CCS FAMILIES

County of Los Angeles

Department of Public Health

Children’s Medical Services

CCS FAMILIES

CALIFORNIA CHILDREN’S SERVICES

Phone: (800) 288-4584

Fax: (855) 481-6821

www.publichealth.lacounty.gov/cms/ccs.htm

Printed by the Los Angeles County Department of Public Health, Children’s

Medical Services (CMS), California Children’s Services.

Para copias en español, llame al (800) 288-4584.

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Table of Contents

Welcome to CCS

Partnering with CCS ....................................................... 5

What is CCS? .................................................................. 6

How is a child eligible for CCS Services? ........................ 7

Fees and applicaon ..................................................... 8

CCS Services

Care coordinaon (by a Nurse Case Manager) ........9-11

Diagnosc services ...................................................... 12

Treatment services ...................................................... 12

Special Care Centers (SCCs) ......................................... 13

Medical Therapy Program (MTP) services..............14-15

Other services ............................................................. 16

Using CCS Services

What is a Service Authorizaon Request (SAR)? ....17-18

Will my child need to change doctors? ....................... 19

What if I do not agree with a CCS decision? ............... 20

The appeal process ...................................................... 20

The annual review ....................................................... 21

Case closure ................................................................ 21

Transion ..................................................................... 22

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Welcome to CCS

(California Children’s Services)

We care about your child’s health!

We hope this booklet will help you understand:

 the CCS program

 how you can partner with CCS

 the services CCS oers

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How Does CCS Partner with You?

We pledge to:

 treat you with respect.

 give you the informaon and support needed for your

child’s health and well-being.

 work with you to provide high-quality healthcare for

your child.

This is what we call Patient-Family Centered Care.

We believe the best way to care for a child is to help

the family.

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What Is CCS?

Across the state, CCS pays for medical

care and therapy services for children

under 21 years of age who have certain

healthcare needs. Care is provided by

doctors, hospitals, and related

healthcare professionals. In Los Ange-

les County, CCS is run by the LA County

Department of Public Health (DPH),

Children’s Medical Services (CMS),

which is a part of the California De-

partment of Health Care Services

(DHCS).

CCS is the “payor of last resort.” That means: if you have private

insurance coverage, the insurer is responsible for paying for the

services before CCS can pay.

There are two types of services which may be oered to your

child. Your child may be eligible for one or both.

1. The General Program coordinates care that is related to

the CCS-eligible condion.

2. The Medical Therapy Program (MTP) oers therapy

services for your child’s CCS-eligible condion.

CCS is not the Department of Children and Family Services

(DCFS). CCS is a program that supports the care of children

with special healthcare needs.

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How Does a Child Become

Eligible for LA County

CCS Services?

Your child gets CCS services because s/he meets all four CCS

eligibility rules:

1. Age-eligible: The child or young adult is under 21 years of age.

2. Residenally eligible: The child

lives in Los Angeles County. Each

county in California has a CCS

program, and if you move to

another county, we will help you

transfer to that county’s CCS

program.

3. Medically eligible: The child has a medical condition that is

covered by CCS. This is called having a “CCS-eligible condition.”

Your child’s doctor should be able to identify if your child’s

condition might be eligible for CCS.

CCS covers many serious health and physical conditions. CCS

only pays for services for the eligible conditions. If your child

has other medical needs, we will do our best to help you find

resources in your community to address these needs.

More informaon about CCS and the medically eligible

conditions can be found online at: www.dhcs.ca.gov/services/ccs

or you can call (800) 288-4584 if you have questions.

Continued on page 8

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4. Financially eligible:

One of the following condions must be met:

 The child has full scope Medi-Cal coverage or is eligible for

full scope Medi-Cal.

 The family’s Adjusted Gross Income (AGI) is less than

$40,000 per year.

 The family’s AGI is $40,000 or higher, but they would spend

20% or more on medical services for the child’s CCS-eligible

condion without CCS.

Families who meet the income qualicaon

must also apply for Medi-Cal.

Fees and Application

Fees

Please note that some families may be required to pay:

 an annual assessment fee of $20 and

 an annual enrollment fee, using a sliding scale based on

family income and size.

A family in need can ask us to lower or “waive” these fees if there

is nancial hardship.

Applicaon

CCS will require a signed applicaon before services can be pro-

vided.

A parent can get an applicaon form from:

 your child’s doctor, or his/her sta

 hospital sta

 calling CCS

 hp://www.dhcs.ca.gov/services/ccs/Pages/apply.aspx

If you have quesons about your nancial or residenal

eligibility, you can ask your Nurse Case Manager (see page 9)

or speak with a nancial worker. Call (800) 288-4584 to be

transferred to them directly.

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Care Coordination

Your Nurse Case Manager (NCM)

Your partner in the CCS system is your Nurse Case Manager (NCM).

You will be notified by mail on who your child’s assigned NCM is and

how to contact him/her. Please call your NCM when you have ques-

tions about your child’s care. If your NCM cannot talk with you right

away, leave a detailed message and include your child’s name, your

phone number, and your child’s CCS number. If you don’t hear back

from your NCM after 3 business days, please call the (800) 288-4584

for assistance.

If your call is urgent, and your NCM is not available, you can also

ask for his/her supervisor. Our goal is that you have an ongoing

partnership with your NCM to meet your child’s healthcare needs.

If you don’t know who your NCM is, call (800) 288-4584 to nd out.

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Your NCM’s role is to work with you to coordinate your child’s CCS

services. Your NCM relies on your child’s doctor’s reports to make

decisions. With the information in the reports, the NCM will author-

ize doctors that have been approved by the CCS program (known as

“paneled doctors”) to provide treatment and other services. See

pages 17-18 for more information on authorizations.

The NCM is available to talk with you about any concerns you may

have about your child. It is important to feel comfortable talking

with your child’s NCM.

If you nd it hard to talk with your NCM, ask to speak with a Nurse

Supervisor.

You are welcome to call your NCM during oce

hours. We are here to help you with ANY quesons

about the program.

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Please help by asking your child’s doctor to send your child’s

reports to the NCM as soon as possible. Remember to keep a

copy for your own record. If you have this informaon, you can

send a copy to CCS if the doctor’s report is delayed or missing.

Contact your NCM if your child’s healthcare needs change. Re-

member, it is also important to call your NCM with any changes of

personal informaon, such as phone number, address or insurance.

We have interpretaon services available. Call (800) 288-4584 and

nofy the representave of which language you are able to speak.

Your NCM can also help you nd resources outside of CCS, such as

Regional Center, family resource centers, or available through your

child’s school.

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Diagnostic Services

CCS may be able to pay for doctor visits and tesng to see if your

child has a CCS-eligible condion. Your NCM can help you if you

have quesons about this.

Treatment Services

CCS pays for medical treatment for your child’s CCS-eligible

condion, including:

 Doctor visits

 Emergency room care

 Hospital stays

 Surgery

 Medicaon

 Special equipment

 Other medically

necessary services

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Special Care Centers

Your child may receive services at a Special Care Center (SCC), ap-

proved by CCS. A SCC is a clinic where a team of doctors and other

professionals (like nurses, therapists, and social workers) work to-

gether with your family to help provide treatment for your child.

The following types of centers of SCC’s may provide services based

on your child’s healthcare needs:

• Bone Marrow Transplant Center

• Burn Center

• Cardiology (Heart) Center

• Cle Palate Center

• Craniofacial Center

• Cysc Fibrosis & Lung Disease Center

• Communicaon Disorders Center

• Endocrine Center

• Epilepsy Center

• Gastrointesnal Center

• Heart Surgery Center

• Heart and Lung Transplant Center

• Hematology/Oncology Center

• Rehabilitaon Center

• Immunology/Infecous Disease (including AIDS) Center

• Metabolic and Endocrine Center

• Musculoskeletal/Neuro-Musculoskeletal Center

• Hemophilia Center

• Renal (Kidney) Dialysis and Transplant Center

• Rheumatology Center

• Liver Transplant

• Sickle Cell Center

• Neurological Diseases Center

• Speech and Hearing Center

• Spina Bida Center

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Medical Therapy Program (MTP)

Services

Children with physical disabilies may get help through the CCS

Medical Therapy Program (MTP). The MTP provides direct care,

working one-on-one with your child.

Medical eligibility for MTP services is dierent from the general

CCS program. Not all children who have CCS coverage are eligible

for MTP services.

Services are provided at sites known as Medical Therapy Units

(MTUs), which are located in public schools. Physical and occupa-

onal therapy, along with other services may be oered, depend-

ing on your child’s healthcare needs.

If your child needs a referral to a MTP, your doctor or NCM can help.

If your child is eligible for MTP services, you may be assigned a

different NCM who will continue to coordinate all your child's care.

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If your child is eligible for MTP services, it may take several weeks

for child’s referral to be processed before he/she can begin

services at their assigned MTU. Once your referral is processed,

you will receive more informaon about the MTP at your rst

meeng with the therapy sta.

The physical and occupaonal therapy CCS provides through

the MTU is free, regardless of the family’s income. There is no

nancial eligibility requirement for MTP services.

The therapy that CCS provides is usually dierent from what the

school provides. That is because CCS provides therapy which

focuses on your child's medical needs, while the school provides

therapy for your child’s educaonal needs and goals.

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Other Services

Families caring for a child with a CCS-eligible condion may need

other kinds of help. For example,

Counseling Support Services:

Your child or someone in your family might need to talk with

someone about how your child’s condion is aecng their life.

Ask your child’s NCM about counseling support services through

the CCS Social Work Unit at (626) 569-6231.

Ask your child’s NCM if you need any of these services!

Food and lodging (long distance travel and hospital stays):

Somemes families have to travel a very long distance to receive

outpaent and/or hospital care. In some cases, we may help

families with food and lodging.

Transportaon:

If it is hard for you to get your

child to medical care provided by

CCS, talk to your NCM. In some

cases, we may be able to arrange

transportaon for you and your

child.

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Using CCS Services

What is a Service Authorizaon Request (SAR)?

You will hear the term “SAR” used by the medical sta and/or CSS

sta. SARs allow CCS to authorize payment for services for your

child’s CCS-eligible condion. This may include doctors, hospitals,

Special Care Center (SCC) services, medicaon, or medical

equipment and supplies.

When possible, CCS will try to authorize payment of services from

your doctor or SCC of your choice. It may take 1-2 weeks to

receive the SAR leer in the mail, aer your NCM approves it.

If urgent or emergency care is needed, your

provider or the hospital can contact your NCM.

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It is important for you to keep the authorizaon

leer! You may need to show it to your doctor or

pharmacist.

The authorizaon has an expiraon date, so always be sure to

check the date before making a doctor’s appointment.

Be sure all your child’s providers know that

he or she has CCS coverage!

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When Approved for CCS Services,

Will My Child Need

to Change Doctors?

Maybe, because CCS is only allowed to pay for doctors who are

approved by the State CCS Program (“CCS-paneled”).

CCS paneled means that these doctors have passed through a

special application process and show that they have the knowledge

and experience to care for children with CCS-eligible condions.

Many doctors who treat children with special healthcare needs

are already CCS-paneled. (You may ask your child’s doctor if he or

she is “CCS-paneled,” or you can call us to nd out , and/or if you

need to change to another doctor.)

If you do not have a doctor or you need to change doctors, we will

help you nd one.

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What Can I Do If I Don’t Agree

with a CCS Decision?

Most of the me you and CCS will agree on the services your child

needs, but somemes CCS may deny a request from you or your

doctor. If a service request is denied, you will receive a leer

called a Noce of Acon (NOA). If you disagree with this decision,

you have the right to appeal.

Appeal Process

The NOA will come with detailed instrucons on how to appeal.

Remember to:

• Send your appeal to us in wring with the following informaon:

 what decision you are appealing

 what you would like CCS to do

 any other informaon that you think is important

• Be sure to sign your leer.

• Send your appeal within 30 days of the date on the NOA leer

to:

Program Director

California Children’s Services

9320 Telstar Avenue, Suite 226

El Monte, CA 91731

You can get further informaon about how to appeal from your

NCM. There are also community resources that can help you write

and submit an appeal leer. CCS will respond to your appeal

within 21 days.

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The Annual Review

Case Closure

CCS services end when:

 Your child no longer has a CCS-eligible condion because

the condition has changed or treatment has been completed

 Your child is no longer nancially eligible because the fami-

ly’s AGI has changed

 Your child turns 21 years old

 You move outside the state of California

CCS services may also end if your child’s Medi-Cal coverage

changes—talk to your NCM if this happens.

Rest assured that we can always re-open your child’s case if

your family meets the age, medical, nancial and residenal

eligibility requirements (see page 7-8).

Ninety (90) days before your

child’s anniversary of his/her

start date with CCS, we review

your child’s medical reports to

be sure he/she is geng all the

needed services.

We will also check to see if your

child sll meets medical and

nancial eligibility. Somemes,

aer review, the NCM may

determine that your child is no

longer eligible for the CCS

program. If this happens, you

will receive a leer from CCS.

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Transition

There will be changes in your child’s health care when s/he

turns 21. Your child will transion out of the CCS program at

that me. CCS sta wants to help you and your child get

ready for this important milestone. Your NCM will start plan-

ning with your family when your child reaches 18, or at 16 if

they are in the Medical Therapy Program. Your clinical sta

will want to help you begin planning for the following:

 Health coverage - Will your child’s insurance/coverage

change? What will those changes be?

 Primary care doctor - Do you know who your child will

use?

 Specialty care - Do you have an adult care specialist for

your young adult’s health condion(s)?

 Medicaons, medical equipment and other supplies - Do

you know where to get them?

 Living arrangements - Where will s/he live?

 Legal decisions - Do you know what legal decisions need

to be made and who will make them?

 Recreaonal, social, educaonal and other acvies -

How will your child be able to nd and join in them? And,

 Other services- What other services will s/he need?

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Notes

______________________________________________

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IN CASE OF EMERGENCY

 Call 911 or

 Take your child to ANY emergency room or

 Contact your doctor

Our main oce is open Monday-Friday, 8am-5 pm

and is closed on weekends and holidays.

Los Angeles County CCS, Children’s Medical Services

9320 Telstar Avenue, Suite 226, El Monte, CA 91731

Telephone: (800) 288-4584 Fax: (855) 481-6821

www.publichealth.lacounty.gov/cms/ccs.htm

This book belongs to:__________________________________

and:________________________________________________

CCS number:_________________________________________

Start/Annual Review Date:______________________________

CCS Nurse Case Manager (NCM): ________________________

NCM Phone:_________________________________________

If you do not know who your NCM is, call (800) 288-4584 to nd out.

Child

Parent/Legal Guardian

Developed in collaboraon with the Family Resource Center Network of

Los Angeles County (FRCNLAC)/Family Voices and

Paent and Family Centered Care Partners (PFCC Partners).