CPSP Provider Application/Participation
Enrollment Requirements:
- Applicant's site must be actively enrolled in Medi-Cal under an organizational National Provider Identifier (NPI) and be a CPSP-eligible provider type.
- Applicants must have an approved CPSP Provider Application on file with CDPH/MCAH.
Licensed midwives may enroll in Medi-Cal as direct/billing providers and apply as a Comprehensive Perinatal Services Program provider.
The California Department of Public Health (CDPH)/Maternal, Child, and Adolescent Health (MCAH) Division will accept applications from licensed midwives (LMs) to enroll as Comprehensive Perinatal Services Program (CPSP) provider. To apply for CPSP approval, download and complete a
CPSP Provider Application (CDPH 4448) (PDF) and submit the signed form to CDPH/MCAH at
General program inquiries . The CDPH/MCAH CPSP website has additional information and resources for CPSP providers. Request for technical assistance can be submitted to
General program inquiries
.
Before submitting the CDPH/MCAH CPSP application, LMs must enroll in the Medi-Cal program. Medi-Cal enrollment is a prerequisite for LMs to seek reimbursement for CPSP services delivered to Medi-Cal beneficiaries. LMs may request reimbursement for CPSP services through the Medi-Cal Program after receiving approval from CDPH/MCAH. Please refer to the Department Health Care Services (DHCS) billing provider manual for billing guidance and further information related to CPSP services at
Pregnancy: Comprehensive Perinatal Services Program (CPSP) (preg com) (PDF) ; Non-Physician Medical Practitioners (NMP) (non ph) (PDF) .
Eligible CPSP Provider Types:
- Physician specializing in obstetrics and gynecology, pediatrics, family medicine, or general medicine
- Physician group
- Certified nurse midwife (CNM)
- Licensed midwife (LM)
- Hospital outpatient clinic
- Community clinic
- County clinic
- Alternative birth center
To apply for CPSP approval:
- Download the current version of the CPSP Provider Application (CDPH 4448) and Additional CPSP Practitioners Form (CDPH 4448A), if applicable, from the CPSP website.
- Complete and submit forms CDPH 4448 and CDPH 4448A to CDPH/MCAH Division to
CPSP general inquiriers .
- Newly approved CPSP providers are advised to download the CPSP protocols, assessments, and individual care plan (ICP) templates listed below. The assessment/ICP templates are for the staff's use when delivering CPSP services. The protocol template and assessment/ICP templates are designed to be utilized together.
- Submit customized, site-specific CPSP protocols to
General program inquiries
within six months of application approval.
Changes to approved CPSP Protocols must be documented and filed and kept in the provider's office for audit purposes. CDPH is only collecting new CPSP provider Protocols as part of the CPSP Application process. Changes to approved CPSP Protocols may include, but are not limited to:
- Nutrition, Psychosocial, and Health Education Assessment Tools
- General Description of Practice
- List of Delivery Hospitals
- Antepartum/Intrapartum/Postpartum and Dual Provider Agreements
- Staff updates
- Protocol updates
As part of monitoring/oversite of the CPSP Program, CDPH/MCAH will be conducting a yearly CPSP Annual Survey and will be requesting CPSP Protocols for review or audit purposes. The CPSP Annual Survey and CPSP Protocol reviews will be in lieu of the chart reviews and Administrative Reviews previously conducted by the PSCs.
CPSP Annual Survey
All approved CPSP providers will be required to complete and submit the CPSP Annual Survey beginning one year following approval as a requirement for the CPSP provider to remain in “good standing.” CPSP Annual Surveys must be completed by April 30 of each calendar year. You may access the link here for the
CPSP Annual Survey.
Protocol Changes
CDPH is not routinely collecting updates to CPSP Protocols for current CPSP providers. Updates or changes to a provider’s “Approved” CPSP Protocols
must be documented and filed in the provider’s office/clinic and will be made available upon CDPH’s request for review or for CPSP audit purposes.
For general questions and assistance with CPSP training and CPSP protocols email
General program inquiries
.
For billing inquiries contact Medi-Cal’s Telephone Service Center at 1-800-541-5555.