Maternity Program

Recognizing the strong relationship between the health of parents and the health of their infants, the Maternity Program is a comprehensive care management program designed to support Blue Shield of California Promise Health Plan members and their partners before, during, and after pregnancy with a goal of improved health outcomes for parents and their infants.

The Maternity Program offers:

• Support and education to help members manage their personal health needs during the perinatal period
• Connection to community resources for members who are pregnant and who have recently delivered
• Care management for members experiencing a high-risk pregnancy
• Resources for members who may be experiencing a pregnancy loss
• Guidance in managing decisions around pregnancy and family planning

The Maternity Program aims to:

• Increase access to providers, resources, and services
• Address racial disparities in access and outcomes
• Improve maternal and infant clinical health outcomes
• Improve quality of care as demonstrated through CMS Core, HEDIS, and other clinical priorities
• Reduce the costs associated with high-risk pregnancies by improving clinical outcomes

To refer Blue Shield Promise members to the Maternity Program:

 Please complete the Maternity Program referral form and fax it to (844) 893-1211

 Call (888) 802-4410

What can providers expect when referring members to the Maternity Program?

The Maternity Program care team is composed of dedicated nurses, social workers, and care coordinators. Members will be outreached within two business days of receiving the referral, and then contacted as needed throughout the duration of the pregnancy until three months postpartum.

The program is completely confidential and is available to members at no extra cost.

Your office may be contacted for any care coordination needs.

Other related programs

Maternal Mental Health

The Maternity Program has specialized social workers on the team to provide support. We can also refer members to other behavioral health specialists.

We provide access to specialists who can offer help and guidance on:

• Stress management
• Management of depression & anxiety
• Addressing adverse childhood experiences
• Other behavioral health conditions
   

Blue Shield Promise also offers guidance for helping providers to comply with California’s mandate (AB 2193) that perinatal patients be screened for depression. Visit the Maternal Mental Health page for more information on the requirement, the approved and recommended depression screening tools, and resources/next steps for perinatal members who screen positive for depression.

Doula services

Blue Shield Promise Medi-Cal doula services are part of our effort to improve access to pregnancy care and ensure healthy outcomes for parent and baby. Doulas are birth workers who offer support to members through pregnancy, labor, and postpartum. They also offer nonmedical support in the event of miscarriage, stillbirth, and abortion. During pregnancy, doulas can connect you with community resources and help you create a birth plan. They can also help you with birthing techniques.

Doulas offer many types of support. This includes perinatal and labor support and guidance, health navigation, evidence-based education, development of a birth plan, and linkages to community-based resources.
 

How to refer a Medi-Cal member for doula services

Providers need to write a recommendation for Medi-Cal members to get doula services.

With a provider recommendation, the member is eligible for the following doula services:

• 1 initial visit with a doula
• Up to 8 additional visits, these can be a combination of prenatal and postpartum visits
• Support during labor and delivery (including labor and delivery resulting in a stillbirth), abortion or miscarriage
• Up to 2 three-hour postpartum visits; these are in addition to the 9 visits above (1 initial, 8 prenatal/postpartum)

The first provider recommendation can be offered through the following methods:

• Written recommendation in the member’s record
• Provider order for doula services by plan, physician, or another group by a licensed provider
• Recommendation form signed by an authorized provider that a member can provide to a doula
• Referral to Blue Shield Promise Maternity Care Management program, indicating recommendation for doula services

Members can also get doula services for up to 12 months after the end of their pregnancy. They can call their providers or the Maternity Care Management team if they need more doula visits. Providers can provide a second recommendation, for up to nine more visits.

Prior authorization is needed for support services for more than one labor and delivery per year and support services for more than two miscarriages per year.

To recommend Blue Shield Promise members for doula services:

Complete the Maternity Program referral form and fax it to (844) 893-1211.

For more information, call (888) 802-4410 (TTY: 711).

Maternal compliance and oversight

Blue Shield Promise needs your assistance to ensure that our members get optimal perinatal care and the best possible pregnancy outcomes. In addition, we must maintain compliance with the Department of Health Care Services (DHCS) Policy Letter (PL) 12-003 – Obstetrical Care – Perinatal Services.

Blue Shield Promise is required to ensure that our providers are following Comprehensive Perinatal Services Program (CPSP) or American College of Obstetricians and Gynecologists (ACOG) practice guidelines. We will be doing medical record reviews to monitor compliance with this requirement. Monitoring began in the first quarter of 2021 when requests for medical records were sent to randomly selected providers.

Please notify us via email at CPSPMonitoring@blueshieldca.com if these requests are to be sent to a specific contact, centralized location, or if access to your electronic medical record (EMR) system is available.

The Medical Record Review Tool will be included with medical record requests and is available upon request. Once we have completed our medical record review, we will share your results with you. Providers must achieve a score of 80% or higher to receive a passing score. Any score lower than 80% or noted trending deficiencies may require a Corrective Action Plan (CAP). In the event a CAP is required, Blue Shield Promise will provide additional training and resources as needed.

We thank you for your cooperation to ensure compliance with PL 12-003 by responding promptly to our requests for medical records and completing CAPs in a timely manner.

We value our relationship with you, and truly appreciate the care you provide for our members. We recognize how busy you are and thank you in advance working with us in this important effort. Please contact us via email at CPSPMonitoring@blueshieldca.com with questions.

For more information, please visit these California Department of Public Health (CDPH) and American College of Obstetricians and Gynecologists (ACOG) websites:

• CDPH Comprehensive Perinatal Services Program
• ACOG Clinical Information