS Value Based Payment Program Guide is Now Available! (PDF) - Published March, 27, 2020
• Value Based Payments (VBP) Program Guide (PDF) - Published: April 22, 2020

Value Based Payments Dispute Forms

• Value Based Payments Program - Paid Claims Dispute Request (PDF) Published: April 15, 2020
• Value Based Payments Program - Encounter Dispute Request (PDF) Published: April 15, 2020

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.

Public Health Advisory

• Community Transmission of COVID-19 in the Coachella Valley and Countywide Testing Availability (PDF) - March 12, 2020
• San Bernardino County Public Health Guidance on COVID-19 (PDF) - March 12, 2020
• Community Transmission of COVID-19 in the Coachella Valley (PDF) - March 09, 2020
• Status Update on COVID-19 Coronavirus (PDF) - March 5, 2020
• Severe Acute Pulmonary Disease Associated with Cannabis or Cannabidiol Oil (PDF) - August 15, 2019
• Nationwide Shortage of Tuberculin Test Antigens: CDC Recommendations for Patient Care and Public Health Practice (PDF) - August 5, 2019

By clicking on the links below, you will be leaving the IEHP website.

Centers for Disease Control and Prevention (CDC)

The CDC has developed a one-stop-shop toolkit with products about vaccines and measles. These products include accurate, science-based evidence that can help counter misinformation about measles and MMR vaccine. (By clicking the links below, you will be leaving the IEHP website.)

• Measles Outbreak Toolkit
• Toolkit for Healthcare Providers
• Measles FAQs

California Department of Public Health (CDPH)

The California Department of Public Health (CDPH) has developed two new measles tools for providers. Both tools are attached and can be found on the CDPH Measles Disease webpage. (By clicking on this link, you will be leaving the IEHP website.)

• Summary of Current Recommendations on Measles Immunization CDPH (PDF)
• Should I Test for Measles: A Guide for California Healthcare Providers (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. (By clicking on this link, you will be leaving the IEHP website.)

Regulatory Updates 

Read APL 17-009 (PDF) and DPL 17-002 (PDF) for information regarding Provider-Preventable Conditions. Visit Reporting of Provider Preventable Conditions for DHCS instructions for online reporting. By clicking on these links, you will be leaving the IEHP website.

Medicare Outpatient Observation Notice (MOON)

In the event any Medicare recipient has been in a status of outpatient observation for greater than 24 hours, Acute Hospitals are required to provide Medicare Members with a Medicare Outpatient Observation Notice (MOON). Medicare recipients must receive the MOON within 36 hours of admission to observation level of care.

Please refer to the following website for further details on MOON requirements at https://www.federalregister.gov/articles/2016/08/22/2016-18476/medicare-program-hospital-inpatient-prospective-payment-system-for-acute-care-hospitals-etc.  By clicking on this link, you will be leaving the IEHP website.

Document Catalog:

1. MOON FAQs (PDF)
2. MOON Instruction Summary (PDF)
3. CMS Manual System 10611_Pub 100-04 Medicare Claims Processing MOON Instructions (PDF)
4. MOON Forms
   • MOON English (PDF)
   • MOON English Large Print (PDF)
   • MOON Spanish (PDF)
   • MOON Spanish Large Print (PDF)
5. MOON Correspondence (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.

Cal MediConnect Quality Withhold Measures

• Cal MediConnect Quality Withhold Measures (PDF)
• California Specific Quality Withhold Technical Notes for DY 2 to 5 (PDF)
• Core Quality Withhold Technical Notes for DY 2 to 5 (PDF)

Flu Updates

The flu season is upon us and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) published the updated recommendations regarding the use of influenza vaccine. Vaccine manufacturers are expected to provide adequate vaccines this year.

To assist you, IEHP will continually update you on the latest recommendations, news and resources on these flu viruses. As the flu season progresses, you may see an increase in office visits from the Members with flu-like symptoms - and if they are unable to reach you after hours, refer them to our 24-hour Nurse Advice Line, 7 days a week, including holidays at (888) 244-IEHP (4347). 

• Careful Antibiotic Use  (PDF)
• Pediatric Clinical Practice Guideline Summary (PDF)
• Adult Clinical Practice Guideline Summary (PDF)

Web Resources

By clicking on these links, you will be leaving the IEHP website.

• http://eziz.org
• https://www.phcdocs.org/Programs/AWARE

Preventive Services

Immunizations

By clicking on these links, you will be leaving the IEHP website.

• CDC ACIP Vaccine Recommendations and Guidelines: https://www.cdc.gov/vaccines/hcp/acip-recs/index.html
• CDC ACIP Immunization Schedule for Children: https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
• CDC ACIP Immunization Schedule for Adults: https://www.cdc.gov/vaccines/schedules/hcp/adult.html
• USPSTF Task Force's Immunization Recommendations: https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=immunization
• California Immunization Registry Portal (CAIR): https://cair.cdph.ca.gov/CAPRD/portalInfoManager.do
• Immunization Timing 2020 (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.