If you are a new Alliance member, you will be asked to complete the Initial Health Assessment (IHA). The IHA is completed during your first visit with your primary doctor. This primary doctor is also called a primary care provider or PCP. The purpose of the IHA is for your PCP to learn about your health history and care needs. During the visit, your PCP may ask you questions about your health history or may ask you to complete a health survey. In addition, your PCP may tell you about health education counseling and classes that may help you. If your child is a new Alliance member, the IHA will be completed with your child’s primary care provider or PCP. Initial Health Assessment: What it is and why it is important If you or your child are new Alliance members and you need help finding a doctor, please call Member Services at 800-700-3874 (TTY: Dial 7-1-1). It is important for your doctor to complete the IHA within 120 days of your new enrollment with the Alliance. You can call your PCP to schedule your IHA appointment. When you call your PCP, you can give your Alliance member ID number that is on your new ID card. It is recommended that you take your Alliance ID card and a list of your medications to your appointments with the doctor. Living Healthy A newsletter for the members of Central California Alliance for Health Standard U.S. Postage PAID Walla Walla, WA Permit No. 44 Central California Alliance for Health 1600 Green Hills Road, Suite 101 Scotts Valley, CA 95066 March 2022 | VOLUME 28, ISSUE 1
HEALTHY PEOPLE . HEALTHY COMMUN I T I ES . The best way to keep updated about COVID-19 There is a lot being said on the news, on social media and in our communities about COVID-19. It is important to get your information from reliable sources. These reliable sources include: ■ The Centers for Disease Control and Prevention (CDC) COVID-19 website: cdc.gov/coronavirus. ■ Your county’s public health department. Merced County Hotline number: 209-381-1200 (Monday through Friday, 8 a.m. to 5 p.m.) COVID-19 website: co.merced.ca.us/3350 Monterey County Hotline number: 831-769-8700 (Monday through Friday, 8 a.m. to 5 p.m.) COVID-19 website: co.monterey.ca.us/government/departments-a-h/ health/diseases/2019-novel-coronavirus-covid-19 Santa Cruz County Hotline number: 831-454-4242 (Monday through Friday, 8 a.m. to 5 p.m. or call 211 outside of these hours.) COVID-19 website: santacruzhealth.org/HSAHome/HSADivisions/ PublicHealth/CommunicableDiseaseControl/CoronavirusHome.aspx Your primary doctor If you are not sure who your primary doctor is or you need to choose a primary doctor, you can call the Alliance’s Member Services department, and someone will help you. The number is 800-700-3874 (TTY: 877-548-0857) Monday through Friday, from 8 a.m. to 5:30 p.m. Our offices are open! The Alliance re-opened its offices in Merced, Monterey and Santa Cruz counties. If you wish to speak to an Alliance representative in person, you may now do so. The Alliance will be following public health guidelines to slow the spread of COVID-19 and ensure the health and safety of our staff and visitors. You can visit us at the following locations: Merced County Office 530 West 16th Street, Suite B Merced, CA 95340 Monday through Friday, 8 a.m. to 5 p.m. Monterey County Office 950 East Blanco Road, Suite 101 Salinas, CA 93901 Monday through Friday, 8 a.m. to 5 p.m. Santa Cruz County Main Office 1600 Green Hills Road, Suite 101 Scotts Valley, CA 95066 Monday through Friday, 8 a.m. to 5 p.m. You may also call our Member Services team at 800-700-3874, Monday through Friday, 8 a.m. to 5:30 p.m. If you need language assistance, we have a special telephone line to get an interpreter who speaks your language, available to you at no cost. For the Hearing or Speech Assistance Line, call 800-735-2929 (TTY: Dial 7-1-1). You do not have to call or visit in person. You can visit our website at www.thealliance.health to get instant access to many member services, including: ■ Replacing your ID card. ■ Updating your personal information. ■ Choosing your doctor. You can also check the Alliance website for COVID-19 information for Medi-Cal members at www.thealliance .health/covid-19-info. We also post updates from reliable sources, like those above, on our Facebook page: facebook.com/ TheAllianceForHealth. 2 Living Healthy
HEALTHY PEOPLE . HEALTHY COMMUN I T I ES . Did you know the Alliance offers health education programs? At the Alliance, we care about your health! That’s why our health education programs give Alliance members the tools they need to get healthy and stay healthy. There is no cost for Alliance members to participate. The Alliance offers programs that can help you manage a chronic condition, including: Diabetes and Prediabetes Programs— help members with education on managing diabetes or prediabetes. Healthy Breathing for Life— helps members with education on managing asthma. Healthier Living Program— for members living with chronic condition(s) like diabetes, high blood pressure or depression. The workshops are offered in three different ways: ■ Over the phone. ■ Virtually with online meetings. ■ In person (currently on hold due to the pandemic). Alliance members who complete all six classes can receive a $50 Target gift card. Wellness that Works (formerlyWeight Watchers)— helps members 18 years and older with education on weight management. The Alliance also offers programs that can help you and your family stay healthy, including: Healthy Moms and Healthy Babies— for pregnant members and members who recently had a baby. We can help with prenatal and postpartum health education, breastfeeding support, pediatric care and parenting. We can also give referrals to local resources. Alliance members who see their doctor within the first 13 weeks of being pregnant are entered into a raffle for a chance to win a $50 Target gift card. Members who see their doctor three to eight weeks after having a baby will receive a $25 Target gift card. Healthy Weight for Life— for parents with children between the ages of 2 to 18. This program promotes new ways to help children reach a healthy weight and make healthier lifestyle changes. The workshops are offered in three different ways: ■ Over the phone. ■ Virtually with online meetings. ■ In person (currently on hold due to the pandemic). Alliance members who complete all 10 classes can receive a $100 Target gift card. Members can also be entered in a raffle to win a bike. Tobacco Cessation Support— for members who want to stop smoking and/or using tobacco products. We support the prevention and cessation of tobacco use, and we offer many ways to help members quit smoking or using any tobacco products. If you would like to sign up for a program or have questions, please call the Alliance Health Education Line at 800-700-3874, ext. 5580. If you need language assistance, please call the Hearing or Speech Assistance Line at 800-735-2929 (TTY: Dial 7-1-1). This number is a special telephone line to get an interpreter who speaks your language, at no cost to you. 3 Living Healthy
HEALTHY PEOPLE . HEALTHY COMMUN I T I ES . Newer medicine is available for type 2 diabetes Diabetes can damage your kidneys, eyes, nerves and cause other problems. It is important to have good control of your blood sugar. Some medicines for type 2 diabetes can help with: ■ Your blood sugar levels. ■ Your blood pressure and weight. ■ Protecting your heart and kidneys. There are many medicines that treat type 2 diabetes: Medicine names: Invokana, Jardiance, Farxiga, Steglatro What they do: get rid of sugar through your urine (peeing). These medicines are good for your kidney and heart. They help you lose weight and improve blood pressure. Possible side effects: yeast infection, urinary tract infection (UTI) and dehydration. Medicine names: Byetta, Bydureon, Victoza, Trulicity, Ozempic, Rybelsus What they do: slow digestion of food. They are helpful in losing weight. Victoza, Trulicity and Ozempic are especially good for your heart. This type of medicine makes you feel full after eating, which helps you in losing weight. Possible side effects: nausea, vomiting and diarrhea that get better after some time has passed. If you have type 2 diabetes, ask your doctor if any of these medicines are right for you. To help members communicate better with their doctors and us, the Alliance provides both telephonic and face-to-face interpreting services, as well as translation of written member information, at no cost. Members can ask for: ■ A trained American Sign Language (ASL) interpreter. ■ A trained language interpreter. ■ Alliance-written information in Braille, large print or audio format. ■ Alliance-written information in a language they can understand. If you need to reach the Alliance’s Language Assistance Services or have questions, please call the Alliance Member Services Department at 800-700-3874. For the Hearing or Speech Assistance Line, call 800-735-2929 (TTY: Dial 7-1-1). Alliance’s Language Assistance Services 4 Living Healthy
HEALTHY PEOPLE . HEALTHY COMMUN I T I ES . Formulary updates If you are a Medi-Cal member, your prescriptions that are filled at a pharmacy are covered by Medi-Cal Rx, and not the Alliance. You can view the formulary for Medi-Cal Rx at medi-calrx.dhcs.ca.gov, or you can request a copy by calling 800-977-2273 (TTY: Dial 7-1-1), 24 hours a day, 7 days a week. If you are an IHSS member, formulary and authorizations are managed by MedImpact. You can view the formulary on the Alliance website at www.thealliance.health/for-providers/ manage-care/pharmacy-services/ pharmacy-formulary. You can request a copy by calling Member Services at 800-700-3874 (TTY: 7-1-1), Monday through Friday, 8 a.m. to 5:30 p.m. If you have questions about a medication, call MedImpact at 800-788-2949. As of January 1, 2022, your prescriptions that are filled at a pharmacy are covered by Medi-Cal Rx, and not the Alliance. Medi-Cal Rx is a new program provided by the Department of Health Care Services to help you with your pharmacy needs. When filling a prescription at the pharmacy, you will need to present your Medi-Cal Benefits Identification Card (BIC). You should have received it when you first became eligible for Medi-Cal benefits. There are two (2) different types of the BIC card, shown below, and either one will work. Your Alliance ID card will no longer be used by pharmacies when filling prescriptions. However, the Medi-Cal Rx phone number is also listed on your Alliance ID card. If you have questions about your pharmacy benefits, need help finding a pharmacy, or if you are not happy with the services Medi-Cal Rx provides and would like to file a complaint, call Medi-Cal Rx at 800-977-2273 (TTY: Dial 7-1-1) or go to medi-calrx.dhcs.ca.gov. They are open 24 hours a day, 7 days a week. If you are unhappy with Medi-Cal Rx, you can also submit a complaint in writing by filling out a Medi-Cal Rx Complaint Form online at medi-calrx.dhcs.ca.gov/cms/ medicalrx/static-assets/documents/member/complaints/Medi-Cal_Rx_Complaint _Form_v1.0.pdf. Additional information about Medi-Cal Rx is available on our website at www.thealliance.health/for-members/get-care/prescription-drugs-and -pharmacy-benefits/introducing-medi-cal-rx. MEDI-CAL RX What do I need to know? If you do not have a BIC, you may ask for a replacement for free. Please contact your local county Medi-Cal office. Merced County Human Services Agency 209-385-3000 Monterey County Department of Social Services 877-410-8823 Santa Cruz County Human Services Department 888-421-8080 5 Living Healthy
HEALTHY PEOPLE . HEALTHY COMMUN I T I ES . Did you know that the Alliance offers transportation to your doctor’s appointments and for picking up prescriptions? There are two types available for members: Non-emergency Medical Transportation (NEMT) NEMT is for when you: ■ Need help getting in and out of a vehicle or have special transportation needs. ■ Have a prescription from your doctor to use this service. Examples of NEMT are: ■ When a member needs transportation by wheelchair van, ambulance or air transport. Non-medical Transportation (NMT) This benefit is only available to MediCal members. NMT is for when you: ■ Are able to get in and out of a vehicle without help. ■ Do not need special medical equipment while traveling to or from an approved appointment. ■ Are able to show that you do not have any other transportation options. Examples of NMT are: ■ When a member can use the public bus, taxicab and rideshares (Lyft/Uber). How to ask for NEMT or NMT transportation services: ■ For NEMT: At least 5 business days before your appointment, call the Alliance at 800-700-3874, ext. 5640 or 831-430-5640, Monday through Friday from 8 a.m. to 5 p.m. ■ For NMT: At least 5 business days before your appointment, call the Alliance at 800-700-3874 (TTY: Dial 7-1-1), Monday through Friday from 8 a.m. to 5:30 p.m. ■ When you have an urgent appointment, call as soon as you can but know that services cannot be guaranteed. ■ Please have your Alliance Member ID card ready when you call. ■ For changes to reservations, 24-hour notice is required. A prior authorization is required. If you are eligible for transportation services, the Alliance will determine which option you need and help you with scheduling your transportation service. Transportation is only available to or from a Medi-Cal covered service, including medical, mental health, substance use disorder and dental appointments. Transportation services What it is and how it works To learn more about this benefit, please see your Evidence of Coverage, or call Member Services at 800-700-3874 (TTY: Dial 7-1-1), Monday through Friday from 8 a.m. to 5:30 p.m. 6 Living Healthy
HEALTHY PEOPLE . HEALTHY COMMUN I T I ES . WIC Reads! WIC (Women, Infants and Children) programs across the state have received grants to promote literacy. Between November 2021 and June 2022, Merced, Monterey and Santa Cruz counties’ WIC programs will be educating families about the importance of reading, pairing books with nutritionmessages and providing books toWIC families. Call your localWIC office for any questions aboutWIC services. Santa Cruz County: 831-722-7121 Monterey County: 831-796-2888 Merced County: 209-383-4859 Patients often do not show up for their scheduled doctor appointments (called a no-show). The reason might be because they: ■ Forgot about the appointment. ■ Do not have a way to get to their appointment. ■ Are not able to go to the appointment and did not call the doctor’s office to cancel. When members are a no-show to an appointment, their health care is delayed. It is important for our members to receive care at the right time! How to avoid being a no-show ■ Update your contact information with your doctor’s office to make sure they have your current information. This will help you receive your appointment reminders. ■ If you cannot make your appointment, please call your doctor’s office to let them know you will need to reschedule. Here are some resources to help you get the care you need at the right time: Language Assistance: You do not have to use family or friends to interpret for you. Your doctor can call a special telephone line to get an interpreter who speaks your language. Then you and your doctor will talk through the interpreter. You do not have to pay for this service. For help with getting an interpreter or understanding something we send you in writing, please call Member Services at 800-700-3874, ext. 5505. How to avoid missing your doctor appointments Nurse Advice Line: If you or your child is sick or have medical questions, call your doctor. If you can’t reach your doctor, call the Alliance Nurse Advice Line. The service is available to members 24 hours a day, 7 days a week. A registered nurse is ready to answer your health care questions, help you with what to do next or connect you with a doctor. Call 844-971-8907 (TTY: Dial 7-1-1). Transportation: If you have a transportation challenge, please call Member Services at 800-700-3874. 7 Living Healthy
Follow us on Facebook! Find us at facebook.com/TheAllianceForHealth. Stay up-to-date with: ■ Tips and services for Medi-Cal members. ■ Local community information. ■ COVID-19 updates. Getting an appointment How long should you have to wait? We know it is important for you to get care when you need it. Sometimes it is not possible for a doctor to see you right away. Some appointments might take longer to schedule than others. For example, you should be able to get an urgent care (care when you are sick) appointment sooner than an appointment for a regular check-up. We work with the doctors and clinics in our network to make sure you can get care when you need it. We have always done this because we know it is important. Health plans in California have to meet certain standards for access to care. The regulations to put this law into place are called the Timely Access to Non-emergency Health Care Services standards. There are different standards for different types of appointments. In the chart below are the standards Appointment type You should be able to get an appointment within: Urgent care appointments that do not require pre-approval (prior authorization) 48 hours Urgent care appointments that do require pre-approval (prior authorization) 96 hours Non-urgent primary care appointments 10 business days Non-urgent specialist 15 business days Non-urgent mental health provider (non-doctor) 10 business days Non-urgent appointment for ancillary (supporting) services for the diagnosis or treatment of injury, illness or other health condition 15 business days Telephone wait times during normal business hours 10 minutes Triage—24/7 services 24/7 services—No more than 30 minutes If you feel you are not getting care when you need it, call Member Services at 800-700-3874 (TTY: Dial 7-1-1). for different types of appointments. The waiting times for an appointment may be longer if the provider feels that it will not harm your health. LIVING HEALTHY is published for the members and community partners of CENTRAL CALIFORNIA ALLIANCE FOR HEALTH, 1600 Green Hills Road, Suite 101, Scotts Valley, CA 95066, telephone 831-430-5500 or 800-700-3874, ext. 5505, website www.thealliance.health. Information in LIVING HEALTHY comes from a wide range of medical experts. If you have any concerns or questions about specific content that may affect your health, please contact your health care provider. Models may be used in photos and illustrations. 2022 © Coffey Communications, Inc. All rights reserved. Member Services Project Specialist Yomayra Gomez Quality and Health Programs Supervisors Desirre Herrera and Mao Moua Quality and Health Programs Manager Deborah Pineda www.thealliance.health Living Healthy
RkJQdWJsaXNoZXIy NzIxMDA=