CPSP
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Health Net participating providers who are not Comprehensive Perinatal Services Program (CPSP)-certified by the California Department of Public Health (CDPH) are required to enter into agreements with CDPH-certified CPSP providers to ensure that all pregnant women have access to care in accordance with Department of Health Care Services (DHCS) requirements. The required services include:
- Client orientation
- Obstetrical services
- Nutrition, psychosocial and health education support services initial assessments
- Formal reassessments offered each subsequent trimester and in the postpartum period
- Development of individualized care plans (ICPs) that include planned actions as indicated by the assessments and objectives for each of the four categories, with revision at least each subsequent trimester and postpartum
- Case coordination
- Vitamin and mineral supplementation
- Referral to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
- Provision of, or referral for, dental, genetic, family planning, and well-child care (Child Health and Disability Prevention (CHDP) program) services
CDPH-certified CPSP providers who contract to provide CPSP support services for non-certified providers are responsible for providing all support services and assessments, ICPs, reassessments, interventions, and case coordination information to pregnant members enrolled in CPSP upon referral from the identified obstetric provider.
The division of responsibilities between obstetric care providers and CDPH-certified CPSP providers for the rendering of CPSP support services is outlined below. Providers in a participating physician group (PPG) should contact their PPG administrator for sources of CPSP support services.
Obstetrical care provider responsibilities:
- Provide for all obstetrical care, including antepartum, intrapartum and postpartum care
- Prescribe prenatal vitamins and indicated medications
- Refer all pregnant Medi-Cal members to a CPSP support services provider
- Provide a copy of all antepartum exams, labor and delivery experience, and postpartum exam to a CPSP support services provider to be included in CPSP chart
- Include copies of all assessments, reassessments and interventions by CPSP support services provider in the medical chart
Responsibilities of the CPSP support services provider:
- Provide support services assessment, an ICP, reassessments, interventions, and case coordination information to pregnant members enrolled in CPSP pursuant to a referral
- Bill for all CPSP services, including case coordination bonus if called for by contract
- Provide copy of assessments, reassessments and intervention documentation to an obstetric provider for inclusion in the obstetric medical record each trimester and more frequently if needed
- Include copies of obstetric exams, labor and delivery experience, and postpartum exam in CPSP chart as received from the obstetric provider
The ICP must comply with the requirements described in the Comprehensive Risk Assessment and Individualized Care Plan discussion.
The Health Net Medi-Cal Health Services Department is available to coordinate care with other case management agencies to ensure that services are available to the member and to avoid duplication.
The Health Net public programs administrators verify the status of participating providers with the California Department of Public Health (CDPH) before they begin providing health care. Comprehensive Perinatal Services Program (CPSP) certification is verified annually.
Contracting CDPH-certified CPSP providers are responsible for providing CPSP services to pregnant members and for complying with CPSP requirements. CDPH-certified CPSP providers are also responsible for complying with Health Net policies, procedures and standards, including:
- Use of assessment and documentation tools (CPSP assessment tools, individualized care plans (ICPs) and protocols are available at no cost to participating providers)
- Submission of encounter and outcomes data (PDF)
Health care workers who perform CPSP support services assessments and interventions must meet
Medi-Cal standards for comprehensive perinatal providers. More information about these requirements may be found in the CPSP Provider Handbook.
Health plan-approved policies, procedures and standards are available from the Health Net Public Program Department.
The provision of Comprehensive Perinatal Services Program (CPSP) services to pregnant members is the responsibility of all California Department of Public Health (CDPH)-certified CPSP providers who participate with Health Net.
All CDPH-certified CPSP providers must have access to Health Net's CPSP protocols and the CPSP Enhancement Steps to Take materials. These materials contain information helpful to staff members in assessing, planning actions (for common pregnancy conditions and discomforts, not for high-risk situations) and referral of pregnant members.
Pregnant members are assigned a facility for delivery. The obstetric provider forwards a copy of the member's prenatal care records in accordance with the facility's procedures.
Women with high-risk pregnancies must be directed to facilities with advanced obstetrics and California Children's Services (CCS)-designated neonatal care units. Care for CCS-eligible newborns is carved out of Health Net's coverage.
The following conditions require specialized care and may require member referral or transport:
- Intermediate, community or regional neonatal intensive care unit (NICU) designation recommended:
- Premature rupture of membranes, 32 to 34 weeks gestation
- Premature labor greater than 32 weeks and less than 36 weeks gestation
- Twins or triplets at 34 to 38 weeks gestation
- Hydrops fetalis
- Community or regional NICU designation recommended:
- Intrauterine growth retardation
- Premature rupture of membranes less than 32 weeks gestation, unknown dates with estimated fetal weight 2,000 grams
- Premature labor less than 32 weeks gestation and unknown dates with estimated fetal weight 2,000 grams
- Trauma requiring intensive care or surgical correction or requiring a procedure that may result in the onset of premature labor
- Acute abdominal emergencies
- Preeclampsia, eclampsia or other hypertensive complication
- Third-trimester bleeding
- Multiple gestation less than 34 weeks gestation and all pregnancies where there are more than three fetuses
- Medical complications:
- Infections
- Heart disease
- Diabetes mellitus
- Thyrotoxicosis
- Renal disease with deteriorating function or increased hypertension
- Hepatic disease
- Drug overdose
- Fetal conditions:
- Anomalies that may require surgery
- Congenital anomalies requiring specialized newborn care
- Erythroblastosis requiring intrauterine transfusion
- Neonatal conditions where transport may be indicated:
- Gestation less than 32 weeks or weight less than 1,500 grams
- Persistent respiratory stress
- Seizures refractory to usual treatment
- Congenital malformations requiring special diagnostic procedures or surgical care
- Sequelae of hypoxia persisting beyond two hours, with evidence of multisystem involvement
- Cardiac disorders that require special diagnostic procedures or surgery
- Sepsis
Health Net assesses and tracks all participating providers' ability to deliver Comprehensive Perinatal Services Program (CPSP) services required by Medi-Cal. Health Net monitors compliance and provision of obstetrical services according to the American Congress of Obstetrics and Gynecology (ACOG) guidelines for Prenatal and Perinatal Health (PDF).
All compliance monitoring and oversight activities are undertaken with the goal of helping the obstetrical provider comply with the standards.
A non-California Department of Public Health (CDPH)-certified provider must comply with Health Net policies, procedures and standards, including:
- Use of assessment and documentation tools (Comprehensive Perinatal Services Program (CPSP) assessment tools, individualized care plans (ICPs) and protocols are available at no cost to participating providers)
- Submission of encounter and outcomes data (PDF)
- Establishment of a formal agreement with a CDPH-certified CPSP provider for provision of CPSP support services for Medi-Cal members
The Health Net public health program administrator is available to provide information about:
- Memorandum of understanding (MOU) or formal agreement language requirements
- Coordination activities requirements
- CPSP program information and technical assistance in collaboration with local public health departments' CPSP coordinators