The Comprehensive Perinatal Services Program
Learn how the AI-generated research projects were createdOverall Conclusion
The State has provided limited oversight of the Comprehensive Perinatal Services Program and has not meaningfully improved the program. Data limitations and insufficient oversight hinder the ability to determine whether Medi-Cal members receive CPSP services as intended or whether the program is effectively reducing low birthweight or improving maternal-infant outcomes. Without strengthened data collection, comprehensive provider oversight (across fee-for-service and managed care), and proactive outreach, CPSP is unlikely to achieve its goals.
Source Document
Audit Scope
The audit examines the Comprehensive Perinatal Services Program (CPSP) oversight by the California Department of Health Care Services and the California Department of Public Health, including their management of fee-for-service and Medi-Cal managed care; it evaluates the adequacy of program data collection and reporting, provider oversight (including chart reviews and provider education), and outreach to Medi-Cal members and providers. The scope covers the program’s governance and operation during the period surrounding the CPSP and CalAIM transition, with a focus on data and oversight activities for the period 2018–2022, and it notes development through 2023–2024, including the planned replacement of local oversight with a provider‑verified annual survey and the anticipated expansion of managed care enrollment under CalAIM. The analysis includes the roles of Health Care Services and Public Health, the interaction with managed care plans, and the implications for utilization and outcomes of perinatal services.
Key Findings Summary
The State provided limited oversight of the CPSP by Health Care Services and Public Health and did not exercise full authority to drive program improvements.
There are significant data limitations that prevent meaningful measurement of CPSP usage, including non-exclusive billing codes used by managed care plans and lack of systematic data collection for fee-for-service providers.
Utilization data for the CPSP is incomplete: in 2022, it could be assessed for only about 14% of Medi‑Cal members, with fee-for-service members showing some utilization (more than half pregnant members in fee-for-service plans received CPSP services during pregnancy; less than 16% received CPSP services within 60 days after birth).
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AI-Assisted
AI Scope Summary
This audit examines whether California's Comprehensive Perinatal Services Program is adequately overseen and utilized, focusing on data adequacy, provider oversight, and outreach, across fee-for-service and managed care delivery, and identifies barriers and opportunities for program improvement.
AI-Generated Insight
The audit uncovers systemwide gaps in data, oversight, and communications that are hindering the CPSP’s ability to improve maternal and infant health outcomes in California. The reliance on non-specific billing codes, fragmented oversight (by both Health Care Services and Public Health), and the anticipated shift to survey-based oversight under CalAIM pose risks to the reliability of CPSP usage data and the program’s effectiveness. The report underscores the need for robust, independent verification, standardized data collection, and proactive outreach to ensure CPSP services are delivered to Medi‑Cal members who need them.