California Children’s Services. (CCS) Coordination. For dates of service up to CalOptima’s implementation of the WCM program, which will be no sooner than July 1, 2019, County agrees, for Members eligible for and/or receiving CCS Program benefits, to obtain authorization from and xxxx the CCS Program for all services eligible for CCS Program reimbursement regardless of time, effort and/or expense required in obtaining CCS Program authorization and/or reimbursement. County agrees to pursue authorization and/or reimbursement for services from the CCS Program fully and completely prior to seeking authorization and/or reimbursement from CalOptima. Pursuing CCS Program authorization and reimbursement shall include, but not be limited to, submitting clean and complete Claims in format(s) mandated by the CCS Program, submitting and/or resubmitting documentation required by the CCS Program in order to receive authorization and/or reimbursement, obtaining reconsideration in instances where the CCS Program has denied authorization and/or reimbursement, and the filing and pursuing of all applicable appeals and grievances with the CCS Program. As directed by DHCS, a separate WCM Memorandum of Understanding (WCM MOU) between CalOptima and County is effective July 1, 2019 or the date CalOptima’s Whole Child Model program becomes effective, whichever is later. Thereafter, County and CalOptima shall coordinate their CCS operations pursuant to that WCM MOU rather than pursuant to this Contract.
California Children’s Services. (CCS) Under CCS regulations, children under the age of 21 who meet medical, residential, and financial criteria are eligible for CCS covered services. CCS covered services are those services provided to CCS-eligible children to treat their CCS-eligible medical condition including any or all of the following: expert diagnosis; medical treatment; surgical treatment; hospital care; physical therapy; occupational therapy; special treatment; materials; durable medical equipment and their upkeep; maintenance, care and transportation; and maintenance, transportation or care incidental to any other form of service. (Health & Safety Code Section 123840). Services must be prescribed, ordered, or requested by a CCS-paneled physician. CCS and Child Health and Disability Prevention programs are combined at the state level in the Children’s Medical Services (CMS) branch of the California Department of Health Care Services (DHCS). The Orange County CCS Program is mandated by State and Federal regulations to coordinate CCS activities at the local level. Activities related to the Medi-Cal population include: assisting Medi-Cal eligibles to gain and maintain access to specialized medical services provided by a network of CCS- paneled providers; coordinating specialized medical care; authorizing specialty diagnostic and treatment services; providing physical/occupational therapy services; and assessing compliance with CCS requirements. County/California Children’s Services and CalOptima Responsibilities Category County/California Children’s Services CalOptima/Health Networks Liaison Designate a case manager to serve as a liaison to CalOptima. CCS liaison will assist in problem identification of the day-to-day operational issues regarding the referral and eligibility process with the Health Networks and CalOptima. Meet, at a minimum, quarterly to ensure ongoing communication, resolve operational and administrative issues, and identify policy issues needing resolution at the management level. Designate a case manager to serve as liaison to CCS. CalOptima or Health Network liaison will assist in problem identification of the day-to-day operational issues regarding the referral and eligibility process with the CalOptima and its contracting Health Networks. Meet, at a minimum, quarterly to ensure ongoing communication, resolve operational and administrative issues, and identify policy issues needing resolution at the management level. Identification and Referral Shall determine C...
California Children’s Services. “CCS”) Program - A state and county program providing Medically Necessary services to treat CCS-Eligible Conditions.
California Children’s Services. Medical Eligibility for the Medical Therapy Program 22 CA ADC § 41517.5 Barclays Official California Code of Regulations Title 22. Social Security Division 2. Department of Social Services -Department of Health Services Subdivision 7. California Children's Services Chapter 3. Client Application and Eligibility Requirements Article 2. Medical Eligibility
California Children’s Services. The SELPA shall assure that a Medical Treatment Unit shall be established as part of the Interagency Agreement with California Children’s Services (CCS) consistent with State law. Jointly, the member LEAs shall contribute to these costs via the LACOE unreimbursed cost provision of this agreement.
California Children’s Services. “CCS”)-Eligible Condition - means a medical condition that qualifies a Child to receive medical services under the CCS Program, as specified in 22 CCR section 41515.1 et seq. DRAFT
California Children’s Services. (CCS) Services provided by the CCS program are not covered under this Contract. Upon adequate diagnostic evidence that a Medi-Cal Member under 21 years of age may have a CCS-eligible condition, Contractor shall refer the Member to the local CCS office for determination of eligibility.
