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THE COMPREHENSIVE PERINATAL SERVICES PROGRAM


Medi-Cal Reimbursement for Comprehensive Perinatal Services

GOALS OF THE PROGRAM

  • To decrease the incidence of low birthweight in infants
  • To improve the outcome of every pregnancy

  • To give every baby a healthy start in life

  • To lower health care costs by preventing catastrophic and
    chronic illness in infants and children

WHAT IS THE COMPREHENSIVE PERINATAL SERVICES PROGRAM?

This program provides enhanced reimbursement for comprehensive perinatal services from conception through two months postpartum. Providers can receive enhanced reimbursement for care given to women with proof of Medi-Cal eligibility who elect to receive such services.
In the nationally regarded California OB Access Study, comprehensive perinatal services were shown to reduce the low birthweight rate by one-third and to save approximately $2 in short-term neonatal intensive care costs alone for every $1 spent.

WHAT ARE THE COMPREHENSIVE PERINATAL SERVICES?

Comprehensive perinatal services include:
  • Patient orientation to comprehensive perinatal services
  • Assessment, reassessment, interventions and follow-up services in:
    • Obstetrics
    • Nutrition
    • Health Education (including education for informed consent) and
    • Psychosocial Services
  • Individual Case Coordination
  • Prenatal Vitamin and Mineral Supplements
  • Perinatal and Parenting Education, individual or group, including classes


WHO CAN BECOME A COMPREHENSIVE PERINATAL PROVIDER?

Any of the following can be a Comprehensive Perinatal Provider, as long as they have a valid and current Medi-Cal provider number and are certified by the State Department of Health Services:
  • Physicians in general practice, family practice, obstetrics and gynecology, and pediatrics
  • Groups of physicians, any of whose members is one of the above physicians
  • Certified Nurse Midwives
  • Preferred provider organizations
  • Clinics (county, community, hospital)

REIMBURSEMENT SCHEDULE

  Minimum
(Minutes) 		Maximum*
(Hours) 		Rate
Client Orientation,
Individual
15 2 $30.32/hr.
Prenatal Vitamin/
Mineral Supplement
 		    $36.00
**Initial Individual Assessments and Care Plan Development in:
  • Nutrition
  • Psychosocial
  • Health Education
30
30
30 		2
2
2.5 		$30.32/hr.
$30.32/hr.
$30.32/hr.
Follow-up Individual Antepartum Reassessment, Treatment and/or Intervention in:
  • Nutrition
  • Psychosocial
  • Health Education
15
15
15 		2
3
2		 $30.32/hr.
$30.32/hr.
$30.32/hr.
Follow-up Group Antepartum Reassessment, Treatment and/or Intervention in:
  • Nutrition
  • Psychosocial
  • Health Education
15
15
15 		3
4
2 		$10.12/pt/hr.
$10.12/pt/hr.
$10.12/pt/hr.
***Perinatal Education,
Group		 15 18 $10.12/pt/hr.
***Perinatal Education,
Individual		 15 4 $30.32/hr.
Postpartum Individual Assessment, Treatment and/or Intervention in:
  • Nutrition
  • Psychosocial
  • Health Education
15
15
15 		1
1.5
1 		$30.32/hr.
$30.32/hr.
$30.32/hr.
In addition, the CPSP Provider may earn reimbursement for:
  • Care within 16 weeks LMP
  • The 10th antepartum visit
    $50.00
$100.00
*Medi-Cal TARs (Treatment Authorization Requests) are required for services in excess of the benefits listed above.
**The CPSP Provider will be eligible for a case Coordination fee of $76.89 if initial individual assessments and care plan development in nutrition, psychosocial, and health education are completed within 4 weeks of entry into care. Entry into care is the time of the first billable comprehensive perinatal service.
***Perinatal education may be given both ante- and postpartum.

HOW DOES ONE OBTAIN MORE INFORMATION ABOUT THE COMPREHENSIVE PERINATAL SERVICES PROGRAM?


Contact the Comprehensive Perinatal Services Program (CPSP) Coordinator at:

County of Riverside Community Health Agency
Department of Public Health
Maternal, Child and Adolescent Health
ATTN: Diane Ewing, MPH
4065 County Circle Drive, Room 212
Riverside, CA 92503
(951) 358-5260
OR
Maternal and Child Health Branch
Department of Health Services
714 "P" Street, Room 350
Sacramento, CA 95814


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