Reminder: Initial Health Appointments (IHA)
| Date: | September 18, 2024 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) |
| To: | Health Plan Providers and Facilities |
| Type: | Informational/Educational |
| Subject: | Reminder: Initial Health Appointments (IHA) |
| Business: | Medi-Cal Managed Care |
The following alert is a reminder regarding Initial Health Appointments (IHA):
Health Plan members must be seen for an Initial Health Appointment (IHA) with their Primary Care Physician (PCP) within one hundred twenty (120) days of the date of Enrollment with Health Plan OR change of PCP.
For members less than 18 months of age, IHA must happen within 120 calendar days of enrollment with Health Plan or within periodicity timelines established by the American Academy of Pediatrics (AAP) Bright Futures for age 2 and younger, whichever is sooner.
To download a list of your members due for an IHA, login to the DRE Provider Portal.
An IHA must be provided in a way that is culturally and linguistically appropriate for the member and must be documented in the member’s medical record.
An IHA must include ALL the following at a minimum:
- A history of the member’s physical and mental health.
- An identification of risks.
- An assessment of need for preventive screens or services.
- Health education; and
- The diagnosis and plan for treatment of any diseases.
An IHA is not necessary if the PCP determines that the member’s medical record contains complete information that was updated within the previous 12 months.
For children and youth (i.e., individuals under age 21), Early and Periodic Screening, Diagnostic and Treatment (EPSDT) screenings will continue to be covered in accordance with the AAP/Bright Futures periodicity schedule.
The IHA must include age-appropriate childhood screenings, including but not limited to screenings for ACEs, developmental, depression, autism, vision, hearing, lead, and substance use disorder (SUD).
For Adults, PCPs should continue to provide all preventive screenings for adults as recommended by the United States Preventive Services Taskforce (USPSTF) but will no longer require all these elements to be completed during the initial appointment, so long as members receive all required screenings in a timely manner consistent with USPSTF guidelines.
AAP/Bright Futures Periodicity Guidelines: https://www.aap.org/en/practice-management/care-delivery-approaches/periodicity-schedule/
USPSTF Recommendations: https://www.uspreventiveservicestaskforce.org/uspstf/topic_search_results?topic_status=P
DHCS APL 22-030 Initial Health Appointment: https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2022/APL22-030.pdf
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website WWW.HPSJ-MVHP.ORG
