CCS services
The San Francisco CCS program provides 2 distinct services
- Medical case management services for all medically, residentially and financially eligible children and youth with CCS-eligible conditions.
Direct physical therapy (PT) and occupational therapy (OT) services for all San Francisco children who have a Medical Therapy Program (MTP)-eligible medical condition.
There is no financial eligibility requirement for the CCS Medical Therapy Program (MTP)
Steps to receiving CCS services
Step 1: Referral
Anyone can refer a child or youth to CCS, such as the child or youth themselves, parents, caregivers, doctors, and schools.
Step 2: Diagnosis
A doctor identifies that the child or youth may have an eligible medical condition. Examples may include sickle cell disease, cerebral palsy, hearing loss, diabetes, leukemia, and many other serious conditions and disabling injuries. The doctor sends clinical document that supports the diagnosis for which the patient is being referred to CCS for review by the CCS office. When requesting Medical Therapy Program services, this must be clearly stated in communications with the CCS office.
Step 3: Application
Family/youth downloads, completes, and signs an application for CCS services, which can be submitted by fax, by mail, or in person at 333 Valencia Street, 4th Floor, San Francisco, CA 94103. Fax: (628) 217-6701.
**Please note that the application must be signed by a parent or legal guardian if the patient is a minor.**
Click here to view and complete the English CCS Application or Spanish CCS Application.
The family will then be contacted by mail to gather additional information. Additionally, CCS will include a Notice of Privacy Practices so that the client and/or family are aware of their rights and responsibilities under the Health Insurance Portability and Accountability Act (HIPAA).
Step 4: Determining Eligibility
Once the referral and clinical documents are received, the CCS team determines if the client is medically eligible for CCS services.
Once the application is received the Eligibility Worker determines whether the client is residentially and financially eligible for CCS services.
Step 5: Diagnostic Services or Treatment Services
CCS approves health care treatment services for the child or youth's eligible medical condition. If a CCS-eligible diagnosis is likely but has not yet been made, then CCS may cover diagnostic services by the appropriate CCS-paneled specialists.
Each time the child or youth needs to see a new doctor or get new medication/equipment, their medical provider will fill out a Service Authorization Request (SAR) and send it to CCS. A SAR must specify what service is being requested. All SARs are usually reviewed within 5 business days of receipt. Once approved, a copy of the SAR approval is then mailed to the home of the child or youth. Then the family/youth can schedule an appointment for the care that was approved. Some SARs can be used to access many different medical services using the same SAR approval number, provided these services are related to the CCS-eligible condition. You can contact CCS to find out the status of a SAR or if you have any questions about a SAR.
If eligible for the Medical Therapy Program, the family will receive a phone call from the Medical Therapy Program.
If a request, application, or service is denied, the family/youth will receive a Notice of Action (NOA) by mail explaining the reason for the denial and instructions on how a family can appeal the decision.
Step 6: Payment for Services
CCS authorizes services related to a child or youth's medical condition. CCS is a public health program and not a health insurance program; however, CCS coordinates with Medi-Cal/Managed Care programs and may cover certain services that are not in network for Medi-Cal Managed Care or private insurance. Claims for services that have been authorized by CCS are to be submitted directly to the State's fiscal intermediary for payment. San Francisco CCS does NOT pay medical providers directly. See the State website Authorizations and Claims for more information.
Medical eligibility
The criteria for medical eligibility for CCS case management and the Medical Therapy Program (MTP) are not the same. View an overview of CCS medical eligibility which includes the MTP medical eligibility.
Service Authorization Request (SAR)
Service Authorization Requests (SARs) may be submitted electronically (how to submit an eSAR) or by fax. You must be registered with the State to submit via eSAR. To submit by fax, complete the SAR form and fax to (628) 217-6701.
Referring providers and health care systems who are registered with the state can view the status of a CCS case or SAR on PEDI.
Medical care must be provided by a CCS-paneled provider or Special Care Center.
Become a CCS a provider
Click here for instructions for becoming a CCS provider.
Billing
CCS does not adjudicate claims. Claims are processed by Medi-Cal Fiscal Intermediary contracted by the Department of Health Care Services (DHCS). The Fiscal Intermediary can be reached at 1-800-541-5555. There are prompts for different programs. Please choose the option for California Children's Services. The Fiscal Intermediary representative will request the SAR number for the billing process. For more information please visit Billing Questions.
Contact us
Please call us at (628) 217-6700 with any questions.