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Anyone may refer a child to CCS to determine if the child has an approved CCS medically eligible condition. Most children are referred by the family physician, specialist or hospital. The physician or hospital can supply important medical information necessary in making the CCS medical eligibility determination and may also participate in the child’s CCS treatment program.
You should apply for the CCS program at your local CCS office in the county where you reside. This office should be contacted for assistance as requests for CCS coverage must be made on or before the day services are rendered, except for emergencies. This office can tell you if your child may be eligible for the CCS program. CCS eligibility must be determined before services can be covered by CCS.
The county CCS office or the appropriate State Regional Office will consider your child’s medical condition as well as the family’s residential and financial status to determine CCS eligibility. This is accomplished by completing the necessary application forms and providing the required documentation. Based on this information and completed paperwork the CCS program will approve or deny your application. If your application is denied, you have the right to appeal the decisions.
Your child’s HF coverage does not provide payments for services to fully diagnose or treat a CCS eligible medical condition. If your child is suspected of having a CCS eligible medical condition, you will be referred to a special CCS paneled provider who is experienced in diagnosing and treating the suspected eligible medical condition.
Upon approval by CCS, the diagnosis and treatment services will be covered by the CCS program. CCS is a partner with the HF program to provide your child with the specialized medical care needed to treat your child’s CCS eligible medical condition.
You must accept the CCS referral to a CCS paneled or approved provider in order to receive all the benefits of the CCS program. The HF plan remains responsible for providing your child’s primary care, prevention and other treatment services not authorized by the CCS program. You must inform CCS at the time your child’s HF coverage changes or is terminated.
Children who are Medi-Cal eligible and have approved CCS medical conditions are usually eligible for CCS case management and other services not covered by Medi-Cal. This is also true for children who are enrolled in Medi-Cal managed care plans. This arrangement assures that all children with complex, disabling medical conditions will receive appropriate specialized care.
Your child can be eligible for the CCS program even though you have private health insurance coverage. If your child is a CCS applicant/client and has individual or group private health insurance coverage, you must report it to the office and the child’s health care provider. Private health insurance entitlement is used to help reduce CCS program costs.
Some families may be required to pay an annual assessment and/or annual enrollment fee. These fees are used to help cover the following:
All of these services are provided by the CCS program to ensure that clients receive the best care possible from physicians and specialists who provide medical care to children. The annual assessment fee is $20 and the annual enrollment fee is calculated based on family income and household size.