What is this CHDP Program? +The Child Health and Disability Prevention program was established to assure that all low-income children and youth in California have access to preventive health care services.
See PDF File
Where do I apply to become a CHDP Provider? +
Health Assessment providers apply to the local CHDP program in each local jurisdiction in which they wish to render services.Providers submit:
- - California Child Health and Disability (CHDP) Program Assessment Provider Application (DHCS 4490) and
- - CHDP Health Assessment Provider Program Agreement (DHCS 4491)
Enrollment in the CHDP program is accomplished through a partnership between the State Children’s Medical Services (CMS) Branch and the local CHDP program The application process for a health assessment provider includes both facility and medical record reviews.
How do I contact the local CHDP Program? +Office Number: (805) 981-5174
Office Fax: (805) 658-4505
Address: 2240 E Gonzales Rd Suite 270
Oxnard, CA 93036
How long does it take to process an application? +The Computer Media Claims (CMC) Help Desk has 10 days from the date of receipt to process the applications. Provider information on the application must match the provider information on Department of Health Care Services Provider Master File. Submitter information (if applicable) on the application must match the submitter information on Department of Health Care Services Submitter Master File. The application needs original signature(s) on page 4. Incomplete or incorrect applications will be returned to the provider/submitter for correction. For form completion assistance, call the CMC Help Desk at (916) 636-1100.
As a qualified provider, what services do I need to provide for the CHDP population? +CHDP health assessment providers must maintain current CHDP enrollment in each county or local jurisdiction in which they render services and agree to provide services according to CHDP program laws, regulations, guidelines, policies and procedures. A complete list of responsibilities can be found in the CHDP Provider Manual.Health Assessment including a dental evaluation and referral, vision and hearing, Immunizations, developmental assessment, laboratory screening tests and appropriate health education/anticipatory guidance.
How is my practice reimbursed for the services delivered? +Billing is done through CMS 1500 form and PM 160 form See online Provider Manual for billing codes and maximum reimbursement rates.
What is Medi-Cal Managed Care? +Medi-Cal Managed Care provides high quality, accessible, and cost-effective health care through managed care delivery systems. The local Medi-Cal Managed Care system is Gold Coast who will be the primary servicer for your CHDP Medi-Cal patients. http://goldcoasthealthplan.org/
What does the local CHDP Program provide in the way of support to my practice? +The program will assign a public health nurse consultant to assist you during the beginning of the CHDP program. The assistance includes training of staff, access to resources available to the low income child population, ongoing monthly staff in-services, oral health items to facilitate the Brighter Smile.( See PHN services flyer)
Do I use the private immunization vaccines for the CHDP population? +On the California Vaccine for Children (VFC) website (http://eziz.org/vfc/) there are 2015 program participation requirements at a glance to review as well as enrollment steps and forms to view. All vaccine delivery for CHDP clients will be from the VFC inventory provided by the state.
What happens to my practice once approval to provide health assessments to CHDP children occurs? +Once you pass the initial site and medical record review by CHDP local program, Gold Coast and Vaccine for Children, the CHDP program will then monitor your practice every three years with a facility review providing your practice with any new requirements from the state.
Where do I send the PM 160s? +“Number 1- White Copy” is mailed to:
“Green PM 160 form” CHDP Gateway (use the address on the bottom right hand corner of the PM 160)
P.O. Box 15300
Sacramento, CA 95851-1300
“Brown PM 160 form” Gold Coast Health Plan
Gold Coast Health Plan
P.O. Box 9152
Oxnard, CA 93031-9152
“Number 2-Yellow Copy” is sent to the CHDP program in the county/city in which the service was provided.
2240 E. Gonzales Rd. Suite 270
Oxnard, CA 93036
* Please send PM 160s no more than a month after exam date
“Number 3-White Copy” is retained by the provider in the patient’s record.
“Number 4-Pink Copy” is given to the parent or legal guardian.