The Comprehensive Perinatal Services Program Insert name of PSC Insert date CPSP PSC: Add your contact information on this slide Welcome and thank all for attending Introduce self and ask others to introduce themselves as appropriate Outline goal of meeting –

What is the CPSP? The CPSP provides enhanced perinatal services for Medi-Cal eligible women from the date of conception through the end of the second month after delivery The CPSP has been shown to improve birth outcomes Medi-Cal Managed Care plans are required to provide access to CPSP services for all Medi-Cal eligible enrollees PSC share: The Comprehensive Perinatal Services Program (CPSP) provides a model of enhanced perinatal services for Medi-Cal eligible low-income, pregnant and postpartum women from the date of conception through the end of the second month after delivery. For example, if a woman delivers January 15, her CPSP coverage lasts through March 31. The program was developed from the OB Access Project, a successful perinatal demonstration project for 7,000 low income women that operated from 1979 to 1982 in 13 California counties. Comprehensive services were shown to reduce the low birth weight rate by one-third and to save approximately $2 in short-term Neonatal Intensive Care Unit (NICU) costs for every $1 spent. Because of these positive results, CPSP was legislated in 1984 and included as part of the Medi-Cal program in 1987. Medi-Cal Managed Care health plans are required to provide access to CPSP services for all Medi-Cal eligible enrollees.

Goals of the CPSP Decrease and maintain the decreased level of perinatal, maternal and infant mortality and morbidity Support methods of providing comprehensive prenatal care that prevent prematurity and the incidence of low birth weight infants http://www.cdph.ca.gov/services/funding/mcah/Documents/MO-MCAH-MCAHPP-2012-13.pdf PSC: This slide aligns with the CPSP provider brochure – make sure each person has a copy as needed http://www.cdph.ca.gov/programs/CPSP/Documents/MO-CPSP-ProviderBrochure-2012.pdf

Why be a CPSP Provider? Better patient outcomes CPSP offers higher reimbursement More staffing flexibility CPSP enables providers to bill for services that non-licensed staff perform PSC share: We know when pregnant women receive health education, nutrition and psycho social support services – they have better birth outcomes! CPSP is unique. It is the only (please confirm ONLY) Medi-Cal program that reimburses non-licensed staff at the physician rate. This means that your staff who currently work 1:1 with CPSP eligible patients, providing health education, nutrition, and or psycho social support services can be recognized as Comprehensive Perinatal Health Workers (CPHWs). We will discuss this further – later – but for now, a CPHW must be at least 18 yo with a high school education and one year of paid perinatal experience. Often medical assistants qualify for this category.

Basic OB vs. CPSP Reimbursement Service Basic OB CPSP Initial Exam 126.31 Antepartum Exam 483.84 Delivery 544.72 Postpartum Exam 60.48 Early entry into care 56.63* Vitamins 30.00 Case Coordination 85.34* 10th antepartum visit 113.26* Support Services (max) 1077.20 Total potential payments (before TAR) $1215.35 $2577.78 Support service reimbursement for health education, nutrition, and psychosocial services is available only to approved CPSP providers. For Fee for Services providers – Support services provided individually are reimbursed at $33.64/hour up to 23 hours. Group classes are reimbursed at $11.24/patient/hour up to 27 hours. A Coordination fee of $85.34 is available if all three, support service assessments are provided within four weeks of entry into care. CPSP providers may dispense a 300-day supply of vitamin/mineral supplements to pregnant women reimbursed at $30.00 (I think this is incorrect$$) Total = $1077.20 + $169. 89 = $1,247.09 Additional fee from Case Coordination Fee = $85.34 Providers that offer CPSP support services have the potential to earn an additional $ 1,372.42 in CPSP reimbursement! Potential Overall Total Reimbursement (including OB care) without TARS = $2,577.78 * Not available to FQHCs

CPSP Flow Sheet and Billing Summary PSC share: – Each box represents a CPSP billable unit – as you can see there are a lot of billable units in addition to the OB visits! CPSP support services are billed per 15 minute units. 0-7 minutes = 0 units and is not billable 8-22 minutes = 1 unit 23-37 minutes = 2 units 38-52 minutes = 3 units 53-67 minutes = 4 units 68-82 minutes = 5 units 83-97 minutes = 6 units Highlight the types of services and the number of units providers can bill; include postpartum visits and the flexibility to provide postpartum support for women in addition to the “6 week checkup” (i.e. lactation support).

CPSP Documentation Requirements and Forms Client Orientation Initial Assessments Individualized Care Plans Reassessments (second, third trimester and postpartum) Referrals All recommended forms are located here: http://www.cdph.ca.gov/programs/CPSP/Pages/LHJPerinatalServicesCoordinatorInformation.aspx PSC share: Sample forms are on the CPSP Website (see link). There are two types of forms: Three column combined assessment and care plan forms and separate assessment and care plan forms. Providers may ask questions in a different way, but must cover all of the items in the assessment forms.

CPSP Services Initial assessments Orientation Case Coordination OB Psychosocial Health Education Nutrition Perinatal Education individual groups Vitamin/mineral supplements Initial assessments Trimester reassessments Postpartum assessments Intervention/follow-up PSC share: All Medi Cal sites offer the OB care – what we are talking about today, is the support services – these are services that you may already be providing – educating the woman about her risk for diabetes, teaching about breastfeeding and childbirth, offering behavioral health appointments to address stress and past trauma. Under CPSP these are all billable encounters! And, we know that these services make a difference in pregnancy and birth outcomes.

CPSP Model of Care Client centered Strength-based Multi-disciplinary Site specific protocols Culturally sensitive Community referrals Voluntary participation CPSP is client centered—focuses on the client’s priorities. It uses the client’s strengths to address her needs. There are four domains of CPSP; obstetric care, nutrition, psychosocial, and health education. Each office structures CPSP to fit their staffing, and describes their procedures in office protocols. CPSP is culturally sensitive. The provider may refer the client to community services as needed, and the PSC can provide information on community resources for referrals. And CPSP is voluntary; the client chooses to participate.

Who can Become a CPSP Provider? Any of the following can become a CPSP provider, if they have an active National Provider Identifier (NPI) number and are an active Medi-Cal provider in good standing with Medi-Cal and their licensing board: Physicians, including general practitioners, family practice physicians, pediatricians, or obstetrician-gynecologists Certified Nurse Midwives (CNMs) Medical Groups Clinics PPOs http://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/pregcom_m00o03.doc

Who can Deliver CPSP Services? All CPSP Providers and the following CPSP Practitioners may deliver CPSP services under the supervision of a physician and as permitted by their Scope of Practice, if licensed. Registered Nurses Nurse Practitioners Physician Assistants Social Workers Health Educators Childbirth Educators Registered Dieticians Comprehensive Perinatal Health Workers (CPHW) who are at least 18 years old, have a High School Diploma, and have a minimum one year paid perinatal experience. http://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/pregcom_m00o03.doc PSC share: Reinforce that CPSP is the only Medi Cal program that allows non licensed staff to bill for their services (1:1, face-to-face etc). Comprehensive Perinatal Health Workers = are at least 18 years old, have a High School Diploma, and have a minimum one year paid perinatal experience. A health worker who is not listed but has the CPHW qualifications (for example, psychologist, person licensed outside of California, LVN) may work in CPSP.

Models of CPSP Service Delivery Approved CPSP providers can be found in solo practice, group practice, health departments, hospitals, community clinics, managed care plans, Federally Qualified Health Center (FQHCs), Indian Health Services (IHS), Rural Health Clinics (RHCs), and residency programs In some cases, obstetrical services are provided in the provider’s office with other services provided elsewhere, under subcontract, or by a second CPSP provider Flexibility of program design and implementation allows for the use of a wide range of professional and paraprofessional personnel PSC share: (From the provider brochure - ) Approved CPSP providers can be found in solo practice, group practice, health departments, hospitals, community clinics, managed care plans, Federally Qualified Health Center (FQHC), Indian Health Services (IHS), Rural Health Clinics (RHCs), and residency programs. In some cases, obstetrical services are provided in the provider’s office with other services provided elsewhere, under subcontract, or by a second CPSP provider. In other cases the entire CPSP program is offered within a single location. Flexibility of program design and implementation allows for the use of a wide range of professional and paraprofessional personnel.

Protocols for CPSP Services & Supervision 22 CCR 51179.9 defines “Protocol” as "written procedures for providing psychosocial, nutrition, and health education services and related case coordination.” 22 CCR 51179.5 defines “Personal supervision” as "evaluation, in accordance with protocols, by a licensed physician, of services performed by others through direct communication, either in person or through electronic means.” http://www.cdph.ca.gov/services/funding/mcah/Documents/MO-MCAH-MCAHPP-2012-13.pdf http://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/pregcom_m00o03.doc PSC share: Protocols can seem overwhelming – however, we have approved templates that are adaptable and I can provide technical assistance as needed. Personal supervision is important – since non licensed staff provide many of the services – this requirement is designed to ensure quality care. Also the 22 CCR … is a reference to the legislation this program is built upon – “Title 22”. Do we need this: CPSP Protocols must be reviewed and signed by a health educator, dietician, and social worker consistent with program. A CPSP provider must develop written protocols for each enhanced service – nutrition, health education and psychosocial – within six months of being approved as a CPSP provider. The PSC is available to provide consultation and technical assistance to the provider in developing protocols. Template protocols are available for use by the provider from the PSC. A protocol creates a system for delivering CPSP services in the provider’s specific setting. The protocol specifies assessment and reassessment care planning and referral mechanisms and sets the criteria and standards to measure and monitor quality of care. Newly developed site-specific CPSP Protocols, not based on a sample protocol, must be reviewed and signed by a health educator, dietician, and social worker consistent with program regulations. Providers must identify health education, nutrition and psychosocial consultants in the appropriate boxes on the application who are available for consultation for each discipline. Providers may develop their site-specific protocols using previously approved sample protocols. The PSC may provide sample protocols to the provider. When using protocols that have been previously approved, the provider must tailor them to be specific for the practice site. The PSC may assist the provider with making these changes. New providers who use previously approved protocols signed by a health educator, dietician, and social worker do not need to have them signed again. Include a statement on the application ―Based on [year] XXX LHJ Protocols‖.

The CPSP Application Process Your CPSP Perinatal Services Coordinator (PSC) can assist you with your application The PSC will review the completed application and submit it to the California Department of Public Health (CDPH/MCAH) for final approval The application approval process may take up to 60 days from the date that CDPH/MCAH receives a completed application http://www.cdph.ca.gov/programs/CPSP/Pages/ApplicationforCertificatio nasaCPSPProvider.aspx PSC share: I am here to provide the technical support you may need to successfully complete the application. Once I review and approve your application it is sent to the state for approval. It is important that we collaborate to develop a quality application that accurately reflects your site and services. *provide a business card, email and or phone number as appropriate for future follow up.

How does the CPSP work in FQHCs & RHCs? TARs (Treatment Authorization Request) are not used in FQHCs or RHCs however, chart documentation for additional CPSP services must demonstrate the same justification necessary to obtain a TAR. FQHCs and RHCs should bill the MCMC plan first for services to MCMC clients and should contact the FI for information regarding any additional payments for which they may be eligible CPSP visits in these health care delivery settings are paid at a flat fee per visit, for on-site and off-site services, as defined in their prospective payment system PSC share: CPSP looks the same in a FQHC site – however, as you may already know the reimbursement is where the models differ. FQHC sites receive an “encounter rate” based on their actual cost of doing business, whereas Fee for Services sites receive the straight Medi Cal rate. Therefore, FQHCs may charge for each encounter provided for support services, whether or not a medical service was provided during the appointment or not. In counties with Managed Care, it gets a bit more complex. Typically there is an agreement that FQHC sites will bill the Managed Care organization, then bill the state for any additional reimbursements. We can talk about this further if you have questions.

Electronic Health Record (EHR) EHRs should facilitate the CPSP work flow in each provider office Each PSC and Provider should evaluate the content and functionality of the EHR system The PSC will review the EHR content using an approved set of CPSP forms as a guide to assure that required elements of State recommended prenatal and postpartum assessment, reassessment, and intervention are included http://www.cdph.ca.gov/services/funding/mcah/Documents/MO-MCAH-MCAHPP-2012-13.pdf PSC share: According to California State MCAH 2012-2013 Policies and Procedures, the documentation and service delivery requirements for CPSP are the same whether a provider has electronic or paper records

Resources: CPSP Website http://www.cdph.ca.gov/programs/CPSP/Pages/default.aspx Provider Handbook http://www.cdph.ca.gov/programs/CPSP/Documents/MO-CPSP-ProviderHandbook.pdf Steps To Take http://www.cdph.ca.gov/programs/CPSP/Documents/MO-CPSP-StepsToTake.pdf Medi-Cal Website http://www.dhcs.ca.gov/Pages/default.aspx PSCs Directory CPSP Perinatal Services Coordinators

Honorable Edmund G. Brown Jr. Governor State of California 2014 California Department of Public Health Maternal and Child Adolescent Health Program 1615 Capitol Avenue, MS 8306 Sacramento, California 95899-7420 Diana Dooley Secretary California Health & Human Services Agency Ron Chapman, MD, MPH Director California Department Of Public Health

Questions?? Thank you!