Health Assessments

Initial Health Appointments (IHAs) are comprehensive visits for newly enrolled Medi-Cal members. PCPs must complete an IHA for all newly linked members within 120 days of enrollment.

The Alliance requires PCPs to use specific IHA billing codes. Please read about IHA requirements in the DHCS All Plan Letter 22-030 and the Population Health Management (PHM) Policy Guide.

Providers may perform required screenings over multiple visits.

PCPs must offer referrals to WIC for all pregnant and breastfeeding members. Members may be eligible for WIC services if they are:

• Pregnant (services are available up to six months after the end of a pregnancy).
• Breastfeeding (services are available up to the infant’s first birthday).
• Infants and children (up to the child’s fifth birthday).

PCPs must provide the WIC agency with the information needed to facilitate a referral, including:

• The member’s name and contact information.
• Relevant medical information, including height, weight and a copy of the member’s most recent hemoglobin and hematocrit test results from within the last 12 months. Provide this information at each health assessment as appropriate.

For more information on referring members to WIC, see the California Department of Public Health (CDPH) WIC page for health care providers(opens in new tab).

Members will need to have at least one of the following risk assessments performed for the IHA and then subsequent assessments annually.
IHA required screenings and assessments

For pediatric patients

• Social Determinants of Health (SDOH) screening to assess housing instability, functioning, quality of life outcomes and risk, utility needs, interpersonal safety, etc.
  • Standardized screening tools for SDOH include: NACHC - PRAPARE, AAFP - Social Needs Screening Tool and AHC – HRSN Screening Tool.
• Adverse Childhood Experiences.
  • Standardized screening tools for adverse childhood experiences include: ACEs Aware - Pediatric ACEs and Related Life-Events Screener (PEARLS)
  • Health Risk Assessment.

For adult patients

• SDOH screening to assess housing instability, functioning, quality of life outcomes and risk, utility needs, interpersonal safety, etc.
  • Standardized screening tools for SDOH include: the NACHC – PRAPARE, AAFP - Social Needs Screening tool and AHC – HRSN Screening tool.
• Cognitive Health Assessment for ages 65+.
  • Standardized screening tools for this assessment include: the General Practitioner Assessment of Cognition (GPCOG), Mini-Cog and Eight-item Informant Interview to Differentiate Aging and Dementia.
• Adverse Childhood Experiences Screening.
  • Use the ACEs Aware - Adverse Childhood Experience Questionnaire for Adults.
  • Health Risk Assessment.

Members should be screened and counseled for risk of sexually transmitted infections. For members who are sexually active and screen positive for risk, the provider should order tests for HIV, hepatitis B and hepatitis C. Additionally, women should be tested for chlamydia and gonorrhea. Tests ordered should be based on the age, gender, pregnancy status and sexual history of the member. For more information about these U.S. Preventive Services Task Force (USPSTF) grade A and B recommendations, see the USPSTF website.

For adolescents, adults and pregnant members, a validated questionnaire to screen for depression, anxiety and suicide risk is required. Examples include:

• Beck Depression Inventory Fast Screen total score
• Beck Depression Inventory II total score [BDI] (Adult).
• Center for Epidemiologic Studies Depression Scale-Revised total score [CESD-R] (Pediatric).
• Edinburgh Postnatal Depression Scale [EPDS] (Pediatric and Adult).
• [DUKE-AD] (Adult).
• Geriatric Depression Scale (GDS) short version total (Adult).
• Geriatric Depression Scale (GDS) total (Adult).
• Patient Health Questionnaire 2 item (PHQ-2) total score [Reported] (Pediatric and Adult).
• Patient Health Questionnaire 9 item (PHQ-9) total score [Reported] (Pediatric and Adult).
• Patient Health Questionnaire-9: (PHQ 9-A) Modified for Teens total score (Pediatric).
• PROMIS-29 Depression score T-score (Pediatric and Adult).
• [CUDOS] (Adult).

• Ages and Stages Questionnaire (ASQ) (Pediatric).

Unhealthy alcohol and drug use screening should begin at age 11, including pregnant women, using validated screening tools such as:

• CRAFFT (Ages 12-21).
• CAGE-AID (Ages 16+).
• BSTAD (Ages 12-17).
• S2BI (Ages 12-17).
• TAPS (Ages 18+).
• AUDIT/AUDIT-C (Ages 18+).
• DAST-10 (Ages 18+).
• NIDA quick screen (Ages 18+).

If a PCP identifies a potential alcohol misuse problem, the PCP should perform an expanded validated screening, including but not limited to:

• NIDA NM-ASSIST.
• DAST-20.

If expanded screening indicates the member is at risk, the PCP must offer alcohol use brief behavioral counseling interventions or refer the member for further evaluation and treatment through the member’s county alcohol and drug program. For brief intervention resources, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website.

Documentation requirements

Providers must screen all eligible members annually and retain documentation of SABIRT services provided to members in the medical record. When a member transfers from one provider to another, the receiving provider must attempt to obtain the member’s prior medical records, including those pertaining to the provision of preventive services, including SABIRT services.

Member medical records must include the following:

• The service provided (e.g., screen and brief intervention).
• The name of the screening instrument and the score on the screening instrument.
• The name of the assessment instrument (when indicated) and the score on the assessment.
• If and where a referral to an AUD or SUD program was made.

Both the expanded screening and the behavioral counseling intervention are covered by Medi-Cal.

For more information, see:

• Section 3 in the Provider Manual.
• US Preventative Services Task Force (USPTF) recommendations.
• DHCS All Plan Letter 21-014.

If you have questions about health assessments, contact Provider Services.

• Pediatric Screening Tool
• Pediatric Vaccine Tools
• Well-Care Frequencies
• American Academy of Pediatrics Guidelines for Bright Futures
• California Management Guidelines: Childhood Lead Poisoning
• Standard of Care Guidelines: Childhood Lead Poisoning
• U.S. Preventive Services Task Force (USPSTF) Recommendations for Primary Care Practice

How to meet Initial Health Appointment requirements - Central California Alliance for Health (thealliance.health)