1. CPSP Application Overview Candice Zimmerman, CPSP Manager Lorraine Cardenas, Program Analyst November 2, 2011

2. Staff Available for Consultation MCAH staff are available for consultation to the PSC during the provider application review: –Nurse Consultants: Paula Curran, Imelda Hoeckelmann, and Mary Wieg (TA for clinical related issues) –Application Analyst: Lorraine Cardenas for general application questions

3. CPSP Provider Approval PSCs will be making a RECOMMENDATION to state MCAH regarding the approval of CPSP providers State MCAH staff is responsible for final approval and submission of the application to Medi-Cal PSCs DO have the authority to NOT recommend that a Medi-Cal provider be approved as a CPSP provider.

4. CPSP Provider Application Process The Title 22 California Code of Regulations Section 51249 specifies that eligible Medi-Cal providers must submit an application to become a CPSP provider. CPSP application process can be found on page 42 of the MCAH/CPSP Policies and Procedures (P & P) Manual

5. Local PSC Application Review: Prospective CPSP providers must be Medi-Cal providers in good standing The CPSP application and instructions (CDPH 4448) is located on the CPSP web page at: http://www.cdph.ca.gov/programs/CPSP/Pages/ default.aspx http://www.cdph.ca.gov/programs/CPSP/Pages/ default.aspx PSC receives CPSP provider application PSC should schedule a visit with supervising physician

6. Local PSC CPSP Application Review Check application for completeness Ensure the National Provider Identifier (NPI) and business address match Information from Medi-Cal Complete Application Review checklist (CPP3) Notify provider of needed corrections NOTE: A separate application must be submitted for each service site

7. CPSP Provider Application Review: Sections 1 and 2 Section 1: Check identifying information –Legal name must be the same as used for Federal Internal Revenue Tax Identification –Check that name, address, phone, fax, etc. are completed Section 2: Please check the Provider type (Check only one)

8. CPSP Provider Application Review: Section 3 Section 3: Provider should answer “Yes” to the question: “Are you a Current Medi-Cal Provider?” Section 4: Document all staff providing CPSP services (obstetrical, health education, psychosocial and nutrition services).

9. CPSP Provider Application Review: Section 4 Indicate Practitioner Type (e.g., MD, MSW) CA License, Certificate, Registration Number CA License Look Up for CPSP Practitioners: Licensed Staff: http://www2.dca.ca.gov/pls/wllpub/wllquery$.startup http://www2.dca.ca.gov/pls/wllpub/wllquery$.startup RDs: https://secure.eatright.org/cgi- bin/lansaweb?procfun+prweb28+p28fn01+prd+eng

10. CPSP Provider Application Review: Section 4 Expiration Date of License, Certificate or Registration Number The following information is needed: –Year graduated –Degree completed –Name of Institution/ University

11. CPSP Provider Application Review: Section 4 Ensure applicant indicates number of years of experience in Maternal Child Health for each practitioner

12. CPSP Provider Application Review: Section 4 Indicate which functions the practitioner will perform by placing an “X” in the corresponding columns. Obstetrics – Only MD’s, CNM’s, NP, and PA’s may have an X placed in this column. Supervision –All CPSP services must be provided under the personal supervision of a physician.

13. CPSP Provider Application Review: Section 4 Indicate Backup practitioner in absence of provider Indicate staff conducting client orientation

14. CPSP Provider Application Review: Section 4 Indicate staff providing the following services: –Health Education –Nutrition –Psychosocial –Case Coordination

15. CPSP Provider Application Review: Section 4 Consultation –Staff member or outside contractor who provides consultation for patients with obstetrical problems Indicate staff approving protocols: –The Health Educator, RD, and Social Worker must approve protocols that have not been previously approved.

16. CPSP Provider Application Review: Section 5 Indicate that provider has attended state- sponsored training (CPSP Provider Overview Training, STT Training) or will attend future training

17. CPSP Provider Application Review: Section 6 Attachment I: Prenatal Medical Record Form(s): – attach a sample of the (ACOG or other approved) prenatal medical record forms used in your practice or clinic Attachment II: The Individual Care Plan –Attach a sample care plan

18. CPSP Provider Application Review: Section 6 Attachment III: Nutrition, Psychosocial, and Health Education Assessment Tools Attachment IV: General Description of Practice Attachment V: List of Delivery Hospitals

19. CPSP Provider Application Review: Section 6 Attachment VI: List of Required Referral Services CHDP WIC Family Planning Genetic Counseling Dental

20. CPSP Provider Application Review: Section 6 Attachment VII: Agreements –Antepartum or Postpartum –Intrapartum –Dual Provider –Agreement must be attached to the application Agreements are not required if site is providing all services and billing from one source

21. CPSP Provider Application Review: Section 6 Provider agreement instructions and checklists are found on the CPSP web site at: http://www.cdph.ca.gov/programs/CPSP/Pa ges/LHJPerinatalServicesCoordinatorInform ation.aspx

22. CPSP Provider Application Review: Section 7 Provide the approximate number of total deliveries by the CPSP applicant for this practice in the last 12 months (indicate Medi-Cal deliveries) Original signature required by authorized agent

23. Application Submission Send original copy of application and Application Checklist (Attachments optional) to: Lorraine Cardenas California Dept. of Public Health 1615 Capitol Ave. MS: 8306 Sacramento, CA 95899-7420

24. Changes to Provider Application Any changes to the application should be submitted to the PSC thirty days before the effective date Mailed, faxed or e-mailed changes will be acceptable

25. Changes to Provider Application All changes to provider applications are reviewed locally and kept on file Only the following application changes are submitted to MCAH: –Provider Name –Change of Service Address –Providers no longer providing CPSP services (End-Date)

26. Changes to Provider Application Changes reviewed locally and kept on file: –Staff Changes –Change of delivery hospital, referrals –Form changes –Change from paper to electronic medical records

27. QUESTIONS??