Referral to CCS

The California Children's Services (CCS) program accepts referrals for eligibility determination from any source (for example, specialist, teacher or parents). Providers may use the California Children's Services Referral form (PDF). Completed forms may be submitted via mail or fax to CCS. Los Angeles (LA) county also requires the LA County CCS Fax Cover Sheet (PDF) when submitting a CCS referral.

A new referral may be sent on a CCS-GHPP SAR (PDF) form or in a letter including all of the following information: 

• Member's name.
• Member's date of birth.
• Name, address and phone number of the parent or legal guardian.
• Medical condition.
• Description of services/procedures being requested.
• Name if CCS-paneled provider and phone number.
• Name, address and phone number of the referral source.

Primary care physicians (PCPs), specialists and participating physician group (PPG) staff must refer potentially eligible children to CCS within 24 hours of identification and inform the parent or legal guardian. Hospitals must refer potentially eligible children to CCS within 24 hours of inpatient admission and inform the parent or legal guardian of the referral to the CCS program.

Referrals to CCS must include:

• Completed CCS SAR form or letter with required information.
• Medical history with sufficient medical information to ascertain the evidence or suspicion of a CCS-eligible condition.
• Recent medical records pertaining to eligible diagnosis or condition.
• Description of services being requested.
• Name of CCS-paneled provider who will perform the requested services (if known).
• Name and phone number of the referral source.
• Completed CCS Application for Service form (if available at the physician's office at the time of referral).

Providers referring a member that has an existing or previously closed case with CCS should make a new referral using the Established CCS-GHPP Client SAR (PDF).

The following are examples of the type of medical documentation that should be included with the CCS referral for some various diagnoses:

• Cerebral palsy - Detailed medical reports documenting the findings from a complete physical and neurological exam.
• HIV infection - Laboratory test results.
• Lead poisoning - Documentation confirming a blood level of 20 micrograms per deciliter or above.
• Scoliosis - X-ray reports showing a curvature of the spine greater than 20 degrees.

On receipt of a referral, the county CCS program sends a CCS program application and service agreement to the family.