Initial Health Appointment (IHA)
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Governs how CenCal Health network Primary Care Providers assess and manage the acute, chronic, preventive, developmental, and behavioral health needs of newly enrolled Members through an Initial Health Appointment.
No material clinical or coverage changes in this revision.
Initial Health Appointment Requirements
Initial Health Appointment criteria and required components
An Initial Health Appointment (IHA) is required for newly enrolled Members unless the PCP determines it is unnecessary based on complete, current medical-record information. The IHA must be completed within the applicable timeframe and include all required assessments, screenings, education, treatment planning, communication, and documentation.
IHA requirement or medical-record exception
ALL of the following
Member eligibility
- Member is newly enrolled with CenCal Health
Timing
- IHA is completed within 120 calendar days of enrollment
- For Members under 18 months, the IHA is provided within 120 calendar days after enrollment or within the applicable AAP Bright Futures periodicity timeline for ages two and younger, whichever is sooner
Required services and assessment
- Documentation includes a history of the Member's physical and mental health
- Risks are identified and assessed
- The need for preventive screens or services is assessed
- Health education is provided
- Diseases are diagnosed and a plan for treatment is established
- The PCP provides, or arranges for provision of, all immunizations necessary to ensure the Member is up to date for their age
- Adverse Childhood Experiences (ACEs) screening is provided
- Required age-specific screenings, including developmental screenings, are provided
Communication and documentation
- The IHA is provided in a culturally and linguistically appropriate manner for the Member
- IHA information is documented in the Member's medical record
- If services are refused, the medical record documents that the services were advised and voluntarily refused by the Member if an emancipated minor, or by the Member's parent or guardian
IHA not necessary
- The PCP determines that an IHA is not necessary because the Member's medical record contains complete information updated within the previous 12 months
EPSDT screening coverage
EPSDT screenings are covered when both eligibility and periodicity requirements are met.
EPSDT coverage
- Member is under age 21
- Screening is provided in accordance with the American Academy of Pediatrics (AAP)/Bright Futures periodicity schedule
Timing and Eligibility Parameters
PCP Responsibilities and Follow-Up
Complete the IHA on Time
PCPs in CenCal Health’s Provider network must complete an Initial Health Appointment (IHA) for each new Member within the required timeframe.
- Members younger than 18 months: complete the IHA within 120 calendar days of enrollment or within the American Academy of Pediatrics (AAP) Bright Futures periodicity timeline for children age two and younger, whichever is sooner.
- Members ages 18 months and older: complete the IHA within 120 calendar days of enrollment.
- For Members under age 21, provide Early and Periodic Screening, Diagnostic and Treatment (EPSDT) screenings according to the AAP/Bright Futures periodicity schedule.
Conduct and Complete the IHA
Conduct the IHA in the primary care medical setting and provide or arrange all required age-appropriate services in a culturally and linguistically appropriate manner.
- Provide or arrange immunizations needed to bring the Member up to date for age.
- Complete Adverse Childhood Experiences (ACEs) screening and required age-specific screenings, including developmental screenings.
- The IHA documentation must address the Member’s physical and mental health history, identified risks, preventive screening or service needs, health education, and diagnoses and treatment plans.
Document the Appointment and Refusals
Document the IHA information and all advised services in the Member’s medical record. If services are refused, record the voluntary refusal and identify the person refusing them.
- For an emancipated minor, document the Member’s voluntary refusal.
- For a non-emancipated minor, document the parent’s or guardian’s voluntary refusal.
- Document the services that were advised, including any applicable screenings, immunizations, and risk assessments.
Coordinate Follow-Up When Requirements Are Unmet
When IHA requirements are not met, CenCal Health case management and Care Coordination work directly with the Member to obtain appropriate services.
- Follow-up services may include health screenings, immunizations, risk assessments, and other appropriate care.
Use the Medical-Record Exception
The Member’s PCP may determine that an IHA is unnecessary when the Member’s medical record contains complete information updated within the previous 12 months.
- Apply this exception only when the record is complete and the information was updated within the prior 12 months.
Policy Terms
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