The Comprehensive Perinatal Services Program

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).

Only a small fraction of provider reviews included CPSP services in 2022 (about 1.7% of 2,600 reviews, i.e., 45 reviews across 18 counties); OB-GYNs and other perinatal service providers who are not designated primary care providers are often excluded from reviews.

Local oversight of fee-for-service providers by Public Health was limited; 22 of 61 local jurisdictions reported no chart reviews from 2018–2022; many reviews declined during the pandemic; Public Health planned to shift to a provider‑verified annual survey rather than robust local chart reviews, reducing independent verification.

Public Health intends to shift oversight away from local coordinators to a provider survey, but without independent verification this could reduce the reliability of oversight results.

Health Care Services’ provider reviews are not consistently focused on perinatal services (CPSP section not always used) and do not systematically feed into broader program improvements; 18 reviews per year were performed in some years, far below expectations given the number of plans and counties.

Overall, the lack of data and oversight limits the ability to confirm that Medi‑Cal members are receiving CPSP services as required and to evaluate the program’s effectiveness in reducing low birthweight and improving maternal-infant outcomes.

Mandate comprehensive CPSP data collection and analysis by Public Health, including maintaining a complete active provider list, collecting local chart review results, and producing regular statewide usage and outcomes reports.

Expand and strengthen provider reviews to include all perinatal service providers (e.g., OB-GYNs) regardless of whether they are designated primary care providers; ensure the CPSP section is consistently applied in reviews and that results feed into program improvements.

Require managed care plans to report CPSP-related data and outcomes, and enable Health Care Services to analyze trends across counties and plans through the new data system (Managed Care Site Review Portal).

Reinforce independent verification for any provider survey-based oversight adopted by Public Health to ensure data reliability and reduce reliance on self‑certification.

Enhance member and provider outreach by updating handbooks to describe the full range of CPSP services, and clarify how to access and utilize CPSP benefits; coordinate with local health jurisdictions to promote CPSP participation.

Utilize enforcement tools as needed (e.g., corrective action plans, sanctions) to drive compliance with CPSP requirements, and tie improvements to measurable CPSP outcomes.

Monitor and report on CPSP outcomes such as low birthweight rates and postpartum care uptake to evaluate program effectiveness and guide continuous improvement.

Establish or require exclusive CPSP-specific billing codes for managed care plans to enable accurate tracking of perinatal services, and ensure consistent reporting of CPSP services across fee-for-service and managed care.

Align CPSP oversight and data activities with the CalAIM initiative to ensure integrated, coordinated, and equity-focused perinatal care delivery.