California Children’s Services (CCS)

The CCS Whole Child Model (WCM) program incorporates children’s Medi-Cal and CCS benefits under the Alliance to provide comprehensive health care for children with complex and chronic medical issues. The program aims to help CCS children and their families get better care coordination, access to care and health results.

The Alliance provides nursing case management, care coordination and social work support to improve overall care for children who are part of the WCM program. Alliance staff can help families enrolled in CCS by:

• Showing them how to use and pay for medical treatment and services through the Whole Child Model.
• Explaining their child’s medical condition and recommending specialists who can treat it.
• Helping families apply for social services like Supplemental Security Income (SSI), food stamps, housing services and other medical programs.
• Helping families resolve concerns or complaints about their child’s medical care.
• Helping families use services and file appeals if their child is not approved for care.

CCS Whole Child Model services include:

• Medical and behavioral health treatment.
• Diagnostic services.
• Medical case management.
• Physical and occupational therapy services.

Pharmacy

Pharmacy benefits and authorization requirements for CCS WCM members are the same as those for Medi-Cal members. See the member pharmacy page for details.

Case Management

The Alliance provides Complex Case Management and Care Coordination services to CCS-eligible Alliance Medi-Cal members who need assistance. For details, see the Complex Cases page.

NICU

The Alliance will authorize Neonatal Intensive Care Unit (NICU) stays based on the CCS policy for Medical Eligibility for Care in a CCS-approved NICU.

Authorization will only be provided for the level of services for which a NICU has been approved by DHCS. If the NICU is not CCS-approved, or if the level of care that is required by the member is above the NICU level of approval, the hospital must follow CCS guidelines for Stabilization, Transfer and Transport of a CCS-Eligible NICU Patient.

Behavioral Health

CCS members are covered for the evaluation and treatment of behavioral health diagnoses when related to a CCS medically eligible condition. The Alliance partners with Carelon Behavioral Health to provide these services. Members can either be referred by their provider or call Carelon directly at 855-765-9700.

Covered behavioral health services include:

• Individual assessment and psychotherapy.
• Psychological and neuropsychological testing.
• Family therapy with the child present.
• Group therapy.
• Crisis intervention.

For more information on services provided by Carelon Behavioral Health, see the Behavioral Health page.

County CCS offices determine a child’s eligibility for the program. Providers should send program referrals to their respective county’s CCS office:

• Merced County
• Monterey County
• Santa Cruz County

The child also needs to be seen by paneled providers. See below for more information.

Providers who are interested in participating in the CCS program must fulfill CCS requirements by provider type, as shown on the DHCS website.

The process to become CCS-paneled is relatively simple. To get started, fill out the online application on the DHCS CCS provider paneling website. Provider paneling training and support materials are also available on the site.

Authorizations

The Alliance will review Referral Requests and Treatment Authorization Requests (TARs) to determine authorization for CCS-eligible members. For more information, see the Referrals and Authorizations page.

Claims, Billing and Payment

The Alliance processes claims for all CCS-eligible Medi-Cal members according to standard policies and procedures with the following additions:

• CCS diagnosis code should only be listed on claims when treating the CCS condition.
• TAR or prior authorization numbers are required on the claim for claims processing.

For details, see the Claims page.