CPSP ApplicationOverview

Candice Zimmerman, CPSP Manager

Lorraine Cardenas, Program Analyst

November 2, 2011

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

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.

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

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

• PSC receives CPSP provider application• PSC should schedule a visit with supervising

physician

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

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)

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).

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

• RDs: https://secure.eatright.org/cgi-bin/lansaweb?procfun+prweb28+p28fn01+prd+eng

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

CPSP Provider Application Review: Section 4

• Ensure applicant indicates number of years of experience in Maternal Child Health for each practitioner

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.

CPSP Provider Application Review: Section 4

• Indicate Backup practitioner in absence of provider

• Indicate staff conducting client orientation

CPSP Provider Application Review: Section 4

• Indicate staff providing the following services:

–Health Education

–Nutrition

–Psychosocial

–Case Coordination

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.

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

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

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

CPSP Provider Application Review: Section 6

• Attachment VI: List of Required Referral Services

• CHDP

• WIC

• Family Planning

• Genetic Counseling

• Dental

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

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/Pages/LHJPerinatalServicesCoordinatorInformation.aspx

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

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

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

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)

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

QUESTIONS??