The Initial Health Appointment (IHA) is a comprehensive care visit that must be completed within the first 120 days of member enrollment. Despite being required and closely monitored by DHCS, IHAs are often not completed.
Please review the guide below to ensure your office is meeting IHA guidelines and recently updated risk assessment requirements and assessment types.
What requirements do IHAs need to meet?
During the IHA, providers assess and manage a new member’s acute, chronic and preventative health needs. Documentation of IHA completion or documentation of a member receiving the IHA within 12 months prior to eligibility is required. Providers are required to document all IHA components in the patient’s medical record. These visits are subject to audit. IHAs include the following:
| IHA component | Description (if applicable) |
| Comprehensive health history | History of present illness, past medical history, social history and review of organ systems. |
| Member risk assessment (include at least one of the listed risk assessment domains)
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| Physical exam | |
| Mental status exam and behavioral assessment (examples include depression, anxiety, drug and alcohol screenings) | Example tools: Patient Health Questionnaire (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS), Drug Abuse Screening Test (DAST-10), Alcohol Use Disorders Identification Test (AUDIT-C) |
| Dental assessment | A review of the organ systems that includes documentation of “inspection of the mouth” or “seeing dentist.” |
| Preventative screenings | Examples: breast cancer, cervical cancer, colorectal cancer, diabetic, cardiovascular disease including high blood pressure and STD screenings. |
| Health education and anticipatory guidance | Examples: Safety, obesity, tobacco use, immunizations. |
| Diagnoses and a plan of care |
For new members under the age of 21, follow the anticipatory guidance covered in accordance with the American Academy of Pediatrics (AAP)/Bright Futures periodicity schedule: https://downloads.aap.org/AAP/PDF/periodicity_schedule.pdf.
How are IHAs billed?
When billing for IHAs, PCPs should use the appropriate CPT codes. See the Alliance’s Initial Health Appointment Tip Sheet for a list of coding requirements: thealliance.health/initial-health-appointment-tip-sheet.
IHA resources
- Pediatric Screening Tool
- Pediatric Vaccine Tools
- APL 22-030 – Initial Health Appointment
- CalAIM Population Health Management Policy Guide
- ACEs Aware Website
