Kern Health Systems (KHS) offers the Community Health Worker (CHW) services benefit for eligible Kern Family Health Care (KFHC) Members. CHW services are preventive health services. CHW will support members to help prevent diseases, disability, and other health conditions or their progression; to prolong life; and to promote physical and mental health. The goal of the service is to enhance quality patient care by offering support to members to address barriers in accessing care, increasing level of engagement, improving health outcomes, reducing health disparities, and achieving health equity.
How to become a CHW?
All CHWs will need to be approved by KHS. CHWs must have lived experience that aligns with Member or population being served. CHWs must demonstrate qualifications through the Certificate Pathway and must provide proof of completion. A CHW who does not have a certificate of completion and has at least 2,000 hours working as a CHW in paid or volunteer positions within the previous three, will have the ability to earn a certificate of completion, as described above, within 18 months of the first CHW visit provided to a member.
Bakersfield College is offering a CHW Certificate Program Pathway. For more information on registration please contact:
Charles Daramola, EdD, MBA, CHES
Professor and Program Director, Public Health Science
charles.daramola@bakersfieldcollege.edu
How do I get a CHW approved with KHS?
Please complete and submit the CHW Application/Check List and the CHW Supervisor Attestation Form to KHS Provider Network Management Credentialing Department for review and approval.
For Asthma Preventive Services Providers (APS), please utilize this application:
Resources
Kern Health Systems (KHS) offers Community Supports Services (CSS) for Kern Family Health Care (KFHC) members that are eligible. The Community Supports Services program is part of the CalAim initiative, which provides members with wrap-around services to address complex medical and behavioral health needs. The program also addresses social determinants of health which impedes their ability to achieve health goals.
Members who qualify can get help to find housing and with housing needs, get food, and have a safe and clean place to stay after a hospital stay.
If you would like more information, or to find out if the KFHC Member qualifies, please call us at 661-632-1590 option 6 or 1-800-391-2000 option 6. You or the eligible KFHC Member may also be contacted by KHS or our contracted CSS providers to see if they are interested in enrolling into a CSS Program.
KHS network providers may submit an assessment to refer a KFHC member to CSS by logging into their KFHC Provider Portal account.
Who is eligible for CSS?
KFHC Members may qualify for CSS if they are experiencing one of the below conditions.
- Homelessness
- Could be or might become homeless
- Complex health issues
- Disabled
- Behavioral disorder
- Substance use disorder
What services does CSS provide?
KHS works with local authority and community service offices to help members get support for housing, food, and other medical support.
Currently, Community Supports Services offers the following services:
- Housing Transition Navigation Services
The program assists members in their search for housing options, which includes helping members complete a housing application, securing required documentation, and providing rental payment assistance.
- Housing Deposits
The program coordinates and secures one-time housing funds to support independent living. Funds may be utilized to pay security deposits, initial utility fees, medical equipment, and basic household expenses.
- Housing Tenancy and Sustaining Services
The program provides support and resources to prevent the loss of housing. Support and resources include the education of tenant and landlord rights and responsibilities, as well as identifying lease violations (i.e., hoarding).
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Short-Term Post-Hospitalization Housing
This program assists members with temporary shelter while recovering from a procedure or illness. During the aftermath, members obtain assistance in gaining housing, which allows them to have a higher level of independence.
- Recuperative Care (Medical Respite)
This short-term residential care program helps members continue their recovery following hospitalization and receive post discharge treatment. Other services include transporting members to appointments as well as providing food and housing assistance.
- Caregiver Respite Services
The program finds volunteers or paid caretakers to provide in-home services for a member's caregiver, either occasionally or on a regular basis. The services are non-medical in nature.
- Medically Supportive Food/Meals/Medically Tailored Meals
This program helps members who experience chronic conditions achieve their nutritional goals by providing healthy meals or supportive nutritional counseling.
- Sobering Centers
This program is used as an alternative destination for individuals who are found to be publicly intoxicated and would otherwise be transported to the emergency department or jail.
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Asthma Remediation
The program helps members make necessary modifications to their home or living environment, to ensure they can maintain a healthy lifestyle while living with asthma. This may include providing members with air purifiers and other medical supplies.
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Assisted Living Facilitates (ALF) Transition
The program enables individuals to live in their community and/or avoid institutionalization whenever possible. The goal is to facilitate transitioning the member from the nursing facility back into a home-like setting and/or prevent future skilled nursing facility admissions.
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Community or Home Transition Services
The program is designed to help members with financial assistance and information needed to transition from living in medical facilities to living in their own homes. The maximum financial support available is $7,000 per member.
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Personal Care and Homemaker Services
The services are offered to individuals who require support with their everyday activities, including but not limited to bathing, dressing, toileting and feeding support for activities of daily living (ADL).
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Day Habilitation Program
The program helps the Member in learning and improving self-help, social skills, necessary to live successfully in the person’s natural environment.
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Environmental Accessibility Adaptations (Home Modifications)
This service provides physical modifications to a home that are necessary to ensure the health, welfare, and safety of the individual, or enable the individual to function with greater independence in the home.
Is there a cost?
There is no cost to the Member for Community Supports Services.
Resources
Kern Health Systems' commitment is to provide quality healthcare to our culturally and linguistically diverse member population. To assist providers in better communicating with patients that are limited in their English proficiency (LEP), KHS' Marketing/Cultural and Linguistics Services Department is making the following resources available to you.
- Desktop displays: Language Line point to language ID display.
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations: The material tool kit was produced by a nationwide team of healthcare professionals. The material will provide resources to address specific operational needs that often arise because of changing service requirements and legal mandates.
- Labels: Tool for providers to document patient's language needs. Preferred Language labels (yellow). Use or refusal of interpreter services (green).
- Online Courses: HRSA: Effective Communication Tools for Healthcare Professionals. Addressing Health Literacy, Cultural Competency, and Limited English Proficiency.
If you need originals of the resources mentioned above, please call Cynthia Cardona, Cultural & Linguistics Services Manager, at 661.617.2498.
The Department of Managed Health Care (DMHC) is committed to protecting health care consumers. The DMHC makes sure that health plans follow the law and remain financially stable. They work every day to solve health care problems and make sure all Californians get the right care at the right time.
To learn more about the DMHC, please visit their website.
Kern Health Systems (KHS) offers the Enhanced Care Management (ECM) benefit for eligible Kern Family Health Care (KFHC) Members. These services help coordinate the Member's physical, behavioral, developmental, oral health, long term services and supports (LTSS), and services that address social determinants of health.
There is no cost to the member for ECM services.
If you would like more information or to find out if the KFHC Member qualifies please call us at 1.800.391.2000 or email us at ecmoutreachspecialist@khs-net.com. You or the eligible KFHC Member may also be contacted by KHS or our contracted ECM providers to see if they are interested in enrolling into an ECM Program.
ECM accepts referrals from our non-contracted community-based partners. Click here to download the referral form.
The ECM Referral Form is intended for non-contracted, community-based partners only. Contracted KFHC providers should submit an ECM Screening Assessment through the KFHC Provider Portal to refer a member for potential ECM services. KFHC members and their caregivers can continue to call KFHC at 1-800-391-2000 ext. #4 or email us at ECMOutreachSpecialist@khs-net.com to see if they qualify for ECM services.
Who is eligible for ECM?
KFHC Members may qualify for ECM if they are within one (1) or more of the following Populations of Focus. Members receiving hospice services and/or members receiving any type of care under a 1915(c) waiver do not qualify.
Adults (Age 21 and over):
Adults experiencing homelessness, such as:
- Lacking adequate nighttime residence
- Living in a shelter
- Imminently losing housing in next 30 days
- Victims fleeing domestic violence
- Part of a family experiencing homelessness
Adults who have been admitted to the hospital three (3) or more times in the past six (6) months or have visited the Emergency Department five (5) or more times in the past six (6) months
Adults with serious mental illness and or substance use disorder needs:
- Members who qualify are those receiving services through County Specialty Mental Health or Drug Medi-Cal and meets one (1) or more of the following:
- Uses the emergency department, urgent care, or inpatient hospital as sole source of care
- Is at high risk of hospital or skilled nursing facility admission, overdose, and/or suicide
- Had two (2) or more emergency department visits, or two (2) or more hospitalizations due to SMI or SUD in past 12 months
- Is pregnant or is less than 12 months post-partum
Adults who are transitioning from incarceration
- Members who qualify are those who transitioned from incarceration within the last 12 months and has at least one (1) of the following:
- Mental illness
- Substance use disorder
- Chronic disease
- Intellectual or developmental disability
- Traumatic brain injury
- HIV
- Pregnancy or Postpartum
Adults Living in the community and are at risk for long-term care institutionalization
- Members who qualify will have all of the following:
- Are living in the community who meet the SNF Level of Care (LOC) criteria; OR who require lower-acuity skilled nursing, such as time-limited and/or intermittent medical and nursing services, support, and/or equipment for prevention, diagnosis, or treatment of acute illness or injury;
- And are actively experiencing at least one complex social or environmental factor influencing their health (including, but not limited to, needing assistance with activities of daily living (ADLs), communication difficulties, access to food, access to stable housing, living alone, the need for conservatorship or guided decision-making, poor or inadequate caregiving which may appear as a lack of safety monitoring);
- And are able to reside continuously in the community with wraparound supports (i.e., some members may not be eligible because they have high-acuity needs or conditions that are not suitable for home-based care due to safety or other concerns).
Adult Nursing Facility Residents Transitioning to the Community
- Members who qualify will have all of the following:
- Are interested in moving out of the institution;
- And are likely candidates to do so successfully;
- And are able to reside continuously in the community.
Adult Birth Equity Population of Focus
- Adults who are pregnant or are postpartum, through 12 months, and are subject to racial and ethnic disparities as defined by California public health on maternal morbidity and mortality, including Black, American India, Alaska Native, and Pacific Islander individuals.
Children and Youth (age 20 and under):
Children and youth who are part of a Homeless Family or Unaccompanied Children/Youth Experiencing Homelessness.
Children and Youth who have been admitted two (2) or more times or have visited the Emergency Department three (3) or more times in the past twelve (12) months.
Children and Youth with serious mental health and/or substance use disorder needs:
- Members who qualify are those receiving services through County Specialty Mental Health or Drug Medi-Cal. No further criteria are required to be met for children and youth to qualify for this ECM population of focus.
Children and Youth transitioning from a youth correctional facility.
- Members who qualify are those who transitioned from incarceration within the last 12 months. No further criteria is required for children/youth.
Children and Youth enrolled in CCS (California Children’s Services) or CCS WCM (California Children’s Services Whole Child Model) with additional needs beyond the CCS condition
- Children and Youth who are enrolled in CCS or CCS WCM and
- Are experiencing at least one complex social factor influencing their health.
Children and Youth involved in Child Welfare
- Children and Youth who:
- Are under age 21 and are currently getting foster care in California;
- Are under age 21 and previously received foster care in any state in the last 12 months;
- Have aged out of foster care on or after their 18th birthday up to age 26;
- Are under age 18 and are eligible for and/or in California’s Adoption Assistance Program
- Are under age 18 and are currently receiving or have received services from California’s Family Maintenance program within the last 12 months.
Youth Birth Equity Population of Focus
- Youth who are pregnant or are postpartum, through 12 months, and are subject to racial and ethnic disparities as defined by California public health on maternal morbidity and mortality, including Balck, American Indian, Alaska Native, and Pacific Islander individuals.
What services does ECM provide?
ECM provides care coordination services led by a care team. The ECM care team will work together with the member's health care providers including their doctors, specialists, pharmacists, case managers, and others, to coordinate the needed care and services.
Members enrolled in ECM will receive services including:
- A Comprehensive Assessment and Care Management Plan
- Enhanced Coordination of Care
- Health Promotion Services
- Comprehensive Transitional Care
- Member and Family Supports
- Coordination and Referral to Community and Social Support Services
Resources
- Department of Health Care Services Enhanced Care Management.
- KFHC Enhanced Care Management Brochure (English/Spanish).
- Enhanced Care Management Population of Focus Listing.
Justice - Involved Liaison
Justice - Involved Liaison
Laurie Garcia
661.617.2612
Laurie.Garcia@khs-net.com
The Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program provides comprehensive health care for Medicaid eligible clients under the age of 21. As of 2023, California refers to EPSDT as Medi-Cal for Kids & Teens. The patient’s primary care provider (PCP) conducts medical, vision, hearing and dental screenings based on the Bright Futures/American Academy of Pediatrics Periodicity (BF/APP) Schedule. Providers are able to refer a member by calling 661.664.2099 or faxing the EPSDT Referral Form to 661.617.2741.
The Kern Health Systems (KHS) Long Term Care (LTC) Program serves to evaluate and manage the health care provided to Kern Family Health Care (KFHC) members requiring LTC services. LTC services are provided utilizing available resources across a continuum of care and in collaboration with members, caregivers, medical home providers, and ancillary health care providers.
The LTC Program assures that:
- The service setting is suitable for our members
- Service is given at the appropriate time
- The number and quality of services provided are appropriate
- Members have access to the providers and care they need
What LTC Covers:
KFHC members shall receive all medically necessary services and get the correct level of care as established by their doctor such as:
- Short term skilled care (also called skilled nursing or post-acute rehabilitation)
- Long term care in a home or group setting
- LTC/Skilled nursing facility
- Subacute care
- Therapy services
- Specialized rehabilitative services
We consider the individual needs of our member such as comorbid conditions, behavioral health, and activities of daily living (ADL) management needs that might exist and the ability of our local service providers to provide the correct services for our members.
LTC Program Team:
LTC program team includes nurses, social workers, and outreach specialists. The LTC team will have a care coordinator and care team that will work with the member and health care providers to help coordinate physical health, behavioral health, developmental health, long term services and supports (LTSS), and community-based services.
If you are a provider or provider office who needs to contact a Medical Director, please call: 661-664-5083
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. http://files.medi-cal.ca.gov/pubsdoco/rates/rateshome.asp
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.
Additional information can be found at http://www.medi-cal.ca.gov.
KHS Adjustment Codes. These provide descriptive adjustment codes that help anyone looking for status determine how a claim was processed.
If you are a provider and would like to file an authorization and/or claims dispute, please download the appropriate form below and submit it to KHS for review and a final decision.
The most recent Provider Manual is located in the Manual and Forms section of the website.
A drug recall occurs when a medication is removed from the market because it is found to be either defective or potentially harmful. The FDA along with pharmaceutical companies monitor medications out on the market for unforeseen problems. If an issue is identified, or the safety of the medication becomes a concern, a recall is initiated.
Information is provided below regarding drug recalls. If you are taking a medication that has been recalled, please talk to your health care providers about the best course of action.
- Class I Recall: a situation in which there is a reasonable probability that the use of or exposure to a violative product will cause serious adverse health consequences or death.
- Class II Recall: a situation in which use of or exposure to a violative product may cause temporary or medically reversible adverse health consequences or where the probability of serious adverse health consequences is remote.
- Class III Recall: a situation in which use of or exposure to a violative product is not likely to cause adverse health consequences.
- Market Withdrawal: occurs when a product has a minor violation that would not be subject to FDA legal action. The firm removes the product from the market or corrects the violation. For example, a product removed from the market due to tampering, without evidence of manufacturing or distribution problems, would be a market withdrawal.
The hyperlinks below contain important safety information regarding drug recalls. If you are taking a medication that has been recalled, please talk to your health care provider about the best course of action.