Initial Health Appointment (IHA) Tip Sheet

The IHA must be completed within 120 days of enrollment in a primary care setting and a culturally and linguistically appropriate manner for the member and can be completed over multiple visits and include:

• Complete or detailed initial physical and mental health history
• Identification of risks
• Age-appropriate assessment for preventive screens or services (see below FAQ for quality measures)
• Health education
• Diagnoses and plan for treatment of any diseases and/or abnormal lab results/assessment findings 

All components of the IHA must be documented in the member’s medical record. Additionally, 

Refusal: A member or member’s parent(s) may refuse the IHA appointment. In this case, documentation of the refusal should be in the member’s medical record along with any attempts to schedule the IHA. 

Missed Appointment: Should a member miss a scheduled appointment, two additional attempts must be made to reschedule the appointment and documentation must be documented in the member’s medical record. 

Attempts to Schedule: Providers must make and document three documented unsuccessful scheduling attempts to be in compliance with the IHA requirement. 

Each month you will receive an IHA compliance report/scorecard through the Provider Portal. This will include a detailed outreach tab of members assigned to you that are due for an IHA or overdue. The report also includes a list of top five and bottom five providers within the PPG who are the most compliant and least compliant for the IHA. Recommended process is:

• Assign a person (e.g. office manager) to review the outreach list provided.
• Contact members at least three times and document all outreach attempts (at least one mail and one phone)
• Explain to your patients why the IHA is important for establishing a relationship with their provider, for your provider to complete a comprehensive physical and mental health exam and getting necessary preventive health screenings and developing a plan of care for any diagnoses and explain that the cost of the visit is completely free to them. 

L.A. Care offers an Initial Health Appointment (IHA) Training as a self-paced eLearning training in L.A. Care University. More information on training is available at: https://lacare.org/providers/training 

Please reach out to your Account Manager with any questions or IHA@lacare.org for any IHA questions. 

L.A. Care does not require providers to regularly submit documentation of each IHA completed. However, if the Corporate Compliance Monitoring team reaches out to you during quarterly monitoring, annual audit or DHCS’ audit to provide files for proof of IHA completion, outreach or member refusals please complete this outreach in a timely manner. 

Incentive: 

Providers can receive an incentive for completing their assigned members’ IHA through the Pay For Performance Program (P4P). 

Each month, L.A. Care provides a list of newly enrolled members due for an IHA to the members’ respective Primary Care Providers (PCPs) and a list of all members due or over-due for an IHA. While all new members are encouraged to schedule their IHA when they join the Plan, PCPs must contact members to schedule the IHA. IHAs must be completed within the timeframes required by the State and L.A. Care. The PCP ensures an IHA is performed within 120 days of enrollment. The IHA can be completed in one or multiple visits. The member’s PCP does not need to complete the IHA if the member’s medical record contains complete IHA information updated within the previous 12 months.

A provider must complete the IHA within the primary care medical setting. That could be the member’s PCP, but it also could be one of the following:

• General Practitioner
• Board Certified Specialists who provide primary care services such as:
  • Internal Medicine
  • Pediatrics
  • OB/GYN
  • Family Practice
• Perinatal Care Providers
• Non-physician mid-level practitioners
  • Nurse Practitioners
  • Certified Nurse Midwives
  • Physician Assistants 

One or more components of the IHA can be completed via telehealth. However, not all components may be achieved via telehealth. 

Yes.

• If the member’s PCP determines that all of the components of the IHA are complete in the member’s medical record within the previous 12 months, that meets the requirements
• The member disenrolled before IHA could be performed
• The member or appropriate delegate, e.g., Parent/guardian refuses an IHA, and this is documented in the member’s medical record
• The member does not schedule an IHA or show up to a planned IHA, and the provider makes reasonable attempts to outreach to the member and documents in the member’s medical record 

Per Department of Health Care Services (DHCS) requirements, APL 22-030, the IHA must be provided in a primary care settings in a manner culturally and linguistically appropriate for the member, using a validated assessment and include: 

1. Comprehensive physical and mental health history
2. Identification of risks
3. Assessment for preventive screens or services (e.g., immunization records, laboratory testing such as blood lead screening for applicable members)
4. Health education
5. Diagnoses and Plan of Treatment for any diseases 

Note: The following Managed Care Accountability Set (MCAS) Quality Measures when addressed and documented also serve to complete an IHA:

• Depression screening and follow-up for adolescents and adults
• Child and adolescent well care visits
• Childhood immunization status combination 10
• Developmental screening in the first three years of life
• Immunizations for adolescents-combination 2
• Lead screening in children
• Topical fluoride for children
• Well-child visits in the first 30 months of life -0 to 15 months – Six or more
• Well-child visits in the first 30 months of life-15 to 30 months –Two or more
• Chlamydia screening in women
• Breast cancer screening
• Cervical cancer screening
• Adults’ access to preventive/ambulatory health services

Not currently. However, providers must document the IHA components within the member’s medical record. They are encouraged to submit the appropriate encounter and ICD-10 and CPT codes for any screening or treatment provided to capture the IHA. In addition, providers will be required to provide evidence when requested for monitoring or auditing to prove completion of IHA components in a file review or proof of exclusions met through documented outreach, etc. Please share the enclosed code sheet with office staff involved with claim or encounter submission. Telehealth codes may be used as well, where appropriate. 

CPT codes are available for assessing health/nutrition (96156), psychosocial status (96152), and individual or group counseling. Please use these in addition to regular Evaluation and Management (E&M) codes. The enclosed table outlines descriptions and codes for each specific purpose and age group.

For questions about IHAs contact IHA@lacare.org

For more information on the Health Education programs available through L.A. Care, please call the L.A. Care’s Health Education & Cultural and Linguistic Department at (855) 856-6943 or email to healthed_info_mailbox@lacare.org.