LA Care: For Providers

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Initial Health Assessments

Make New Member Initial Health Assessments a Priority at Your Practice

The first responsibility that you have to new L.A. Care patients is a first check-up as soon as possible after the member enrolls in the health plan. Called an "initial health assessment," this visit is key to early identification of health problems, treatment, and establishing a strong relationship between the doctor and the new patient.

But for members who are new to managed care or are unfamiliar with the importance of preventive care, initial health assessments don't always occur.

Initial Health Assessment Forms

The Initial Health Assessment must be perfomed using the age appropriate DHS-approved assessment tools. DHS has standardized assessment tools to be administered during office visits, reviewed at least annually and re-administered by the doctor at the appropriate age intervals.

Click on this sentence to access the Inital Health Assessment Forms.

What qualifies as an initial health assessment visit?

A scheduled office visit for a complete history and physical examination
An office visit for a specific problem is an opportunity to start an initial health assessment with documentation. Subsequent scheduled appointments must be completed within the 60 or 120 day timeframe.

The initial health assessment must consist of a history and physical examination with an individual health education behavioral assessment that enables a PCP to comprehensively assess the member's current acute, chronic and preventive health needs.

What does not qualify as an initial health assessment visit?

An office visit for a specific problem without documentation of starting an initial health assessment with subsequent scheduled appointments for completion within the 60 or 120 day timeframe.
Urgent care or an emergency visit.

When a member is able to manage a specific medical problem, the doctor may want to take advantage of these episodic visits to perform all or parts of the initial health assessment.

What are a Doctor's responsibilities regarding initial health assessments?

Schedule every new member for the initial health assessment within the identified timeframe.
Provide adequate documentation of the assessments, including the health education behavioral assessment, follow-up care, any exemptions from the initial health assessment and coordination of care in the medical records.
Provide documentation of all attempts to schedule an initial health assessment, including the follow-up or missed and broken appointments, and periodic preventive screenings.

Follow-Up Care

For follow-up care identified at the time of the initial health assessment, appropriate diagnostic and treatment services are required to be initiated as soon as possible but no later than 60 calendar days following either a preventive screening or other visits that identify a need for follow-up care.

For members identified with complex or chronic conditions prior to enrollment or upon completion of the initial health assessment, the doctor is responsible for adequately documenting appropriate referrals made to linked and carved-out service programs, including CCS, Department of Mental Health, Regional Centers, EPSDT Supplemental Services as well as basic care management/care coordination efforts.

Mandated Timeframes

Initial health assessments are age dependent and are required to be provided within mandated timeframes as follows:

For children under the age of 18 months: within 60 calendar days following enrollment, or within the timelines established by theAmerican Academy of Pediatrics (www.aap.org) for ages two and younger, whichever is less.

For children 18 months and older: within 120 calendar days of enrollment. The assessment must include the elements of the California Child Health and Disability Prevention (CHDP) Program (www.dhs.ca.gov/pcfh/cms/chdp); arrange for immunizations necessary to ensure that a child is up-to-date for their age; and include an age appropriate health education behavioral assessment.

For adults over the age of 21: within 120 calendar days of enrollment, and should include an initial complete history and physical examination as well as a health education behavioral risk assessment. For asymptomatic adults the assessment must include, at a minimum, the core preventive services as established in the latest edition of the Guide to Clinical Preventive Services by the U.S. Preventive Services Task Force (www.ahrq.gov).

If you would like more information on this topic, please feel free to contact your contracted L.A. Care Medi-Cal Managed Care Health Plan.