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HomeMy WebLinkAboutccs-provider-brochure-adaCCS Provider Brochure 2026 INTRODUCTION INTRODUCTION California Children’s Services (CCS) is a state and county public health program for children and youth, birth to age 21. As a medical case management program, CCS coordinates, authorizes and pays for specific medical services and equipment for eligible children and youth. CCS is not an insurance company. The program obligates public funds for diagnostic and treatment services for eligible children and youth. The CCS program was founded in 1927 to help families of children stricken with polio. Since then, CCS has evolved and grown to serve children and youth with many chronic illnesses, serious injuries, and physical disabilities. The CCS Program is a vital part of the larger Family Health Services Division within the Alameda County Health Care Services Agency, Public Health Department. CCS strives to assure coordinated access to high-quality medical services for eligible children and youth. Through this program, children with eligible medical conditions get the multidisciplinary, specialized pediatric health care services they need from a network of credentialed (“CCS-paneled”) specialists, CCS-certified Special Care Centers, and CCS-approved hospitals. At Special Care Centers (SCC), physicians, nurse case managers, social workers, family navigators, dietitians and other professionals assure that clients receive appropriate and comprehensive care for the CCS-eligible condition. CCS has two components: ▪ Medical Case Management Program- CCS nurse case managers connect clients with doctors, Special Care Centers, and other health care professionals. ▪ Medical Therapy Program- provides direct occupational therapy and physical therapy services to children and youth with certain long term physical disabilities. Mission California Children’s Services of Alameda County promotes optimal health outcomes for children and youth with special health care needs through compassionate, comprehensive, and specialized collaboration with families and health care providers. CASE MANAGEMENT PROGRAM CASE MANAGEMENT PROGRAM The Case Management Program consists of a multidisciplinary team that provides family centered care coordination and case management. • Administrative Support Staff • Durable Medical Equipment Coordinator • Family Navigator • Nurse Case Manager • Pediatrician • Social Worker • Therapy Case Coordinator • Transition Specialist Each child or youth is assigned to a Nurse Case Manager (NCM), based on their condition. The NCMs are Public Health Nurses with training related to each child’s or youth’s CCS condition(s). NCMs provide care coordination for clients and providers to meet our goal that every CCS child or youth has the right care, at the right time and the right place. MEDICAL THERAPY PROGRAM MEDICAL THERAPY PROGRAM The CCS Medical Therapy Program (MTP) provides occupational and physical therapy at community- based rehabilitation clinics. A multidisciplinary team meets with the family to develop and implement individual rehabilitation plans to promote the optimal functioning of each child and youth who is medically eligible. In order to be eligible for services in the MTP there must be a current medical report documenting physical findings matching medical eligibility criteria for the MTP. There is no financial eligibility requirement for MTP services. Refer to CCS Regulations, Title 22 Section 41832. MTPs are located at several sites throughout Alameda County including Fremont, San Lorenzo, Oakland, and Livermore. Visit http://www.acphd.org/ccs or call (510) 208-5970 for your nearest clinic location. See “How to Refer” for more information. ELIGIBILITY ELIGIBILITY Requirements to establish eligibility for Alameda County CCS services include all of the following: • Age (birth to 21) • Residency in Alameda County • CCS-eligible medical diagnosis, or reasonable clinical suspicion that a CCS-eligible medical diagnosis may be present Financial eligibility is required for CCS treatment services. Children and youth are financially eligible when they meet one of the following criteria: • Child or youth has full-scope Medi-Cal (no share of cost); or • Adjusted gross income (AGI) is under $40,000 per year; or • The anticipated out-of-pocket cost of care for the CCS- eligible conditions exceeds 20% of the family’s AGI There are NO income requirements for: • Diagnostic Services • Children and youth adopted with a known CCS- eligible condition at the time of adoption • Medical Therapy Program services • High Risk Infant Follow-Up Program MEDICAL ELIGIBILITY This brief summary is intended to help you decide whether to refer a child or youth to CCS. It is not an authoritative statement; the CCS Medical Directors or their designee will determine eligibility. In general, CCS-eligible conditions are chronic, complex, potentially disabling or life-threatening, and they require multidisciplinary care. For specific details on CCS medical eligibility, please refer to the California Code of Regulations, Title 22, Division 2, Part 2, Subdivision 7, CCS Chapter 4, Medical Eligibility, Sections 41515.1 – 41518.9 or call the Alameda County CCS Office for assistance at (510) 208-5970. When in doubt, refer patients to CCS. • Infectious Diseases: HIV infection; treatable congenital infections; CNS infections requiring surgical intervention or producing disabilities requiring rehabilitation; bone infections; ocular infections with potential to lead to permanent visual impairment. • Neoplasms: All malignancies; benign neoplasms causing severe disfigurement or functional derangement. • Endocrine, Nutritional and Metabolic Diseases and Immune Disorders: Most endocrine disorders; inborn errors of metabolism; congenital and acquired immunologic deficiencies resulting in life-threatening infections. • Diseases of Blood & Blood Forming Organs Most are eligible; anemias are eligible if life threatening. • Mental Disorders, Intellectual Disabilities, and Developmental Disabilities: Not eligible; however, CCS may authorize limited treatment for mental disorders if a CCS-eligible condition causes the mental disorder or the mental disorder complicates the management of the CCS-eligible condition. • Nervous System: Usually eligible if life-threatening or if producing a physical disability that significantly impairs daily function. Idiopathic epilepsy is eligible when seizures are uncontrolled per regulation. Self-limited, acute conditions are not covered. • Eye: Disorders, including infections, which may produce permanent visual impairment; strabismus and chronic ophthalmological infections when surgery is required. • Ear & Mastoid: Hearing loss; mastoiditis; cholesteatoma; perforated TM requiring tympanoplasty. • Circulatory System: Conditions involving the heart, blood vessels and lymphatic system. MEDICAL ELIGIBILITY (continued) • Respiratory System: Chronic pulmonary infections; cystic fibrosis; respiratory failure requiring ventilatory assistance; chronic lung disease of various etiologies, including BPD and severe asthma. • Digestive System: Acute liver failure; chronic liver disease; chronic intestinal failure; chronic inflammatory diseases of the GI tract; complicated GERD; medically handicapping malocclusions. • GU System: Acute and chronic glomerulonephritis, chronic nephrosis, obstructive uropathies, nephrocalcinosis, and chronic renal insufficiency. • Skin & Subcutaneous Tissue: Scars, if disfiguring or disabling & requiring surgery; persistent, progressive diseases which are disabling or life-threatening & require multidisciplinary management. • Musculoskeletal System: Chronic musculoskeletal conditions, including connective tissue disorders, that are disabling & require multidisciplinary management or extensive bracing, casting and/or surgery; bone and joint infections; intervertebral disc herniation; scoliosis with curve of 20o or greater. • Congenital Anomalies: When severely disfiguring or when compromising a body function, these conditions are eligible if they are amenable to cure, correction or amelioration. • Perinatal Morbidity & Mortality: Neonates with a CCS-eligible condition or critically ill neonates, who are treated in a CCS-certified NICU. Care includes outpatient follow up for high-risk infants. • Accidents, Poisonings, Violence & Immunization Reactions: Severe life-threatening emergencies that involve the nervous system or vital organs. Fractures of the skull, spine, pelvis or femur or other fractures involving the growth plates or requiring ORIF. Significant burns, foreign bodies, ingestion of drugs or poisons, lead poisoning & envenomations, and severe immunization reactions. Medical Eligibility for Medical Therapy Program To find out about eligibility for California Children’s Services and the Medical Therapy program, please visit: https://govt.westlaw.com/calregs. Click on: Title 22 >Division2 >Subdivision7 >Chapter 3 >Article 2 > Medical Therapy Program 41517.5 TYPES OF SERVICES CCS-authorized services may include the following: • Diagnostic Services for children and youth when there is a reason to suspect a CCS-eligible condition • High Risk Infant Follow-Up Program for certain medically fragile infants and toddlers up to 3 years of age • Treatment Services for the CCS Medically Eligible Condition, which may include: − Coordinated, multidisciplinary clinical services at CCS-certified Special Care Centers − Hospital Care at CCS-certified hospitals − Physician Visits (outpatient and inpatient) with CCS paneled specialists − Medical Imaging and laboratory services − Medical Supplies − Durable Medical Equipment − Medications − Physical and Occupational Therapy − Speech Therapy − Audiological Services, including hearing aids − Orthodontic Care, for children and youth with eligible craniofacial anomalies or medically handicapping malocclusion − Mental Health Services − Home Nursing Visits, short- and long-term shift nursing − Palliative Care services through the Pediatric Palliative Care Waiver (PPCW) − Transportation Coordination Assistance, when needed to access authorized services. − Transition Coordination and Support as youth move into the adult health care system • Confidential HIV Testing and Monitoring Program for infants who are at risk for perinatally acquired HIV/AIDS • Medical Therapy Program (MTP) services for medically eligible children and youth who require medically necessary occupational and/or physical therapy All services, except emergencies, must receive prior authorization. HOW TO REFER / CONTACT US HOW TO REFER The provider must furnish the following information to CCS by mail or fax: 1.Child’s or youth’s name, date of birth, address and phone number 2.Child’s or youth’s Social Security or Medi-Cal number 3.Recent written medical report describing the child’s or youth’s medical condition and services that are needed. For the Medical Therapy Program, medical reports must be dated within the last six months. 4.Name of preferred specialist or treating institution, if known Mail or fax your referral to: California Children’s Services 1100 San Leandro Blvd, Suite 200 San Leandro, CA 94577-1595 Phone: (510) 208-5970 Efax: (510) 273-3884 https://tinyurl.com/ACPHD-CCS Upon request, CCS will provide you with information about the status of your referral. For online access to your authorizations, sign up at this site: http://www.dhcs.ca.gov/services/ccs/cmsnet/Pages/CMSNetProviderEDI.aspx Providers with questions are welcome to call Alameda County CCS at (510) 208-5970. Visit our provider webpage for more information, including how to become paneled as a CCS provider: https://tinyurl.com/ACPHD-CCS-For-Providers.