26-1204 California Children's Services Referral and Care Coordination Requirements

Date: 10/21/26

Same-day referral required for members with CCS-eligible conditions

Effective immediately, providers must follow new California Department of Health Care Services (DHCS) requirements when identifying, evaluating, and referring members who may qualify for California Children’s Services (CCS) or Medical Therapy Program (MTP) services.

What providers must do

When you identify a member who may have a CCS-eligible or MTP-eligible condition, you must:

1. Complete an appropriate health assessment and diagnostic evaluation.
2. Document sufficient clinical information to establish or raise reasonable suspicion of a qualifying condition.
3. Submit a referral to the member's county CCS program on the same day the evaluation is completed.

Referral requirements

Providers must:

• Submit a separate referral for each suspected CCS-eligible or MTP-eligible condition.
• Use the appropriate Service Authorization Request (SAR) form:
  • For members new to CCS: New CCS/GHPP Client Service Authorization Request (SAR).(PDF)
  • For members already enrolled in CCS: Established CCS/GHPP Client Service Authorization Request (SAR).(PDF)
• Submit referrals using a method approved by the county CCS program.
• Ensure an in-person evaluation by a CCS-paneled physician was completed within the previous 12 months and documents the qualifying condition and required physical findings.

Questions regarding directed review requests may be submitted to CCS Directed Review.

CCS care coordination responsibilities

Providers should:

• Coordinate CCS-authorized services with other medically necessary services.
• Communicate with participating physician groups (PPGs), care management teams and county CCS programs.
• Support continuity of care between CCS and non-CCS services.

Once a CCS case is opened, the CCS program assumes responsibility for authorization and coordination of CCS-covered services.

Access CCS Service Authorization Request information

PPGs may request access to the Provider Electronic Data Interchange (PEDI) system for real-time visibility into CCS SAR activity.

To request PEDI access, contact the  CCS Liaison Team at 844-925-0962.

Transition planning requirements

Effective immediately, the Plan and PPGs must maintain policies and procedures to identify CCS and MTP members transitioning out of the program.

Beginning at age 17

The Plan and PPGs must collaborate with the county CCS program to develop a transition plan that includes:

• An adult specialist, medical group or medical home.
• An authorized representative or legal guardian, if applicable.
• Coordination with the member's primary care provider (PCP).
• All CCS members, members with complex medical needs or Enhanced Care Management (ECM)/Community Supports (CS) referrals.
  • Complete the CalViva Health Care Management Referral form.

By age 20

The Plan and PPGs must collaborate with the county CCS program to finalize an exit summary and transition plan.

The exit summary must be shared with:

• The member.
• The member's authorized representative or guardian, if applicable.
• The member's PCP.
• All CCS members, members with complex medical needs or ECM/CS referrals.
  • Complete the  CalViva Health Care Management Referral form.

Community resources for members and families

Providers may connect members and families with community-based resources and support services, including:

• Educational and developmental services through local educational agencies (LEAs), Regional Centers and early intervention programs.
• Care management and social services, including ECM, CS, county social services programs and foster care resources.
• Behavioral health and substance use disorder services.
• Medi-Cal Waiver Program and nutrition assistance programs, including Women, Infants and Children (WIC).
• Foster care, refugee health and child welfare resources.

For additional information, refer to the applicable DHCS resource directories and community programs.

Need help? Contact us

For questions about CCS referrals, provider paneling requirements or CCS processes, contact the CCS Liaison Team at 844-925-0962, or CCS directly using the CCS county office list for the county where the member resides.

For all other questions, contact CalViva Health at 888-893-1569.
 

This information applies to Physicians and Practitioners, Participating Physician Groups (PPGs), Hospitals, and Ancillary Providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.