Initial Health Assessment Training

What is an Initial Health Assessment?

An Initial Health Assessment (IHA) is a comprehensive assessment completed during a patient’s initial encounter(s) with his or her PCP. California Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS) require that all newly enrolled HPSM members receive an IHA within 120 days of becoming a member.

Are providers required to participate?

DHCS expects 100% participation from all providers. Health Plan of San Mateo requires its contracted providers to schedule an IHA visit with all new members on your panel list. This office visits helps:

  • Establish care with your patient
  • Understand the patient’s medical history
  • Assess for any specific needs

If you are unable to reach the member, you must document your contact attempts in the member’s medical record.

What are the components of an IHA?

The IHA consists of a comprehensive history, physical and mental status exam. In addition, where age appropriate, a developmental exam, diagnosis and plan of care, preventive services and the Staying Healthy Assessment (SHA) are also required. A SHA is a standardized form used by all managed care plans to streamline the Individual Health Education Behavioral Assessment (IHEBA).

The SHA forms are available in English, Spanish, Chinese, Tagalog, Russian, Arabic, Armenian, Farsi, Hmong, Khmer, Korean, Somali and Vietnamese.

The Staying Healthy Assessment assists PCPs in:

  • Identifying and tracking individual health risks and behaviors
  • Targeting health education counseling interventions
  • Providing referral and follow-up

You are required to make the SHA a permanent part of the member's medical record and must refer to it annually. When potentially high risk health behaviors are identified, PCPs are expected to ask appropriate follow-up assessment questions to identify patient’s health education needs and facilitate focused educational counseling that addresses health behavior changes.

Where do I find my panel list?

  • A case management list is updated at the beginning of each month with all current and new members added onto your panel. You can view your panel and download your case management list by logging into eReports using the name and password provided.
  • New members are identified on the top of your case management list with an asterisk.*
  • If you are having trouble accessing your panel, please call Provider Services at 650-616-2106 or email psinquiries@hpsm.org.

IHA Incentive

  • The IHA incentive is only available to providers who treat new Medi-Cal and Healthy Kids members who have not had an IHA from another PCP within the last year.
  • HPSM reimburses a flat amount (currently $90) to providers who render the IHA within the first 120 days of a member becoming eligible for HPSM.
  • HPSM may not be able to notify you that you have a new member and verify the member’s eligibility until 30 days after they have become eligible with HPSM. In that case, you would have 90 days after the member has been added onto your eReport panel list to complete the IHA visit and SHA.

How to get the incentive

To receive the incentive, bill using procedure (CPT) codes based on the member’s age. Preventive care visits are not separately reimbursable for HPSM Medi-Cal PCPs. Subsequent preventive medical office visits for Medi-Cal members, including review and updating of the SHA, are an expected part of clinical care that a primary care provider renders.

Age (Years)CPT Code
< 199381
1–499382
5–1199383
12–1799384
18–3999385
40–6499386
65 and older99387