PARTNERSHIP HEALTHPLAN OF CALIFORNIA POLICY / PROCEDURE

Policy/Procedure Number: MP 350 Lead Department: Member Services External Policy Policy/Procedure Title: Weight Management Program Internal Policy Next Review Date: 08/16/2018 Original Date: 07/18/2007 Last Review Date: 08/16/2017 Applies to: Medi-Cal Employees Reviewing IQI P & T QUAC Entities: OPERATIONS EXECUTIVE COMPLIANCE DEPARTMENT BOARD COMPLIANCE FINANCE PAC Approving Entities: CEO COO CREDENTIALING DEPT. DIRECTOR/OFFICER

Approval Signature: Kevin Spencer Approval Date: 08/16/2017

I. RELATED POLICIES: N/A

II. IMPACTED DEPTS.: N/A

III. DEFINITIONS: A. Take off Pounds Sensibly (TOPS) - TOPS is a non-profit, non-commercial, non-sectarian weight loss program with participants who meet weekly to share tips on losing weight, to exchange recipes and to lend encouragement and support. Officers of TOPS are all volunteers.

IV. ATTACHMENTS: A. Website Summary

V. PURPOSE: To define the criteria and outline the enrollment process for the Take off Pounds Sensibly (TOPS) program.

VI. POLICY / PROCEDURE: A. Eligibility Criteria A.1. Available to eligible PHC members who would like to reduce the negative health consequences associated with obesity and are able to attend meetings.

B. TOPS Enrollment B.1. Eligible PHC members and\or member’s representative contact PHC’s Member Services Department to request enrollment into the TOPS program. B.2. The MSR confirms the member’s PHC eligibility and enters a “WL” remark code. B.3. A weekly report of all new “WL” remarks is forwarded to TOPS using “SECURE” email. B.4. The TOPS Program is available in English and limited Spanish.

VII. REFERENCES: N/A

VIII. DISTRIBUTION: A. SharePoint B. Provider Manual C. Website (Member Section - Summary)

IX. POSITION RESPONSIBLE FOR IMPLEMENTING PROCEDURE: Director of Member Services

Page 1 of 2 Policy/Procedure Number: MP 350 Lead Department: Member Services Policy/Procedure Title: Weight Management Program ☒External Policy ☐Internal Policy Original Date: 07/18/2007 Next Review Date: 08/16/2018 Last Review Date: 08/16/2017 Applies to: ☒ Medi-Cal ☐ Employees

X. REVISION DATES: Medi-Cal 10/17/07; 05/21/08; 01/2109; 06/25/09; 08/11/09; 02/01/10; 02/09/11; 08/09/11; 01/10/12; 05/05/13; 09/18/13; 03/18/14; 08/05/16; 09/13/16, 8/8/2017

Healthy Kids 10/17/07; 05/21/08; 01/2109; 06/25/09; 08/11/09; 02/01/10; 02/09/11; 08/09/11; 01/10/12; 05/05/13; 09/18/13; 03/18/14; 08/05/16; 09/13/16

PREVIOUSLY APPLIED TO: Partnership Advantage : MP 350 - 06/2006 to 01/01/2015

Page 2 of 2

Attachment A

TOPS (Take off Pounds Sensibly) TOPS (Take Off Pounds Sensibly), is a common sense approach to managing weight. TOPS also promotes maintaining good health. Enrolled members attend weekly meetings. They share tips on losing weight. They also exchange recipes. They encourage and support each other. The staff is all volunteers. The TOPS weight loss program is non-profit and non-commercial. This program is offered to all eligible PHC members. Are you ready to stop dieting and start making real life changes? Partnership HealthPlan of California will pay your membership for one year, if you qualify. Some TOPS locations charge a chapter fee (on average $5.00 per month). PHC does not pay chapter fees. To join TOPS or get more facts, call the Partnership HealthPlan of California Member Services Department at (800) 863-4155.