Provider Alerts

REMINDER: Initial Health Appointments (IHA)

Health Plan members must be seen for an Initial Health Appointment (IHA) with their Primary Care Physician (PCP) within one hundred twenty (120) days of the date of Enrollment with the health plan, OR a change of PCP.

For members less than 18 months of age, IHA must occur within 120 calendar days of enrollment with the health plan or within the periodicity timelines established by the American Academy of Pediatrics (AAP) Bright Futures for ages 2 and younger, whichever is sooner.

To download a list of your members due for an IHA, log in to the DRE Provider Portal.

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 the following at a minimum:

• A history of the member’s physical and mental health;
• An identification of risks;
• An assessment of the need for preventive screens or services;
• Health education; and
• The diagnosis and plan for the 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 as recommended by the United States Preventive Services Taskforce (USPSTF). However, they will no longer require all these elements to be completed during the initial appointment, as long as members receive all required screenings in a timely manner consistent with USPSTF guidelines.

AAP/Bright Futures Periodicity Guidelines: https://www.aap.org/en/practice-management/care-delivery-approaches/periodicity-schedule/

USPSTF Recommendations: https://www.uspreventiveservicestaskforce.org/uspstf/topic_search_results?topic_status=P

DHCS APL 22-030 Initial Health Appointment: https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2022/APL22-030.pdf

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. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org