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.

As part of the IHA, the PCP should assess the member for referral to the WIC program.

• Document test results, height, weight and the referral to WIC in the member’s medical record at initial referral and at each subsequent health assessment.
• For more information on referring members to WIC, see the California Department of Public Health (CDPH) WIC page for health care providers.

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

• Health Risk Assessment.
• 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)

For adult patients

• Health Risk Assessment.
• 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.
  • Standardized screening tool for this assessment include: ACEs Aware - Adverse Childhood Experience Questionnaire for Adults.

If sexual activity is identified in female members who are at risk for infection, the PCP should perform a routine screening for gonorrhea and chlamydia. For more information about this USPSTF grade B recommendation, see the USPSTF website.

A validated questionnaire to screen for depression and anxiety such as the PHQ9, BDI, GDS, GAD or EPDS tool is required.

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

• AUDIT / AUDIT-C.
• DAST / DAST-10.
• NIDA quick screen.
• CAGE-AID.
• CRAFFT. 

If a PCP identifies a potential alcohol misuse problem, the PCP should perform an expanded validated screening, such as:

• 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
• 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)