New CPSP Provider Application and Process
CPSP website for current program information, policies, procedures, forms, and templates.
How to become an approved CPSP provider:
Enroll in Medi-Cal as one of these CPSP-eligible Provider Types:
- Physician (MD/DO) specializing in obstetrics, pediatrics, family practice, or general medicine
- Physician Group with at least one member who specializes in one of the above specialties
- Certified Nurse Midwife (CNM)
- Certified Nurse Midwife Group
- Community Clinic
- County Clinic
- Hospital Outpatient Clinic
- Alternative Birth Center
Verify practitioner training, experience, and license information to ensure:
- Practitioners’ professional licenses, certificates, or registrations are valid and unexpired
- Practitioners’ training (school, degree, year of graduation) and years of experience comply with Title 22 Regulations
Develop templates for use in delivering CPSP services in alignment with CPSP protocols.
Identify local referral resources for these non-CPSP services:
- Women, Infants & Children (WIC for nutrition and breastfeeding services and supplies
- Child Health and Disability Prevention (CHDP) for child wellness services
- Family Planning, Access, Care and Treatment (Family PACT) For family planning services
- Genetic Disease Screening Program (GDSP) for newborn genetic screening services
- Medi-Cal Dental Program for dental services
Develop site specific CPSP protocols within six months of CPSP approval.
Complete a CPSP Provider Application (CDPH 4448) and, if applicable, an Additional CPSPPractitioners Form (CDPH 4448A).
- Download the current version of the forms from the CPSP website
- Complete the forms and digitally sign the 4448
- Submit the completed, signed CPSP Provider Application to CDPH/MCAH Division via email to
- For assistance with the CPSP application process email CDPH/MCAH Division at
- For assistance with implementing CPSP and for general program inquiries email CDPH/MCAHDivision at
- For assistance with Medi-Cal enrollment or to check status contact Provider Enrollment Division (PED) at (916) 323-1945.
- For assistance with Medi-Cal billing or to leave a message for your Regional Representative contact the Telephone Service Center (TSC) at (800) 541-5555.