Initial health assessment
The Initial Health Assessment (IHA) is a Medi-Cal requirement for all new members to Santa Clara Family Health Plan (SCFHP). It is a comprehensive assessment completed during a new member's initial encounter(s) with a selected or assigned primary care provider. The IHA must be completed within 120 calendar days of enrollment into SCFHP and documented in the medical record.
New members are defined as not enrolled with SCFHP at any time within the last 12 months. New members can be identified through the SCFHP online eligibility look-up. Please contact SCFHP Provider Network Management if you need an account or need help accessing your account.
For more information about the IHA, refer to the provider manual.
- SCFHP website for the Staying Healthy Assessment Tool.
- Who can perform the IHA? When an advanced practitioner performs the IHA, the PCP must ensure that documentation of the IHA is contained in the member's primary medical record and completed in an accurate and comprehensive manner.
- Outreach: If you are attempting to schedule the IHA with a new member but are not having success or cannot reach the member to schedule it, make sure to document a minimum of two attempts to reach the member in the medical record. Credit can be given for the IHA in Facility Site Review Medical Record Review if it can be shown you made a reasonable attempt to schedule the member.
Frequently asked questions
Components of an IHA
Regardless of age, an IHA must have the following components:
Comprehensive history, including:
- History of present illness.
- Past medical history.
- Social history.
- Review of organ system.
Administration of preventive services, including:
- Asymptomatic healthy adults
- Members under 21 years of age
- Provide preventive services specified by the most recent American Academy of Pediatrics/Bright Futures age-specific guidelines and periodicity schedule.
- Perinatal services
- Provide services according to the most current standards of the American College of Obstetrics and Gynecology.
Comprehensive physical and mental status exam
Sufficient to assess and diagnose acute and chronic conditions.
Diagnosis and plan of care
Includes all follow-up activities, including return visit documentation or "PRN" if no specific interval required.
Staying Health Assessment questionnaire
The questionnaire is available in nine languages. It is available for download on the California Department of Health Care Services website.
Staying Healthy Assessment (SHA)
An age-specific SHA must be administered as part of the IHA.
The SHA requirement for members transferring from an outside group may be met if the medical record indicates that an SHA tool or a behavioral risk assessment has been completed within the last 12 months, but it must be included in the current medical record to receive credit for site review medical record review.
Using the California Department of Health Care Services (DHCS) SHA form satisfies this requirement. Forms can be found at the following web pages (available in multiple languages):
Coding guide to IHA
SCFHP uses this set of codes to identify when an IHA was conducted: IHA Technical Specifications. Please ensure your claims submissions contain the appropriate codes for identifying IHA.
SCFHP conducts an annual evaluation of IHAs completed the previous year through medical record review. Findings are used for quality improvement and education.