New CPSP Provider Application and Processā
āāāVisit the
CPSP website for current program information, policies, procedures, forms, and templates.
How to become an approvāāed CPSP provider:
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Enroll in Medi-Cal as one of these CPSP-eligibleā Provider Types:
- Physician (MD/DO) specializing in obstetrics, pediatrics, family practice, or general medicine
- Physician Group with at least one member who specializes in one of the above specialtiesā
- Certified Nurse Midwife (CNM)
- Certified Nurse Midwife Group
- Community Clinic
- County Clinic
- FQHC/RHC/IHS
- Hospital Outpatient Clinic
- Licensed Midwives (LMs)
- Alternative Birth Center
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āVeāārifāāy practitioner trainingāā, experience, and license information to ensure:
- āPrāāactitionersā professional licenses, certificates, or registrations are valid and unexpired
- Practitionersā training (school, degree, year of graduation) and years of experience comply with Title 22 Regulationsā
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Deāvelop templatesāā for use in delivering CPSP services in alignment with CPSP protocols.
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āIdāāenāātify local referral resources for these non-CPSP services:
- Women, Infants & Children (WIC for nutrition and breastfeeding services and supplies
- Child Health and Disability Prevention (CHDP) for child wellness services
- Family Planning, Access, Care and Treatment (Family PACT) For family planning services
- Genetic Disease Screening Program (GDSP) for newborn genetic screening services
- Medi-Cal Dental Program for dental services
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Dāāevelop site specific CPSP protocols within six months āāof CPSP approval.
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āComāāplete a CPSP Provider Application (CDPH 4448) and, if applicable, an Additional CPSPPractitioners Form (CDPH 4448A).
- Download the current version of the forms from the CPSP website
- āComplete the forms and digitally sign the 4448
- Submit the completed, signed CPSP Provider Application to CDPH/MCAH Division via email to
CPSPProviderEnrollment@cdph.ca.gov.
Contact Us:
- For assistance with the CPSP application process email CDPH/MCAH Division at
CPSPProviderEnrollment@cdph.ca.gov.
- For assistance with implementing CPSP and for general program inquiries email CDPH/MCAHDivision at
MCAHCPSPGeneralInquiry@cdph.ca.govā.
- For assistance with Medi-Cal enrollment or to check status contact Provider Enrollment Division (PED) at (916) 323-1945.
- For assistance with Medi-Cal billing or to leave a message for your Regional Representative contact the āTelephone Service Center (TSC) at (800) 541-5555.ā