Compliance

Compliance Program

Inland Empire Health Plan (IEHP) is committed to conducting its health 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 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

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.

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.

General Compliance Training (PDF)

Eligibility to Participate in Federal and State Health Program

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 the following Federal and State exclusionary lists:

• 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

Exclusion Screening

IEHP has a screening process to identify individuals and entities that appear on the DHHS OIG LEIE, the GSA EPLS, the Medicare Opt-Out 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 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:

• Prior to contracts 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 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: Report a Compliance Issue Click Here (By clicking on this link, you will be leaving the IEHP website).

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 explain the case to one of our Representatives. At times, IEHP may request additional information that is necessary to investigate the case. Thus, Provider documentation is strongly encouraged.

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.

Guidelines for Care Management Training

The Centers for Medicare & Medicaid Services (CMS) and the Department of Health Care Services (DHCS) require that IEHP staff and contracted Delegates, Practitioners, and Providers receive training on the Cal MediConnect program and IEHP’s model of care:

• Interdisciplinary Care Team (ICT) Fact Sheet (PDF)
• IEHP Guidelines for Care Management Training (PDF)
• IEHP Guidelines for Care Management Training (HTML)

Member Incentive Forms

• Focus Group Incentive (FGI) - Request for Approval Form (PDF)
• Focus Group Incentive (FGI) - Evaluation Form (PDF)
• Member Incentive (MI) Program - Request for Approval (PDF)
• Member Incentive (MI) Program - Annual Update/End of Program Evaluation (PDF)
• Survey Incentive (SI) - Request for Approval Form (PDF)
• Survey Incentive (SI) - Evaluation Form (PDF)

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: stopmedicalfraud@dhs.ca.gov

The recorded message may be heard in English and four other languages: Spanish, Vietnamese, Cambodian, and Russian. The call is free and the caller may remain anonymous.

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 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).

Nondiscrimination Language

Nondiscrimination Language Access Notice:

• Condensed (PDF)
• Medi-Cal (PDF)
• Medicare (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.

Claims

Medi-Cal Learning Portal

The Medi-Cal Learning Portal provides extensive resources and a broad range of topics for all types of Providers with questions regarding billing requirements and claims processing guidelines. Resources are not limited to webinars, computer based training, and webinars. Providers also have direct access to their Regional Representative and the Small Provider Billing Unit (SPBU) through this link (By clicking on this link, you will be leaving the IEHP website) https://learn.medi-cal.ca.gov/.

Medi-Cal Rates and Codes

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

Medi-Cal Rates

The file lists the maximum reimbursement rates payable by the Medi-Cal program for covered procedures described in the HCPCS and CPT-4 coding system.
Resource: website

CPT Codes

This website is aimed at providing information to Providers on Medicare's National CCI edits, but will not address specific CCI edits.
Resource: website

Alpha-Numeric HCPCS Files

These files contain the Level II alpha-numeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage, and pricing data.
Resource: website

ZIP code To Carrier Locality File

This file is primarily intended for use by ambulance suppliers to map ZIP Codes to CMS carriers and localities. This file will also map ZIP Codes to their State and can determine whether the ZIP Code has a rural designation as determined by CMS.
Resource: website

Medicare Physician Fee Schedule

Information on services covered by the Medicare Physician Fee Schedule (MPFS).
Resource: website

IEHP Fee Schedule

• IEHP Fee Schedule - December 08, 2020 (PDF)

Other Health Coverage (OHC)

• Coordination of Benefits with Other Health Coverage (OHC) (PDF)
• Frequently Asked Questions (FAQs) - OHC (PDF)

Educational Opportunities

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

2020 Care Management Delegation Oversight Medicare IPA Training (MP4 Video) - December 11, 2020

Discussion Topics:

• Introduction to Care Management
• Care Management Program Description
• Health Risk Assessments (HRA)
• Individual Care Plan (ICP)
• Interdisciplinary Care Team (ICT)
• Coordination of Care
• Delegated IPA Reporting Requirements
• Oversight and Monitoring Activities
• Communication to your IEHP Team

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 Cal MediConnect Plan (Medicare-Medicaid Plan) 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:

1. On the first (1^st) of each month, IEHP will provide IPAs and County MH Clinics a list of IEHP DualChoice Members known to be receiving specialty mental health services through the County MH Plans.
2. 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.”
3. 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 Cal MediConnect Plan (Medicare-Medicaid Plan)" and Attachment, “Medicare Provider Reporting Requirements Schedule” in Section 25.
4. 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).

Staying Healthy Assessment (SHA) Training

The Staying Healthy Assessment (SHA) forms consist of seven age-specific pediatric questionnaires and two adult questionnaires.  The Primary Care Physician (PCP) is responsible for ensuring the SHA is administered to each Member within 120 days of enrollment and may be administered as part of the Member's initial health assessment. The training resources below provide information on completing the SHA for your patients.

• Initial Health Assessment Standards (PDF)
• Staying Healthy Assessment (SHA) Training (PDF)
• SHA Pediatric Questions by Age Group (PDF)
• SHA Adult Questions by Age Group (PDF)
• Alternative IHEBA Review Form (PDF)
• Bright Futures Notification Form (PDF)
• SHA Format Notification Form (PDF)

Providers must complete the SHA Training. Please do not forget to fax in the Proof of Training Form to (909) 890-2968 when the training has been completed.

• Proof of Training Form (PDF)

To access the SHA questionnaires under Forms, please click here.

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.

Courses Include: 

• HIV Prevention/PrEP at Health Centers: An Overview and Current Best Practices
• What’s new in PrEP and STIs? Cases From a Sexual Health Clinic
• Insurance Considerations for Navigating Gender-affirming Care
• Building Your Family: LGBTQ Reproductive Options
• Behavioral Health Assessments and Referral for Gender-Affirming Surgery
• Navigating Gender Affirming Care
• Collecting Sexual Orientation and Gender Identity (SO/GI) Data In Electronic Health Records
• Providing Mental Health Assessments for Gender Affirming Surgery Referral Letters

Online Cultural Competency Training

AHRQ Health Literacy Modules Available for Continuing Education (CE) and Maintenance of Certification (MOC) Credit 

Physicians and nurses can earn CE credits while learning about the challenges in caring for patients with low health literacy as well as strategies to improve overall patient communication and care. OptumHealth Education is issuing continuing education credit for taking the AHRQ-developed Health Literacy Knowledge Self-Assessment. No fees are charged for the two CE activities:

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

1. An Updated Overview of Health Literacy
Link (optumhealtheducation.com)
2. Improving Health Literacy by Improving Communication Skills
Link (optumhealtheducation.com)

Pediatricians and family physicians can earn credit for re-certification (MOC Part 2) as well as CE by taking the Health Literacy Knowledge Self-Assessment through the American Board of Pediatrics and the American Academy of Family Physicians, respectively.

To learn about AHRQ’s tools to address health literacy, visit Health Literacy Topics at https://www.ahrq.gov/health-care-information/topics/topic-health-literacy.html

To find out about other free AHRQ continuing education opportunities, go to www.ahrq.gov

Contact moreinfo@optumhealtheducation.com with questions.

The following courses are great resources for Health Professionals, Physicians, Physician Assistants and Nurse Practitioners.

Office of Minority Health - https://cccm.thinkculturalhealth.hhs.gov/

CDC - www.cdc.gov

U.S. Department of Health and Human Service, Health Resources and Services Administration - www.hrsa.gov

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

Facility Site Review Training

Welcome and Thank You for your participation in the IEHP Network and partnering with 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.

• Department of Health Care Services (DHCS)
• IEHP Addendum Tools
• PARS
• Facility Site Review
• Medical Record Review

Department of Health Care Services (DHCS)

• Facility Site Review Standards (PDF)
• Facility Site Review Tool (PDF)
• Medical Record Review Standards (PDF)
• Medical Record Review Tool (PDF)

• APL20-006 - Facility Site Review and Medical Record Review (PDF)
• DPL14-005 - FSR Physical-Accessibility Reviews (PDF)
• PL12-006 - Revised FSR Tool (PDF)
• PL14-004 - Facility Site Review and Medical Record Review (PDF)

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IEHP Addendum Tools

• Att 06 - IEHP Urgent Care Evaluation Tool (PDF)
• IEHP Interim Review (PDF)

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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)

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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

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Access/Safety

Facility Site Review

• Blank Pre-Calculated Dosage Chart (PDF)
• Emergency Exit Routes Factsheet (PDF)
• Evacuation Routes (PDF)
• Glucometer Log (PDF)
• Hemocue Log (PDF)
• Medical Emergency, Earthquake, Fire Protocols (PDF)
• Sample of Sizes of Ambu Bags (PDF)
• Sample Oxygen Tank Set (PDF)

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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)
• PHQ-2 - Sample (PDF)
• PHQ-9 - Sample (PDF)
• Required Documentation Checklist for Adult (PDF)
• TB Risk Assessment Adult (PDF)

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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)

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Coordination of Care

Medical Record Review

• Adult Progress Note - Sample (PDF)
• Missed Appointment Log - Sample (PDF)
• Pediatric Progress Note - Sample (PDF)

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Documentation

Medical Record Review

• Adult General Consent to Treat (PDF)
• Advanced Directives Acknowledgement - English (PDF)
• CAIR Sharing Request (PDF)
• General Consent to Treat Minor (PDF)
• Medical Record Release (PDF)
• Sample Medication List (PDF)
• Signature Page - IEHP (PDF)

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Format

Medical Record Review

• Acknowledgment of Receipt of Notice of Privacy Practice (PDF)

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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)
• 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)

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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)

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Office Management

Facility Site Review

• 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)
• Primary Care Provider Timeframe Access Standards (PDF)
• Referral Log (PDF)
• Referral Process (PDF)
• Sample Office Hours (PDF)
• Wait Time Survey Tool (PDF)

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Pediatric Preventive

Medical Record Review

• AAP Infection Prevention and Control in Pediatric Ambulatory Settings - COVID (PDF)
• AAP Schedule (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)
• Edinburgh Postnatal Depression Scale (EPDS) (PDF)
• General Consent to Treat Minor (PDF)
• PEARLS Assessment (PDF)
• PEARLS Teen Self Assessment (PDF)
• PHQ-2 - Sample (PDF)
• PHQ-A - Sample (PDF)
• Required Documentation Checklist for Pediatric (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)

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Personnel

Facility Site Review

• Bloodborne Pathogens & Post Exposure Plan - Fillable (PDF)
• Domestic Violence (PDF)
• Electronic Resources for Required Employee Training (PDF)
• Employee File Checklist (PDF)
• IEHP Evidence of Staff Training (PDF)
• IEHP P&P Child Abuse Reporting (PDF)
• Medical Assistant Letter of Competency - Fillable (PDF)
• Medical Assistant Venipuncture Form (PDF)
• Medication Administration Procedures (PDF)
• Mid-level Supervision of Medical Assistant (PDF)
• Notice to Consumer PA Sign - English (PDF)
• Notice to Consumer PA Sign - Spanish (PDF)
• Notice to Consumer Sign - English (PDF)
• Notice to Consumer Sign - Spanish (PDF)
• SB697 Practice Agreement (PDF)
• SOC 341 (PDF)
• Standardized Procedures for Nurse Practitioner (PDF)
• Standards on Interpreter Services P&P (PDF)
• Suspected Child Abuse Report (PDF)

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Preventive Services

Facility Site Review

• Pure Tone Audiometer (PDF)
• Sample Eye Chart (PDF)

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Additional Documents

Facility Site Review

• IEHP Phone List (PDF)

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Additional Documents

Medical Record Review

• Electronic Resources for Medical Record Review (PDF)

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Forms

Behavioral Health

• ABA 6 Month and Exit Progress Report Template (Word)
• ABA FBA Report Template (Word)
• ABA School BHT Services Request Form (Word)
• Authorization Release of Information Form - English (PDF)
• Authorization Release of Information Form - Spanish (PDF)
• Behavioral Health Authorization Request Form (PDF)
• Coordination of Care Treatment Plan Form (PDF)
• No Further Treatment Request Form (PDF)
• Psych Testing Battery Plan (for Psychologist use only) (PDF)

• BHT Q2 2020 Provider Training FAQ (PDF)
• BHT Q3 2020 Provider Training FAQ (PDF)
• BHT Q4 2020 Provider Training FAQ (PDF)

Claims

Please select on the links below to obtain the revised CMS 1500 form (version 02/12) and the CMS 1500 Reference Instruction Manual.

• Letter Template
  Medicare-Medicaid Plan
  
  1. Integrated Denial Notice Denial Payment
  Last Updated: 05/12/20

  

  

  2. Integrated Denial Notice Denial Payment (Spanish)
  Last Updated: 05/12/20

  

  

  3. Integrated Denial Notice Denial Payment IPA
  Last Updated: 05/12/20

  

  

  4. Integrated Denial Notice Denial Payment IPA (Spanish)
  Last Updated: 05/12/20

  

  

• Refund Form (PDF)
• Provider Dispute Resolution (PDR) (PDF)
• Clean Claim Tool Guide - UB04 Inpatient Form (PDF)
• Clean Claim Tool Guide - UB04 Outpatient Form (PDF)
• Waiver of Liability Statement - Cal MediConnect Plan (PDF)
• Revised CMS 1500 Health Insurance Claim Form (PDF)
• CMS 1500 Reference Instruction Manual (PDF)

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Compliance

• Click here for Compliance forms

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Delegation Oversight Audit (DOA)

• Biographical Information Sheet (PDF)
• Compliance Program Effectiveness DOA Audit Tool - Medi-Cal
• Compliance Program Effectiveness DOA Audit Tool - Medicare
• Credentialing DOA Audit Tool
• Medi-Cal DOA Tool UM/CM/QI
• Medi-Cal UM Referral Template
• Medicare DOA Tool UM/CM/QI
• Sub-Contracted Facility/Agency Services and Delegated Functions (PDF)

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EFT and ERA 835 Enrollment

• Electronic Funds Transfer (EFT) Form & FAQs (PDF)
• ERA (835) Enrollment Form (PDF)

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Grievance

The Grievance Forms below are for your Member's use when filing a complaint, or has an appeal regarding any aspect of care or service provided by you. Please select the Appeal and Grievance form appropriate for their use:

• Medi-Cal Form
       English (PDF)     Spanish (PDF)
• Medicare Form
       English (PDF)     Spanish (PDF)

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Growth Chart

Inland Empire Health Plan (IEHP) offers you easy access to useful reference materials and forms you may need. It's just one click away. Select the growth chart form that you need by clicking on the link below:

• (0-36 months): Head Circumference-For-Age And Weight- For-Length Percentiles
            Boys (PDF)          Girls (PDF)
• (0-36 months): Length and Weight-For-Age Percentiles
            Boys (PDF)          Girls (PDF)
• (2-20 years): Stature and Weight-For-Age-Percentiles
            Boys (PDF)         Girls (PDF)
• (2-20 years): Body Mass Index For-Age Percentiles
            Boys (PDF)          Girls (PDF)

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Health and Wellness

• DPP Rx Pad (PDF)

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Historical Data Form

• Historical Data Form (PDF)

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Medi-Cal Letter Templates

1. Carve-Out Template (English)
Last Updated: 10/18/17

2. Carve-Out Template (Spanish)
Last Updated: 10/18/17

3. Member Authorization Letter
Last Updated: 11/16/17

4. Notice of Action Taken - Denied (English)
Last Updated: 10/18/17

5. Notice of Action Taken - Denied (Spanish)
Last Updated: 10/18/17

6. Notice of Action Taken - Modified (English)
Last Updated: 10/18/17

7. Notice of Action Taken - Modified (Spanish)
Last Updated: 10/18/17

8. Notice of Action Taken - Terminated (English)
Last Updated: 10/18/17

9. Notice of Action Taken - Terminated (Spanish)
Last Updated: 10/18/17

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Medicare-Medicaid Plan Letter Templates

1. Carve-Out Information Letter
Last Updated: 11/21/17

2. Carve-Out Information Letter (Spanish)
Last Updated: 10/31/17

3. Detailed Explanation of Non-Coverage
Last Updated: 10/31/17

4. Detailed Explanation of Non-Coverage (Spanish)
Last Updated: 10/31/17

5. Detailed Notice of Discharge
Last Updated: 01/26/18

6. Detailed Notice of Discharge (Spanish)
Last Updated: 01/26/18

7. Expedited Criteria Not Met
Last Updated: 10/31/17

8. Expedited Criteria Not Met (Spanish)
Last Updated: 10/31/17

9. Extension Needed for Additional Information
Last Updated: 10/31/17

10. Extension Needed for Additional Information (Spanish)
Last Updated: 10/31/17

11. Integrated Denial Notice
Last Updated: 12/21/18

12. Integrated Denial Notice (Spanish)
Last Updated: 12/21/18

13. Notice of Authorization of Services
Last Updated: 10/31/17

14. Notice of Authorization of Services (Spanish)
Last Updated: 10/31/17

15. Notice of Medicare Non-Coverage
Last Updated: 10/31/17

16. Notice of Medicare Non-Coverage (Spanish)
Last Updated: 10/31/17

17. Notice of Reinstatement of Coverage
Last Updated: 10/31/17

18. Notice of Reinstatement of Coverage (Spanish)
Last Updated: 10/31/17

19. Denial Reason Matrix
Last Updated: 07/03/18

20. Integrated Denial Notice Medical Coverage
Last Updated: 05/12/20

21. Integrated Denial Notice Medical Coverage (Spanish)
Last Updated: 05/12/20

22. Integrated Denial Notice Medical Coverage IPA
Last Updated: 05/19/20

23. Integrated Denial Notice Medical Coverage IPA (Spanish)
Last Updated: 05/12/20

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Medicare

• Positive Airway Pressure Devices for Obstructive Sleep Apnea (PDF)
• Enteral and Parenteral Nutrition (PDF)
• External Infusion Pump (PDF)
• Osteogenesis Stimulators (PDF)
• Oxygen (PDF)
• Seat Lift Mechanisms (PDF)
• Continuation Form (PDF)
• Transcutaneous Electrical Nerve Stimulator (TENS) (PDF)
• Pneumatic Compression Device (PDF)

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Non-Contracted Providers

To submit a referral to IEHP, please fill out the referral form below, include all clinical notes and fax it to IEHP. If you are referring back to yourself, please indicate such. If you need IEHP to direct the referral, please indicate that on the form.

• Referral Authorization Request Form - Non-Contracted Providers (PDF)

If you are interested in becoming a network Provider, please click here.

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Perinatal

IEHP provides standard risk assessment forms that must be used by all Providers of obstetrical (OB) services. Please refer to IEHP Provider Policy 10D1, "Obstetrical Services, Guidelines for Obstetrical Services" for further detail. To obtain copies, simply click on the links below.

• Edinburgh Postnatal Depression Screening Tool - English (PDF)
• Edinburgh Postnatal Depression Screening Tool - Spanish (PDF)
• Initial and Trimester Assessment and Care Plan (PDF)
• Perinatal Protocols (PDF)
• Postpartum Assessment and Care Plan (PDF)
• Pregnancy Notification/Outcome Report (PDF)

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Pharmacy

• Click here for Pharmacy forms.

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Provider Preventable Conditions (PPC)

On May 23,2017, the Department of Healthcare Services (DHCS) released All Plan Letter (APL) 17-009, reporting requirements related to Provider Preventable Conditions. In conjunction, DHCS released Dual Plan Letter (DPL) 17-002. As part of these instructions, the Health Plan, Network Providers, Delegates, Contracted Hospitals, and ambulatory surgical centers must report using PPC Form on DHCS secure online portal for both Medicare and Medi-Cal lines of business.

Further  information is available on the following pages:

• Instructions for Completing Online Reporting of PPCs
• Medi-Cal Guidance on  Reporting Provider-Preventable Conditions
• Frequently Asked Questions
• All Plan Letter (APL) 17-009
• Duals Plan Letter (DPL) 17-002
• PPC Form

Medicare and Medi-Cal lines of business must follow the instructions below:

1. Providers are REQUIRED to send a copy of the completed PPC submission from the DHCS secure online portal to IEHP by fax at (909) 890-5545 within five (5) business days of reporting to DHCS;
2. IEHP does not pay Provider claims nor reimburse a Provider for a PPC, in accordance with 42 CFR Section 438.3(g) and IEHP's three-way Cal MediConnect contract.
3. As outlined in both the APL/DPL - Reporting Requirements related to Provider Preventable Conditions, the following classify as PPCs and must be reported:

Category 1 - HCACs (For Any Inpatient Hospital Setting in Medicaid)

• Any unintended foreign object retained after surgery
• A clinically significant air embolism
• An incidence of blood incompatibility
• A stage III or stage IV pressure ulcer that developed during the patient's stay in the hospital
• A significant fall or trauma that resulted in fracture, dislocation, intracranial injury, crushing injury, burn, or electric shock
• A catheter-associated urinary tract infection
• Vascular catheter-associated infection
• Any of the following manifestations of poor glycemic control: diabetic ketoacidosis; nonketotic hyperosmolar coma; hypoglycemic coma; secondary diabetes with ketoacidosis; or secondary diabetes with hyperosmolarity
• A surgical site infection following:
  • Coronary artery bypass graft (CABG) - mediastinitis
  • Bariatric surgery; including laparoscopic gastric bypass,gastroenterostomy, laparoscopic gastric restrictive surgery
  • Orthopedic procedures; including spine, neck, shoulder, elbow
  • Cardiac implantable electronic device procedures
• Deep vein thrombosis/pulmonary embolism following total knee replacement or hip replacement with pediatric and obstetric exceptions
• Latrogenic pneumothorax with venous catheterization
• A vascular catheter-associated infection

Category 2 - Other Provider Preventable Conditions (For Any Health Care Setting)

• Wrong surgical or other invasive procedure performed on a patient
• Surgical or other invasive procedure performed on the wrong body part
• Surgical or other invasive procedure performed on the wrong patient

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Staying Healthy Assessment

PCPs are responsible for assuring the Staying Healthy Assessment (SHA) Questionnaire is administered during the Initial Health Assessment to each IEHP Member within 120 days of the Member's enrollment.The SHA Questionnaire is available in over nine different languages and in nine separate age categories. 

Printed English and Spanish versions are available through your IPA or you can get the forms you need by using the menu below.

7098 A    0-6 Months 

Select Language: English, Spanish, Arabic, Armenian, Chinese,
Hmong, Korean, Russian, Tagalog, Vietnamese

7098 B    7-12 Months 

Select Language: English, Spanish, Arabic, Armenian, Chinese, 
Hmong, Korean, Russian, Tagalog, Vietnamese

7098 C    1-2 Years

Select Language: English, Spanish, Arabic, Armenian, Chinese, 
Hmong, Korean, Russian, Tagalog, Vietnamese

7098 D    3-4 Years

Select Language: English, Spanish, Arabic, Armenian, Chinese, 
Hmong, Korean, Russian, Tagalog, Vietnamese

7098 E    5-8 Years

Select Language: English, Spanish, Arabic, Armenian, Chinese, 
Hmong, Korean, Russian, Tagalog, Vietnamese

7098 F    9-11 Years

Select Language: English, Spanish, Arabic, Armenian, Chinese, 
Hmong, Korean, Russian, Tagalog, Vietnamese

7098 G    12-17 Years

Select Language: English, Spanish, Arabic, Armenian, Chinese, 
Hmong, Korean, Russian, Tagalog, Vietnamese

7098 H    Adult

Select Language: English, Spanish, Arabic, Armenian, Chinese, 
Hmong, Korean, Russian, Tagalog, Vietnamese

7098 I    Senior 

Select Language: English, Spanish, Arabic, Armenian, Chinese, 
Hmong, Korean, Russian, Tagalog, Vietnamese

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UM/CM

• Authorization for Use and/or Disclosure of Patient Health Information - English (PDF)
• Authorization for Use and/or Disclosure of Patient Health Information - Spanish (PDF)
• Care Management Referral Form (PDF)
• Consent for HIV Test - English (PDF)
• Consent for HIV Test - Spanish (PDF)
• Contraceptive Informed Choice Form - English (PDF)
• Contraceptive Informed Choice Form - Spanish (PDF)
• Diabetic Prescription Referral Form -Preveon Health (PDF)
• Health Risk Assessment (HRA) - IEHP DualChoice - English (PDF)
• Health Risk Assessment (HRA) - IEHP DualChoice - Spanish (PDF)
• HIV Testing Sites - Riverside and San Bernardino (PDF)
• Home Health Check Off List (PDF)
• Long Term Care (LTC) Data Sheet (PDF)
• Non-Emergency Medical Transportation (NEMT) Physician Certification Statement (PCS) (PDF)
• Pain Assessment and Treatment Plan Form (PDF)
• Referral Form (PDF)
• Service Request for Skilled Nursing Facilities (PDF)
• SNF Initial Review (PDF)
• SNF Follow-up Review (PDF)
• Sterilization Consent Form PM-330
  PM-330 Form - Tips and Example (PDF)
  PM-330 Form - English (PDF)
  PM-330 Form - Spanish (PDF)
• Transportation Requests Form (SNF & LTC) (PDF)
• Transportation Requests Form (Hospital) (PDF)
• Wound Assessment - Admission (PDF)
• Wound Assessment - Follow - Up (PDF)
• Wound Assessment - Addendum (PDF)

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Vision

• Opthalmologist Referral Form (PDF)
• Vision Exception Request (VER) Form (PDF)
• PCP Vision Report Form (PDF)
• IEHP Lab Form (PDF)
• Non Covered Services/Materials Waiver Form-English (PDF)
• Non Covered Services/Materials Waiver Form-Spanish (PDF)

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Other

• Authorization of Release - Use & Disclosure of PHI - English (PDF)
• Authorization of Release - Use & Disclosure of PHI - Spanish (PDF)
• CMS 1696 Appointment of Representative - English (PDF)
• CMS 1696 Appointment of Representative - Spanish (PDF)
• Contracts Maintenance Request Form (PDF)
• Provider Services Materials Request Form (PDF)
• 2017 Model Output Report (MOR) Data File Layout (PDF)

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Health & Wellness

IEHP partners with Providers to help educate Members about their health conditions and achieve health goals. IEHP’s Health & Wellness Programs help Members learn how to manage their health and make healthy lifestyle changes. You can refer your IEHP Members to these programs anytime by logging into the Secure Provider Website and completing the Health Education Program Request Form.

• Health Resources
• Kids and Teens
• Managing Your Illness
• Pregnancy and Postpartum
• Senior Health
• Weight Management

Diabetes Prevention Program (DPP) - Live the Life You Love

Format: Online (small group)
Duration: One year
Ages: 18 years and over

This online year-long lifestyle change program helps you make real changes that last. 

During the first 6 months, you will meet weekly with a small online group to learn how to make healthy choices into your life. In the second 6 months, you will meet monthly to practice what you have learned.

No person is alike, so the program will be tailored to meet your needs and honor your customs and values. You will also be paired with a health coach for one year to help you set your goals, such as how to:

• Eat healthier
• Add physical activity into your daily life
• Reduce stress
• Improve problem-solving and coping skills

Studies have shown that those who finish the program can lose weight and prevent Type 2 Diabetes.

Small changes can have big results! Let's start living the best version of you and living the life you love.

Find out if you qualify!

• Click here to visit the Skinny Gene Project online, or
• Call Skinny Gene Project at (909) 922- 0022, Monday - Friday 8am – 5pm., or
• Email hello@skinnygeneproject.org

For Providers

• DPP Rx Pad (PDF)

Educational Resources

2016 Group Needs Assessment (GNA) Report

The 2016 GNA Report describes Medi-Cal Members’ health risks and practices, chronic health condition incidence, utilization patterns, health education and cultural and linguistic needs. IEHP administers the GNA every five years; the findings of the GNA may help Providers better understand and serve our Members.

For questions please contact IEHP Health Education Department at (866) 224-4347.

• 2016 Group Needs Assessment (GNA) Report (PDF)

Provider Education Resources

• Inland Empire EHR Resource Center California Technical Assistance Program to help with EHR implementation and meaningful use.

• "Tips From Former Smokers" campaign featuring Rebecca, a former smoker who struggled with depression for years. Below are links to the campaign materials:
  
  By clicking on these links, you will be leaving the IEHP website.
  
  • Rebecca's Videos: http://www.cdc.gov/tobacco/campaign/tips/resources/videos/rebecca-videos.html
  • Podcast: http://www2c.cdc.gov/podcasts/player.asp?f=8639229
  • Print Ad: http://www.cdc.gov/tobacco/campaign/tips/resources/ads/tips-5-rebecca-full.pdf
  • Mental Health Care Professionals: Help Your Patients Quit Smoking: http://www.cdc.gov/tobacco/campaign/tips/partners/health/mental/index.html
  • Web Button for Rebecca Campaign(under Mental Health Conditions: Depression and Anxiety): http://www.cdc.gov/tobacco/campaign/tips/resources/buttons/index.htm

• Baby's Optimal Nutrition with Ultimate Support (BONUS)
  • Resource Guide (PDF)
  • Breastfeeding Support "BONUS Helpline" News Release
    • English (PDF)
    • Spanish (PDF)

Member Education Resources

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

POLST Registry

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

To login, visit https://www.capolstregistry.org/#/.

To sign up, simply go to https://www.capolstregistry.org/#/mdsignup.

• CPR Correspondence (PDF)
• CPR FAQ (PDF)

For any questions, please contact Care Directives at (888) 621-4383 or email support@caredirectives.org.

Pharmacy Services

Here, you will find links to the Pharmacy Program Manual, Communications, DTM Program, Prior Authorization Criteria, Clinical Practice Guidelines, Forms, IEHP Formulary, and Safety Resources with drug recall information.

If you have any questions regarding services provided by the Pharmaceutical Services Department, please feel free to contact the IEHP Pharmacy Department at (909) 890-2049.

• Pharmaceutical Services

Quality & Clinical Resources and Tools

The tools provided on this page are meant to be used as resources to assist primary care providers in delivering care in accordance with IEHP standards. Resources are reviewed regularly and updated to reflect changes from a regulatory and clinical standpoint.

Clinical Practice Guidelines Library

The guidelines contained on this page are recommended by IEHP with the intent to enhance Member care. All content has been reviewed by IEHP to align with the standards practiced by leading health organizations.

• Asthma (PDF)
• Adult Depression (PDF)

Staying Healthy

The Department of Health and Human Services supports work completed by the USPSTF. For the complete, up to date list of recommendations, please visit (by clicking on this link, you will be leaving the IEHP website) https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/.

• U.S. Prevention Task Force (USPSTF) Recommendations for the Affordable Care Act (ACA) (PDF)

After Hours Care, After Hours Phone Numbers for Coverage Determination and Expedited Appeals,

LabCorp Locations, and Urgent Care Facilities

After Hours Care

IEHP Providers can direct Members to access care after hours. After hour care includes the 24-Hour Nurse Advice Line, DocOnline and Urgent Care Clinics.

24-Hour Nurse Advice Line

Your Members can call the IEHP 24-Hour Nurse Advice Line for medical advice anytime, day or night. 

• DocOnline FAQs (PDF)
• Prescription Medication Refill List (PDF)

After Hours Phone Numbers for Coverage Determination and Expedited Appeals (IEHP Medicare DualChoice Cal MediConnect Members)

The following numbers are to be used for after hour requests:

• Coverage Determinations: Phone: (888) 860-1297
• Expedited Appeals: Phone: (866) 233-4347 and Fax: (909) 890-5748

LabCorp Locations

A listing of LabCorp Patient Service Centers around the Inland Empire can be found below:

• LabCorp Patient Service Centers (PDF)
• LabCorp Patient Service Centers at Walgreens (PDF)

Urgent Care Clinics

Any of your IEHP Members needing medical attention may visit an Urgent Care Clinic after regular business office hours and on weekends. A listing of all Urgent Care Clinics is found on the IEHP Doctor Search.

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

Utilization Management Clinical Criteria

Welcome to the Utilization Management Clinical Criteria page. IEHP has created UM Subcommittee Approved Authorization Guidelines to serve as one of the sets of criteria for medical necessity decisions. Our goal in creating this page is to provide you with easily accessible electronic versions of IEHP’s UM guidelines. IEHP utilizes a variety of sources in developing our UM guidelines which include:

• Medicare and Medi-Cal’s coverage policy statements
• Evidence in the peer-reviewed published medical literature
• Technology assessments and structured evidence reviews
• Evidence-based consensus statements
• Expert opinions of healthcare Providers
• Evidence-based guidelines from nationally recognized professional healthcare organizations and public health agencies.

IEHP is also licensed to use InterQual and Apollo Medical Review Criteria to guide in utilization management decisions.

Since medical technology is constantly evolving, our clinical guidelines are subject to change without prior notification. Additional UM Subcommittee Guidelines may be developed as needed or may be withdrawn from use.

Please note that benefits may vary based on Member’s line of business; therefore, certain services discussed in the UM Subcommittee Guidelines may not be a covered benefit.

Table of Contents (PDF)

Providers may obtain information about criteria, either in general or relating to specific UM decisions, from IEHP upon request by contacting the IEHP UM Department. Please contact the IEHP Provider Relations Team at (909) 890-2054 to be connected to the UM Department. 

Behavioral Health

• Behavioral Health Home Based Services (PDF)
• Criteria for Multidisciplinary Treatment Services (PDF)

Diagnostic Testing

• Elastography (PDF)
• Inflammatory Bowel Disease Serology (PDF)
• Vestibular Autorotation Test (PDF) 

Gynecology and Obstetrics

• Antepartum Fetal Assessment (PDF)
• Full Integrated and Serum Integrated Screening (PDF)

Neurology

• Bone Marrow Transplant in Treatment of Multiple Sclerosis (PDF)
• Genicular Nerve Neurotomy (PDF)

Orthopedic

• Physical Therapy Guidelines for Chronic Conditions (PDF)

Pain Management

• Pain Management - Centers of Excellence (COE) (PDF)
• Referrals to Pain Management Specialist (PDF)

Pediatric

• Deflux Injectable Gel for VUR in Children (PDF)

Surgical Procedures

• Adolescent Bariatric Consultation and Surgery (PDF)
• Bronchial Thermoplasty (PDF)
• Gender Dysphoria (PDF)
• Liver Biopsy in Conjunction with Bariatric Surgery (PDF)
• Natural Orifice Transluminal Endoscopic Surgery (PDF)

Other

• Allocation of Limited Critical Care Resources During a Public Health Emergency (PDF)
• Biosimilar Products (PDF)
• Care Plan Option (PDF)
• Chimeric Antigen Receptor T-Cell Therapy (CAR-T Therapy) (PDF)
• Complementary and Alternative Medicine or Holistic Therapies (PDF)
• Congregate Living Health Facilities (PDF)
• Criteria for Custodial Care: Medi-Cal (PDF)
• Hair Removal Guideline (PDF)
• Health Homes Program (HHP) (PDF)
• Hepatitis C - Center of Excellence (COE) Admission Criteria (PDF)
• My Path (A Palliative Care Approach) (PDF)
• Recuperative Care Admission (PDF)
• Reference Product Pegfilgrastim and Biosimilar Products (PDF)
• Spravato, (eskeamine) (PDF)
• Tertiary Care Center Referral Requests (PDF)
• Transitional Care Medicine (PDF)
• Transportation Criteria (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.