All pregnant members must have access to Comprehensive Perinatal Services Program (CPSP) services, which integrate health education, nutrition and psychosocial services with obstetrical care. CPSP support services providers are required to use the Department of Health Care Services (DHCS)-approved assessment tools. Health Net has developed assessment tools approved by DHCS that are included in this manual. The multidisciplinary approach to delivering perinatal care in the CPSP framework is based on the recognition that providing these services from conception through 60 days following delivery improves pregnancy outcomes.

The provision of CPSP services to pregnant members is the responsibility of all California Department of Public Health (CDPH)-certified CPSP providers who contract with Health Net, a subcontracting health plan or PPG.

Health Net-participating PPGs must maintain and reimburse a network of obstetric and community providers who are CPSP-certified in order to promote access to CPSP and improve birth outcomes for their patients. PPGs may not redirect CPSP services away from participating CPSP-certified providers who are in good standing with the state and local county CPSP program. CPSP-certified providers must be allowed to provide services to Health Net Medi-Cal members. Health Net and CDPH attempt to have all obstetricians providing care to Medi-Cal members become CPSP-certified to allow CPSP services to be provided during routine obstetric prenatal and postpartum visits.

Refer to Doula section of the provider operations manual for additional information.

Individual participating providers who are not certified by the California Department of Public Health (CDPH) for the Comprehensive Perinatal Services Program (CPSP) are reimbursed for maternity services with a global professional fee, which includes all professional services normally provided for routine perinatal care. CPSP providers should bill each service separately, using the DHCS designated "Z" codes.

Compliance with Health Net's perinatal standards of care is monitored by the Health Net State Health Programs Quality Improvement Department.

Comprehensive Perinatal Services Program (CPSP) providers should complete a comprehensive risk assessment and individualized care plan (ICP) if the obstetric care provider is not providing the full scope of CPSP support services.

The comprehensive risk assessment includes information from the medical-obstetric assessment combined with a health education, nutrition and psychosocial assessment. The assessment is designed to evaluate the member's health behaviors, knowledge base, medical conditions, and psychosocial situation. The assessment is conducted by the provider or trained paraprofessional (comprehensive perinatal health worker). The ICP is developed by the provider in consultation with the member. The provider is responsible for making referrals to alleviate identified risks, with priority given to the most severe. This assessment must be administered at the initial prenatal visit, once each trimester thereafter, and at the postpartum visit.

Identified risks, interventions and referrals comprise the ICP. The ICP includes a statement of the risks identified and the interventions taken to address the risks in priority order, the identification of the persons responsible for carrying out the proposed interventions, the evaluation or outcome of the actions taken by the provider or member, and any updates. The provider must retain a copy of the ICP in the member's medical record.

For all members participating in CPSP, risk reassessment occurs during each trimester and the postpartum period. The ICP is revised as indicated.

Health Net makes available the following CPSP assessment tools and resources:

Information regarding perinatal services and community information sources is available from the Health Net Medi-Cal Facility Site Review (FSR) Compliance Department and the Health Net Health Education Department.

Prior to the administration of any assessment, medication, procedure, or treatment, the member must be informed of potential risks that may affect them or their unborn child during pregnancy, labor, birth, or postpartum, and the alternative therapies available to them. The member has a right to consent to or refuse administration of any assessment, medication, procedure, test, or treatment.

The member has the right to:

Upon the discovery that a member is pregnant, all participating providers (including primary care physicians (PCPs), obstetric care providers, midwives, and family planning clinics) are required to notify the care manager of their affiliated participating physician group (PPG). Direct network providers must notify the Health Net Medi-Cal Health Services Department. Primary care physicians only should complete the Confirmation of Pregnancy Form (Medi-Cal, CalViva Health, Community Health Plan of Imperial Valley) for the pregnant member and fax it to the number at the top of the form.

The Pregnancy Outcome Notification Report provides Health Net with the information needed to meet the Department of Health Care Services (DHCS) reporting requirements. Completed forms must be faxed to the Health Net Medi-Cal Health Services Department .

The initial prenatal examination must occur within two weeks (for Medi-Cal facility site review purposes, within seven calendar days) of the initial referral or request for pregnancy-related services. The obstetric provider is expected to provide care for members using standards consistent with current American Congress of Obstetricians and Gynecologists (ACOG) recommendations and within accepted Health Net guidelines.

ACOG's guidelines for Perinatal Care (PDF) recommends the following examination schedule for a woman with an uncomplicated pregnancy:

Women with medical or obstetric problems may require closer surveillance. The interval between visits is determined by the obstetric provider according to the nature and severity of the problems.

Recommended intervals for routine tests for individual members during pregnancy are as follows:

For information on provider responsibility and pregnancy program, refer to Maternal Mental Health Screening Requirement.

When Health Net is notified that a Medi-Cal member is pregnant, the member is offered, with their consent, a pregnancy packet from the Health Net Health Education Department. The packet includes educational materials on various subjects, including breastfeeding, nutrition, exercise, perinatal check-ups, safety, and alcohol and substance misuse. It contains a booklet about having a healthy pregnancy, breastfeeding and caring for a newborn. It also contains information about Health Net's toll-free Breastfeeding and Nutrition Support Line (BNSL), information about postpartum care and information about how to get health insurance coverage after the baby is delivered. The packet is available in English and Spanish and provides member with additional resources on:

Pregnant members are identified through primary care physician (PCP) or obstetric care provider submission of assessment reports, authorizations, inpatient admissions, Comprehensive Perinatal Services Program (CPSP) reports, and member contact with the Health Net Medi-Cal Member Services Department (Health Net or CalViva), the Health Net Medi-Cal Health Services Department or the Health Net Health Education Department.