Transcript CPSP Application Overview Candice Zimmerman, CPSP Manager

CPSP Application
Overview
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/cgibin/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 statesponsored 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/Pa
ges/LHJPerinatalServicesCoordinatorInform
ation.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??