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The Comprehensive Perinatal Services Program
CPSP
Insert name of PSC
Insert date
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What is the CPSP?
•The CPSP provides enhanced perinatal services for Medi-Cal eligible women from the date of conception through the end of the second month after delivery
•The CPSP has been shown to improve birth outcomes
•Medi-Cal Managed Care plans are required to provide access to CPSP services for all Medi-Cal eligible enrollees
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Goals of the CPSP
Decrease and maintain the decreased level of perinatal, maternal and infant mortality and morbidity
Support methods of providing comprehensive prenatal care that prevent prematurity and the incidence of low birth weight infants
http://www.cdph.ca.gov/services/funding/mcah/Documents/MO-MCAH-MCAHPP-2012-13.pdf
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Why be a CPSP Provider?
•Better patient outcomes
•CPSP offers higher reimbursement
•More staffing flexibility
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Basic OB vs. CPSP Reimbursement
Service Basic OB CPSP
Initial Exam 126.31 126.31
Antepartum Exam 483.84 483.84
Delivery 544.72 544.72
Postpartum Exam 60.48 60.48
Early entry into care 0 56.63*
Vitamins 0 30.00
Case Coordination 0 85.34*
10th antepartum visit 0 113.26*
Support Services (max) 0 1077.20
Total potential payments (before TAR) $1215.35 $2577.78
* Not available to FQHCs
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CPSP Flow Sheet and Billing Summary
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CPSP Documentation Requirements and Forms
• Client Orientation• Initial Assessments• Individualized Care Plans• Reassessments (second, third trimester and
postpartum)• Referrals
All recommended forms are located here:
http://www.cdph.ca.gov/programs/CPSP/Pages/LHJPerinatalServicesCoordinatorInformation.aspx
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• Orientation
• Case Coordination
• OB
• Psychosocial
• Health Education
• Nutrition
• Perinatal Education individual groups
• Vitamin/mineral supplements
• Initial assessments• Trimester reassessments• Postpartum assessments• Intervention/follow-up
CPSP Services
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CPSP Model of Care
• Client centered• Strength-based• Multi-disciplinary• Site specific protocols• Culturally sensitive• Community referrals• Voluntary participation
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Who can Become a CPSP Provider?
Any of the following can become a CPSP provider, if they have an active National Provider Identifier (NPI) number and are an active Medi-Cal provider in good standing with Medi-Cal and their licensing board:– Physicians, including general practitioners, family practice
physicians, pediatricians, or obstetrician-gynecologists
– Certified Nurse Midwives (CNMs)
– Medical Groups
– Clinics
– PPOs
http://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/pregcom_m00o03.doc
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Who can Deliver CPSP Services?
All CPSP Providers and the following CPSP Practitioners may deliver CPSP services under the supervision of a physician and as permitted by their Scope of Practice, if licensed.
Registered Nurses Nurse Practitioners Physician Assistants Social Workers Health Educators Childbirth Educators Registered Dieticians Comprehensive Perinatal Health Workers (CPHW) who are at least
18 years old, have a High School Diploma, and have a minimum one year paid perinatal experience.
http://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/pregcom_m00o03.doc
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Models of CPSP Service Delivery
• Approved CPSP providers can be found in solo practice, group practice, health departments, hospitals, community clinics, managed care plans, Federally Qualified Health Center (FQHCs), Indian Health Services (IHS), Rural Health Clinics (RHCs), and residency programs
• In some cases, obstetrical services are provided in the provider’s office with other services provided elsewhere, under subcontract, or by a second CPSP provider
• Flexibility of program design and implementation allows for the use of a wide range of professional and paraprofessional personnel
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Protocols for CPSP Services & Supervision
22 CCR 51179.9 defines “Protocol” as "written procedures for providing psychosocial, nutrition, and health education services and related case coordination.”
22 CCR 51179.5 defines “Personal supervision” as "evaluation, in accordance with protocols, by a licensed physician, of services performed by others through direct communication, either in person or through electronic means.”http://www.cdph.ca.gov/services/funding/mcah/Documents/MO-MCAH-MCAHPP-2012-13.pdf
http://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/pregcom_m00o03.doc
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The CPSP Application Process
• Your CPSP Perinatal Services Coordinator (PSC) can assist you with your application
• The PSC will review the completed application and submit it to the California Department of Public Health (CDPH/MCAH) for final approval
• The application approval process may take up to 60 days from the date that CDPH/MCAH receives a completed application
• http://www.cdph.ca.gov/programs/CPSP/Pages/ApplicationforCertificationasaCPSPProvider.aspx
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How does the CPSP work in FQHCs & RHCs?
• TARs (Treatment Authorization Request) are not used in FQHCs or RHCs however, chart documentation for additional CPSP services must demonstrate the same justification necessary to obtain a TAR.
• FQHCs and RHCs should bill the MCMC plan first for services to MCMC clients and should contact the FI for information regarding any additional payments for which they may be eligible
• CPSP visits in these health care delivery settings are paid at a flat fee per visit, for on-site and off-site services, as defined in their prospective payment system
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Electronic Health Record (EHR)
• EHRs should facilitate the CPSP work flow in each provider office
• Each PSC and Provider should evaluate the content and functionality of the EHR system
• The PSC will review the EHR content using an approved set of CPSP forms as a guide to assure that required elements of State recommended prenatal and postpartum assessment, reassessment, and intervention are included
http://www.cdph.ca.gov/services/funding/mcah/Documents/MO-MCAH-MCAHPP-2012-13.pdf
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Resources:• CPSP Website
http://www.cdph.ca.gov/programs/CPSP/Pages/default.aspx
• Provider Handbook
http://www.cdph.ca.gov/programs/CPSP/Documents/MO-CPSP-ProviderHandbook.pdf
• Steps To Take
http://www.cdph.ca.gov/programs/CPSP/Documents/MO-CPSP-StepsToTake.pdf
• Medi-Cal Website
http://www.dhcs.ca.gov/Pages/default.aspx
• PSCs Directory
CPSP Perinatal Services Coordinators
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Honorable Edmund G. Brown Jr. Governor
State of California
2014California Department of Public Health
Maternal and Child Adolescent Health Program1615 Capitol Avenue, MS 8306
Sacramento, California 95899-7420
Diana DooleySecretary
California Health & Human
Services Agency
Ron Chapman, MD, MPH
DirectorCalifornia
Department Of Public Health
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Thank you!
Questions??