The California Department of Healthcare Services (DHCS) requires primary care providers (PCPs) to administer regular health assessments.
Initial Health Assessments (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. See the Initial Health Assessment Billing Code List for more information. For more detail on IHA requirements, see the DHCS MMCD Policy Letter No. 08-003 and DHCS MMCD Policy Letter 99-07.
There is no specific assessment tool for the IHA. However, the initial assessment must include the appropriate Staying Healthy Assessment for the member’s age group (see below).
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.
DHCS requires primary care providers to administer a Staying Healthy Assessment (SHA) on all Medi-Cal managed care members within 120 days of enrollment with the Alliance and again at defined age intervals.
For more information:
- DHCS Staying Healthy Assessment information.
- DHCS SHA Instruction Sheet for the Provider Office (includes SHA Periodicity Table).
- DHCS Staying Healthy Assessment questionnaires (including English, Spanish and Hmong versions). Use the Staying Healthy Assessment Fax-In Order Form to request printed SHA questionnaires free of charge.
For female members 24 years and younger, if sexual activity is identified in the SHA, the PCP should perform a routine screening for gonorrhea and chlamydia. For more information about this USPSTF grade B recommendation, see the USPSTF website.
Please note, the SHA does not replace a validated depression questionnaire such as the PHQ9 tool.
For members over 18, the SHA includes an alcohol screening question. If a member answers “yes” to the SHA alcohol screening question or if a PCP identifies a potential alcohol misuse problem, the PCP should perform expanded alcohol screening using the Alcohol Use Disorder Identification Test-Concise (AUDIT-C) or other validated alcohol screening.
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.
Both the expanded screening and the behavioral counseling intervention are covered by Medi-Cal. Each member is eligible for three screenings annually as well as additional screenings if considered medically necessary. Each member is also eligible for at least three brief intervention sessions per year.
For more information, see:
- Section 3 in the Provider Manual.
- US Preventative Services Task Force (USPTF) recommendations.
- DHCS All Plan Letter 18-014.
If you have questions about health assessments, contact Provider Services.