1. www.hsahealth.org STANISLAUS COUNTY HEALTH SERVICES AGENCY California Children’s Services (CCS) Ceres Unified Nurse’s Meeting March 21, 2023

2. www.hsahealth.org What is California Children’s Services CCS? CCS is a County program funded by Federal, State and County funds that arranges and pays for medical care and therapy services for children from birth to less than 21 years of age with chronic and debilitating medical conditions. Eligibility is based on medical, financial, and residential qualifications. 3,600 children receive services through CCS in Stanislaus County.

3. www.hsahealth.org CCS Program Benefits Medical Case Management Diagnostic Services Treatment Services Special Care Centers Maintenance and Transportation (M&T) Assistance Medical Therapy Program in Schools Transition Planning

4. www.hsahealth.org CCS Carve Out The “carve out” means that Medi-Cal Managed Care plans are not capitated to provide services for a child’s CCS eligible condition. Once CCS eligibility has been established, the CCS program assumes case management responsibility of the CCS eligible condition and authorized medically necessary care. Managed Care Plans continue to provide primary care services and other services not related to the CCS eligible condition. CCS does not cover mental heath services. The CCS-eligible medical condition is “carved out” of Medi-Cal Managed Care plans responsibility.

5. www.hsahealth.org Medi-Cal Vs CCS

6. www.hsahealth.org Medical Eligibility Only certain conditions are covered by CCS. In general, CCS covers medical conditions that are physically disabling or require medical, surgical, or rehabilitative services.

7. www.hsahealth.org Examples of CCS Eligible Conditions congenital heart disease cancers, tumors hemophilia, sickle cell anemia thyroid problems, diabetes serious chronic kidney problems liver or intestine diseases cleft lip/palate, spina bifida hearing loss, cataracts cerebral palsy, uncontrolled seizures rheumatoid arthritis, muscular dystrophy AIDS severe head, brain, or spinal cord injuries, severe burns problems caused by premature birth severely crooked teeth broken bones

8. www.hsahealth.org CCS Provider’s Role Become CCS paneled Referral to the CCS program Referral to a specialist at a Special Care Center (SCC) Management of well-child checks not related to CCS condition (Primary Care Providers) Local management of CCS condition in coordination with SCC

9. www.hsahealth.org Referrals For New Client Referrals: Fax Completed DHCS 4488 Form Complete Additional Services Requested from Other Health Care Providers (Sections 30-31) Include available medical documentation For Existing CCS Clients: Fax Completed DHCS 4509 Form Complete Additional Services Requested from Other Health Care Providers (Section 40) Include available medical documentation

10. www.hsahealth.org CCS Referral Process A new referral to the CCS Program is defined as a request directed to the CCS Program to authorize medical services for a potential CCS client who: Is under 21 years of age and is not a client of the CCS Program and has, or is suspected of having, a CCS program medically eligible condition. A referral may originate from any source, including health care providers, parents, legal guardians, school nurses, regional center counselors, or other interested parties.

11. www.hsahealth.org CCS Referral Formats A CCS referral may be submitted using any of the following formats and must include all the previously mentioned referral requirements: A New Referral CCS/GHPP Client Service Authorization Request (SAR) (form DHCS 4488) A written or verbal request by a parent or legal guardian Electronic Referral (eSAR)

12. www.hsahealth.org Service Authorization Request (SAR) A Service Authorization (SAR) enables providers to render and be reimbursed for specified services authorized by the CCS program. The physician’s authorization number (SAR number) may be shared, when appropriate, for reimbursement with other health care providers from whom the physician has requested ancillary services such as laboratory, pharmacy, radiology, or other physician specialty services.

13. www.hsahealth.org SAR Request Forms Available Online (Includes Instructions) http://www.dhcs.ca.gov/formsandpubs/forms/Pages/CCSFo rms.aspx For New Client Referrals: New Referral CCS/GHPP Client Service Authorization Request (SAR) (DHCS 4488, 09/15) For Existing CCS Clients: Established CCS/GHPP Client Service Authorization Request (SAR) (DHCS 4509, 09/15)

14. www.hsahealth.org Service Code Group (SCG) What are service code groupings? 13 groups of provider codes that are authorized to CCS- paneled or approved providers for the care of a CCS client’s CCS eligible medical condition. The SCG contains a listing of codes that allow the provider to care for the CCS client’s CCS eligible medical condition without needing to obtain repeated single prior authorizations.

15. www.hsahealth.org SCG Types SCG 01 – Physician (covers office visits, most medications, x-rays, MRIs, EEGs, Cat Scans, lab work) SCG 02 – General Special Care Centers (Includes 01) SCG 08 – Rural Health/Federally Qualified Health Clinics (can be used by the pharmacy for most medications).

16. www.hsahealth.org PEDI Access Our office encourages you to sign-up for online PEDI (Provider Electronic Data Interchange) Access. PEDI is an online tool for providers to be able to access the status of requests for services including the ability to print authorizations, denials and Notices of Action. This website has all the information for providers and to download to apply for PEDI: http://www.dhcs.ca.gov/services/ccs/cmsnet/Pages/CMSNe tProviderEDI.aspx

17. www.hsahealth.org DHCS Online Resources California Children's Services Website http://www.dhcs.ca.gov/services/ccs/Pages/default.aspx Service Authorization Request (SAR) Tools http://www.dhcs.ca.gov/services/ccs/cmsnet/Pages/SARTo ols.aspx Overview of Medical Eligibility http://www.dhcs.ca.gov/services/ccs/Pages/medicaleligibilit y.aspx

18. www.hsahealth.org CCS Paneling The website for providers to apply to become CCS paneled: https://cmsprovider.cahwnet.gov/PANEL/index.jsp https://cmsprovider.cahwnet.gov/PANEL/index.jsp Email: ProviderPaneling@dhcs.ca.govProviderPaneling@dhcs.ca.gov

19. www.hsahealth.org Stanislaus County CCS Contacts Linda Smith, CCS Coordinator Email: lsmith@schsa.orglsmith@schsa.org Phone: (209) 558-4480 Dawn Moreno, CCS Clerical Supervisor Email: dmoreno@schsa.orgdmoreno@schsa.org Phone: (209) 558-6836

20. www.hsahealth.org Thank You Health Services Agency Public Health Division California Children’s Services 4701 Stoddard Road Modesto, CA 95356 PO Box 3088 Modesto, CA 95355 Phone: (209) 558-7515 Fax: (209) 558-7862