CenCal Health’s Medical Record Review (MRR) program evaluates documentation for Initial Health Assessments (IHAs) and Wellness Visits to help ensure members receive timely, comprehensive preventive care. Reviews are guided by evidence-based recommendations from organizations including the U.S. Preventive Services Task Force (USPSTF), the American Academy of Pediatrics (AAP)/Bright Futures, and the American College of Obstetricians and Gynecologists (ACOG).
Following these standards supports early detection, care coordination, and improved health outcomes throughout our community. We appreciate the ongoing partnership and commitment of our provider network in advancing this important work.
Primary Care Provider Responsibilities
Primary Care Providers (PCPs) are essential to ensuring members receive preventive care according to recommended timelines.
PCP responsibilities include:
- Scheduling an Initial Health Assessment (IHA) for each new member within 120 days of enrollment or according to age-appropriate preventive care guidelines, whichever is sooner.
- Scheduling Wellness Visits based on the member’s age, health status, and identified risk factors.
- Assessing and documenting preventive service needs, providing appropriate diagnostic or follow-up care within 60 days, and documenting services offered, including those declined by the member.
- Submitting requested medical records in a timely manner when record requests are received.
Focus on Lead Exposure
Protecting children from lead exposure is crucial for lifelong good health. Even low levels of lead in the blood can negatively affect learning, attention, and academic performance.
Lead Screening
- Universal blood lead testing is required at 12 months and 24 months.
- All pediatric Medi-Cal members are considered high risk under federal Medicaid/EPSDT policy.
- Additional testing is required after age 2 if:
- There is no prior documented test (catch-up requirement 24-72 months).
- New or increased risk factors are identified.
- Previous result was elevated and requires follow-up.
- There is clinical concern based on symptoms or exposure history.
Lead Risk Assessment
- Risk assessment is required at each periodic health assessment between 6 months and 72 months.
- It is used to:
- Identify new or ongoing exposures (e.g., older housing, renovation, environmental/household changes).
- Determine if additional testing is clinically indicated.
Anticipatory Guidance
- Anticipatory guidance is required at every periodic health assessment between 6 months and 72 months.
- Provide oral or written information informing parents that children can be harmed by lead exposure and lead testing recommendations.
- Common sources: deteriorating paint and household dust.
- Highest risk from crawling through early childhood.
Key takeaway: Lead risk assessments and anticipatory guidance are required at every periodic health assessment from 6 through 72 months of age; however, they do not replace the required blood lead tests at 12 and 24 months. After age 2, testing becomes more targeted based on the child’s risk factors, history, and clinical judgment. All lead screening activities, including risk assessment and anticipatory guidance, must be clearly documented in the medical record.
Further Information
For detailed information on lead guidelines and best practices, please visit: www.cencalhealth.org/providers/care-guidelines/medi-cal-for-kids-teens-services/lead-testing/.
For questions about CenCal Health’s Medical Record Review process, please contact the Clinical Quality team at: [email protected].
Additional Resources and Tools
To find members who are due for an IHA, navigate to the Coordination of Care section in the CenCal Health Provider Portal and select the “Assignment” tab. To locate patients who need lead testing, refer to the Lead Testing Opportunity Report available in the Provider Portal.