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Local Maternal, Child and Adolescent Health (MCAH) Programs​

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GAVIN NEWSOM
Governor

State of California—Health and Human Services Agency
California Department of Public Health


 


May 16, 2023

Dear MCAH Directors and Local Health Department Leadership:

RE: Transition of the Perinatal Services Coordinators (PSCs) activities supporting Provider Enrollment, Technical Assistance/Training, and ensuring Monitoring/Oversight of the Comprehensive Perinatal Services Program (CPSP)

The purpose of this letter is to inform Local Health Jurisdictions (LHJs) of the transition of the Perinatal Services Coordinator (PSC) activities supporting provider enrollment, technical assistance/training, and monitoring/oversight activities of the CPSP Program.

By 2024, the Department of Health Care Services (DHCS) envisions 99 percent of all Medi-Cal beneficiaries will be in managed care, a very different landscape from when the CPSP program was first launched. As more pregnant people transfer from fee-for-service (FFS) to Medi-Cal managed care (MCMC), the California Department of Public Health’s Maternal, Child, and Adolescent Health Division (CDPH/MCAH) responsibility to support FFS providers delivering CPSP services is expected to decrease. At this time, DHCS is not anticipating any changes to the CPSP program, including reimbursement of the CPSP providers. This notice applies only to the transition of the PSC role and responsibility that is funded and overseen by CDPH/MCAH.

CDPH/MCAH has already noticed a decline in the numbers of providers seeking enrollment in the CPSP program. In response to this transition, CDPH/MCAH has taken the initiative throughout this past year to inform and engage the local MCAH Directors, Coordinators, and PSCs of the forthcoming changes to CPSP and the PSC roles and responsibilities (see Appendix A​).

California Statutes

The California Health and Safety Code (HSC) §123475-123525 established a community-based system of comprehensive perinatal care for low-income individuals. The California Welfare & Institiutions Code (WIC) §14134.5 established CPSP as a Medi-Cal benefit.

In 2007, CPSP duties were divided between DHCS and CDPH. DHCS is responsible for establishing a method for reimbursement of CPSP providers, while CDPH collaborates with local health departments to enroll, provide technical assistance, and monitor CPSP providers. CDPH provides funding to local health departments for administration of the CPSP program. See Appe​​ndix B​ for statutes guiding program administration.

PSC Roles and Responsibilities

The role of the PSC is to provide insight into the health and environment (i.e. community, home, and school) of the perinatal population within their local jurisdiction. The PSCs network with perinatal providers and community organizations to provide referrals and linkage to neighborhood services and resources. Though the PSC is not a required position, CDPH/MCAH encourages local MCAH programs to retain the PSC position to promote shared goals of optimal maternal and infant health. If an LHJ does not have a PSC, the MCAH Director is responsible for the PSC activities.

Since the number of providers enrolling in CPSP is expected to continue to decline, the PSCs roles and responsibilities will be transitioning away from previous duties of CPSP FFS provider enrollment and recruitment, technical assistance/training, and monitoring/oversight of the CPSP Program. The current enrollment rates indicate that CDPH/MCAH staff can meet provider application demands, assist with technical assistance needs, and provide monitoring/oversight of active billing FFS CPSP providers. The PSCs will continue to act as a resource and assist with the Title V goal of linkage to services for pregnant and postpartum individuals and will be instrumental in working with MCMC Plans and other maternal and perinatal care providers to ensure accessibility and equity of services in each LHJ.

Community driven perinatal activities

The PSCs responsibilities will continue to focus on improving birth outcomes based on the needs of their community, including:

  • Developing a comprehensive community resource and referral guide of available health and social services;

  • Informing providers of emerging public health issues impacting the perinatal population; coordinating perinatal activities and implementing local best or promising practice strategies to improve maternal and perinatal systems of care; and

  • Collaborating with partners to identify strategies and activities to improve access to early prenatal and postpartum health care services.

Examples of PSC activities will be listed in the updated Local MCAH Policies and Procedures Manual (PDF, 1.1 MB) soon to be released.

Required PSC activities related to CPSP (Funded in MCAH budget described below)

In order minimize gaps during this transition period, CDPH/MCAH is committed to ongoing engagement with our local partners during this transition. For LHJs with enrolled CPSP Providers during fiscal year 2023-24, PSCs should:

Partner with CDPH/MCAH to engage and share ideas to support State-level processes.

  • Partner with CDPH/MCAH to direct provider enrollment communication to the CDPH/MCAH CPSP webpage or CPSP Provider Enrollment mailbox at CPSPProviderEnrollment@cdph.ca.gov.

  • Partner with CDPH/MCAH to develop best practices and offer recommendations to streamline State-level provider enrollment processes.

  • Partner with CDPH/MCAH to provide input and recommendations on State-level activities for monitoring and oversight of “active” CPSP Providers (“Active” CPSP Providers have billed for CPSP services within the last 12 months).

Funding

Primary funding for the PSC position is provided by Title V Maternal and Child Health (MCH) Services Block Grant and Title XIX. While Title V and Title XIX dollars will continue to support PSC activities, funds will not be used to support PSC activities related to training or monitoring/oversight activities for CPSP or CPSP-like services for MCMC or FFS providers.

Examples of PSC responsibilities that would qualify for Title XIX funding include:

  • Providing outreach services to identify pregnant individuals and infants who are eligible for Medi-Cal services;

  • Providing and promoting preventive services, such as STI/STD screenings and treatment and family planning services, for people of reproductive age that include gap-filling prenatal health services; and

  • Providing and maintaining information to the public regarding health care providers and practitioners who provide services.

Additional examples of Title XIX funding activities can be found in the MCAH Fiscal Policies and Procedures (PDF, 1.5 MB).

During this transitional year, CDPH/MCAH recognizes that PSCs may be communicating with providers who are finalizing applications that are already in process. In addition, PSCs may be assisting new providers interested in enrolling in the CPSP Program who require instructions from the PSC on the state enrollment procedure. As a result, during FY 2023⁠–⁠2​4, funding flexibility may be allowed to support CPSP provider enrollment as CDPH/MCAH finalizes the establishment of provider enrollment processes. To support associated LHJs funding flexibility, Local MCAH will need to work with MCAH Program and Contract Staff to approve Local Scopes of Work (SOW) and Budgets.

For Fiscal Year –2023-24 CPSP Next Steps:

  • Retain CPSP Medi-Cal Applications and Supplemental Changes on File (Local) for a period of seven years in compliance with MCAH Fiscal Policies and Procedures (PDF, 1.5 MB). Only new CPSP applications starting July 1, 2023, will be forwarded to CDPH/MCAH CPSP Provider Enrollment mailbox at CPSPProviderEnrollment@cdph.ca.gov.

  • If an application is in process before July 1, 2023, the PSC should continue with the provider enrollment application until completion.

  • Updates to applications will be forwarded to CDPH/MCAH at CPSPProviderEnrollment@cdph.ca.gov.

  • CPSP Provider Application, Tools, and Training Resources will continue to be housed on the CDPH/MCAH CPSP website.

  • Provider and general questions regarding CPSP and/or CPSP​ Provider Enrollment should be directed to the CPSP Provider Enrollment mailbox at CPSPProviderEnrollment@cdph.ca.gov​.

  • Provider enrollment assistance and CPSP general questions can be offered by an LHJ if approved in the SOW and Budget by the MCAH Local MCAH Unit during this transitional year.

  • All CPSP Medi-Cal billing inquiry and other Medi-Cal related services will be directed to Medi-Cal Telephone Service Center at 1-800-541-5555.

Thank you for your commitment and dedicated efforts on behalf of the MCAH population. If you have any additional questions, please contact Dr. Karen Ramstrom, Maternal and Infant Health Branch Chief at Karen.Ramstrom@cdph.ca.gov or Mari Taylan, Chief, Perinatal Programs and Local MCAH Support Section at Mari.Taylan@cdph.ca.gov.

Sincerely,


Originally signed by: 
Karen C Ramstrom, DO, MSPH Chief,
Maternal & Infant Health Branch 
Maternal, Child, and Adolescent Health Division


APPENDIX A. Communication with LHJs 2022-2023 Regarding Transition of CPSP Activities

The following timeline indicates the steps CDPH/MCAH has undertaken to inform the MCAH Directors, Coordinators, and PSCs of the forthcoming changes to CPSP and the PSC role:

  • April 7, 2022—CDPH/MCAH MCAH Directors call agenda item in response to MCAH Directors’ questions generated by DHCS Medi-Cal Strategy to Support Health and Opportunity for Children and Families (March 2, 2022, webinar March 14)

    • Strategy includes reference to “upcoming Medi-Cal managed care contract procurement to establish greater accountability for delivering high-quality care to pregnant individuals….enrolled in Medi-Cal.”

  • May 18, 2022—Dr. Palav Babaria, DHCS, guest speaker at MCAH State Day included in her CalAIM update information on the Medi-Cal shift of beneficiaries from FFS to managed care plans and implications for programs such as CPSP

  • September 1, 2022—CDPH/MCAH MCAH Directors call included a “Listening Session” regarding suggestions about the proposed roles and responsibilities of the PSC position

  • May - October 2022—CDPH/MCAH gathered responses to MCAH Directors questions from DHCS and distributed in writing to MCAH Directors

  • October 18, 2022—DHCS presented at MCAH State Day and addressed the transition to managed care

  • October 24, 2022—DHCS meeting with MCAH Action Executive Committee

  • November 30, 2022—CDPH/MCAH convened the MCAH Directors/Coordinators from the seven largest LHJs whose PSCs’ workload relies heavily on the enrollment, technical assistance, and monitoring/oversight of the CPSP Program to provide an update on CPSP and hear concerns/questions

  • December 1, 2022—CDPH/MCAH MCAH Directors Call to receive feedback on next steps, resulting in a request that MCAH conduct regional MCAH/PSC meetings

  • December 13 and 14, 2022—CDPH/MCAH held four regional meetings with MCAH Directors/Coordinators and PSCs to discuss the CPSP transition and corresponding PSC duties

  • March 24, 2023—CDPH/MCAH informed, and requested feedback from, the MCAH Action Executive Committee of the proposed verbiage change in the revised MCAH Policies and Procedures (P&Ps) regarding the PSC required duties with CPSP

    • PSC required duties were developed in response to comments and concerns heard during the December 2022 regional meetings and need for ongoing collaboration during FY 23/24 to ensure a smooth transition of local level responsibilities to the State

  • March 30, 2023—CDPH/MCAH informed, and requested feedback from, the PSC Executive Committee of the proposed verbiage change in the revised MCAH P&Ps regarding the PSC required duties with CPSP

  • April 4, 2023—CDPH/MCAH presented at the PSC Annual Meeting and engaged with the PSCs and MCAH Directors to discuss the changing role of the PSC roles and responsibilities with CPSP. LHD executives and health officers (CHEAC and CCLHO) were invited to join this meeting.

APPENDIX B. Statutes and Regulations

Comprehensive Perinatal Services

The following statutes were transferred from DHCS to CDPH in 2007 upon the creation of CDPH: California HSC §123475-123525 (Community-Based Perinatal System) and California WIC §14134.5 (CPSP Medi-Cal Benefit).

Provider Enrollment [reference: 22 CCR § 51249​]

  • CDPH is authorized to review and evaluate a provider’s CPSP application based on the established Title 22 criteria and WIC 14134.5.

  • CDPH is responsible for assuring that providers meet the criteria defined by CPSP applicable statutes and regulations prior to enrollment

Training and Technical Assistance [reference: California WIC § 14135.5 (g)]

  • CDPH is required to provide technical assistance to LHJs to establish a community perinatal program. This may include certifying and monitoring providers of comprehensive perinatal services.

Monitoring and Oversight [reference: California WIC § 14134.5 (i)]

  • Statute requires CDPH to develop systems for the monitoring and oversight of comprehensive perinatal services.

  • CDPH/MCAH Division defines “monitoring” by requiring each LHJ to implement individualized activities, based on local capacity and needs, to improve access to early and quality perinatal services. CDPH/MCAH will utilize both State and local data and reports to monitor specific perinatal outcomes and provide technical assistance to the LHJs as appropriate.

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