20-299 Complete the IHA within 120 Days to Help Manage Your Patients Health Care Needs
Use the assessment for new Medi-Cal patients
An Initial Health Assessment (IHA) must be completed for all newly enrolled California Health & Wellness Plan (CHWP) members, including those with disabilities. It can be conducted by a primary care physician (PCP), nurse practitioner, certified nurse midwife, or physician assistant.
The IHA, at a minimum, must include:
- Physical, social or mental health histories.
- Preventive care services.
- Physical examination.
- Completion of the age-appropriate Staying Healthy Assessment (SHA) form or Department of Health Care Services (DHCS) approved alternative Individual Health Education Behavioral Assessment (IHEBA).
Follow these IHA guidelines
Please follow these requirements for completing the IHA, in accordance with DHCS Policy Letters 08-003 and 13-001.
IHA requirements for Medi-Cal patients
Follow the Bright Futures/American Academy of Pediatrics (AAP) Recommendations for Preventive Pediatric Health Care, also known as the Periodicity Schedule, for all new pediatric members for wellness examinations. These are available online.
For members under age 18 months, providers should follow the AAP periodicity schedule for ages two and younger, whichever is less.
The AAP periodicity schedule includes age specific assessments and services required by the Child Health and Disability Prevention (CHDP) Program. When exams occur more frequently using the AAP periodicity schedule rather than the CHDP exam schedule, the IHA must follow the AAP exam schedule and the scheduled assessments must include all content required by the CHDP for the lower age nearest to the current age of the child. Refer to the Child Health and Disability Prevention (CHDP) Program in the provider operations manual for more information on preventive services for members under the age of 21.
21 and older
Follow DHCS guidelines and CHWP preventive care services guidelines.
The U.S. Preventive Services Task Force (USPSTF) A and B Recommendations are considered the minimum acceptable standards for adult preventive care services. These are online.
Use the SHA to assess acute, chronic and preventive health needs
An age-appropriate SHA can help:
- Identify high-risk behaviors of individual members.
- Assign priority to individual health education needs of members related to lifestyle, behavior, environment, culture, and language.
- Begin discussions and counseling regarding high-risk behaviors.
- Provide tailored health education counseling, interventions, referrals, and follow-up care for members.
- Conduct the age-appropriate SHA to new and existing members as part of the 120-day IHA. Remember to:
- Administer the SHA when members enter a new age group.
- Check with members on an annual basis to determine any changes and provide needed health education counseling, intervention, referral, and follow-up.
- Sign, date and document topics discussed and assistance provided, and keep the SHA as part of the patient’s medical record.
Find the SHA online or by calling Health Education
The SHA form is available in English and other languages. An instruction sheet for the SHA is also online (PDF).
To request approval to use an electronic version of the SHA or to request copies, contact the Health Education Department at 1-800-804-6074.
You must document all exceptions for not completing the IHA in the member’s medical record. Record all notes on member contacts, outreach attempts, appointment scheduling, or the member’s refusal to schedule an appointment or receive care.
Exceptions for completing the IHA timely include:
- All IHA elements were completed within 12 months prior to the effective date of enrollment.
- Missed scheduled appointments with evidence of:
- Two additional attempts to reschedule via mail or by telephone,
- Provider attempts to update members contact information, and
- Provider attempts to perform the IHA past the 120-day requirement until the IHA is completed.
Evidence of timely completion of the IHA and SHA is determined during periodic facility site and medical record review audits.
Identify members who need an IHA with online reports
Providers can access new member reports online. Additionally, plan providers can obtain monthly patient eligibility lists online to help with completing the IHA requirements. Providers need to register and log in to the secure web portal, then select Patients to access and download the lists.
Use correct claim codes to bill the IHA
Use the below billing codes for IHA:
99202–99205, 99211–99215, 99381–99387, 99391–99397, 99461, G0438, G0439
Staying Healthy Assessment
Outreach activities help remind members to make appointments with you
CHWP conducts these IHA outreach activities to remind members to schedule appointments with their PCPs.
- Welcome packet – Includes an IHA notification, an identification (ID) card, appropriate provider directory, and information on how to schedule an appointment with their PCP. The IHA notification instructs new members to schedule an appointment with their PCP and provides education and contact information.
- Welcome telephone call – After the new member packet has been sent, automated recorded calls are made to welcome members to the plan. The call is to remind members to have their IHA completed within 120 days of enrollment. The Member Services telephone number is provided for questions or help.
- Reminder mailing – Sent to new members prior to 120 days of enrollment.
Providers are encouraged to access CHWP’s provider portal online for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CHWP at 1-877-658-0305.