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.
Update: Licensed midwives may enroll in Medi-Cal as direct/billing providers and apply as a Comprehensive Perinatal Services Program provider.
(Read more)
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
New Information for all approved CPSP Providers
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.
Contact Us
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.