Initial Health Appointments
| Date: | February 14, 2023 |
| To: | Health Plan of San Joaquin (HPSJ) Contracted Providers and Facilities |
| From: | HPSJ |
| Type: | Informational |
| Subject: | Initial Health Appointments |
| Business: | Medi-Cal Managed Care |
INITIAL HEALTH APPOINTMENTS
The Department of Health Care Services (DHCS) issued and update to the Initial Health Appointment (IHA) addressed in All Plan Letter (APL) 22-030 located on this link https://www.dhcs.ca.gov/formsandpubs/Pages/AllPlanLetters.aspx. A summary of this update has been provided below.
Within one hundred twenty (120) days of the date of Enrollment or change of Primary Care Physician (PCP), the practitioner /provider must perform an Initial Health Appointment (IHA) for all Members.
For members less than 18 months of age, IHA must happen within 120 calendar days of enrollment or within periodicity timelines established by the American Academy of Pediatrics (AAP) Bright Futures for age 2 and younger, whichever is sooner. The Staying Healthy Assessment (SHA), also known as the Individual Health Education Behavioral Assessment (IHEBA) tool is no longer required for Medi-Cal members. The primary care visits will be considered as a proxy for the IHA.
An Initial Health Appointment (IHA) must be provided in a way that is culturally and linguistically appropriate for the Member and must be documented in the Member’s medical record.
An IHA must include ALL of the following:
- A history of the Member’s physical and mental health.
- An identification of risks.
- An assessment of need for preventive screens or services.
- Health education; and
- The diagnosis and plan for treatment of any diseases.
An IHA is not necessary if the PCP determines that the Member’s medical record contains complete information that was updated within the previous 12 months.
For children and youth (i.e., individuals under age 21), Early and Periodic Screening, Diagnostic and Treatment (EPSDT) screenings will continue to be covered in accordance with the AAP/Bright Futures periodicity schedule. The IHA must include age- appropriate childhood screenings, including but not limited to screenings for ACEs, developmental, depression, autism, vision, hearing, lead, and substance use disorder (SUD).
For Adults, PCPs should continue to provide all preventive screenings for adults and children as recommended by the United States Preventive Services Taskforce (USPSTF) but will no longer require all of these elements to be completed during the initial appointment, so long as members receive all required screenings in a timely manner consistent with USPSTF guidelines.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared.