Eligibility California Children’s Services CCS Medical Therapy Unit 30

					California Children’s Services (CCS)                                 Medical Therapy Unit
30 Van Ness, Suite 210                                               1595 Quintara Street
San Francisco, CA 94102                                              San Francisco, CA 94116
(415) 575-5700                                                       (415) 759-2919

California Children’s Services (CCS) and the Medical Therapy Unit (MTU) provide
specialized medical care, physical therapy, and occupational therapy for children ages
birth to 21 years of age who have an eligible condition and meet the following program
requirements.


Eligibility           Anyone under the age of 21 who:
                       - has or is suspected of having a medical condition covered by CCS,
                       - is a resident of San Francisco, and
                       - has a family income of less than $40,000, or
                       - whose out-of-pocket medical expenses for a CCS-eligible child are
                          expected to be more than 20% of family income
                      There are no financial eligibility requirements for children who:
                       - need diagnostic services to confirm a CCS eligible medical
                          condition, or
                       - were adopted with a known CCS eligible medical condition, or
                       - are applying only for services through the Medical Therapy
                          Program, or
                       - have Medi-Cal full scope, no share of cost; or
                       - have Health Families coverage, or
                       - live on an Indian reservation.
                   (see reverse side for additional eligibility criteria)



Services           CCS may pay for or provide:
                    Treatment, such as doctor services, hospital and surgical care,
                      physical and occupational therapy, laboratory tests, X-rays, orthopedic
                      appliances and medical equipment that is related to the CCS eligible
                      condition.
                    Medical case management to help get medical specialists and care for
                      children when medically necessary, and referral to other agencies,
                      including public health nursing and regional centers.
                    Medical Therapy Program (MTP), which provides physical and/or
                      occupational therapy at treatment sites in selected public schools for
                      children who are medically eligible. Medical Therapy Conference is
                      offered as an opportunity to consult with a specialized physician in a
                      rehab team conference.


Referral              The referral should include:
& Eligibility          -a complete referral form
Documentation          -any pertinent medical reports
                      For eligibility to be determined, please provide:
                       -proof of your child’s age, i.e. birth certificate
                       -proof of your residence, i.e. rent or utility receipts
                       -documentation of your income, i.e. recent tax returns
                       -health insurance information
                  Contact CCS at 575-5700 with any questions about referral or eligibility
                  paperwork.

Timeframe for        Medical eligibility is determined within 5 days of receipt of a complete
Services              referral and thorough medical reports.
                     If eligible, family receives program application form.
                     Full application process is completed within 60 days after receipt of a
                      complete referral.
Key Staff            Medical Consultant- These physicians review the medical records to
Positions             determine medical eligibility and can request diagnostic testing if
                      necessary.
                     Eligibility worker- The eligibility worker will assist with the financial
                      and residential eligibility determination.
                     Case Manager- These Public Health Nurses assist with coordination of
                      medical care and provide authorizations for approved services.

CCS-covered Medical Conditions:

Only certain conditions are covered by CCS. In general, CCS covers medical conditions
that are physically disabling or require medical, surgical, or rehabilitative services.
Listed below are categories of medical conditions that may be covered and some
examples of each:

   Conditions involving the heart (congenital heart disease)
   Neoplasms (cancers, tumors)
   Diseases of the blood (hemophilia, sickle cell anemia)
   Endocrine, nutritional, and metabolic diseases (thyroid problems, PKU, diabetes)
   Diseases of the genito-urinary system (serious chronic kidney problems)
   Diseases of the gastrointestinal system (chronic inflammatory disease, diseases of
    the liver)
   Serious birth defects (cleft lip/palate, spina bifida)
   Diseases of the sense organs (hearing loss, glaucoma, cataracts)
   Diseases of the nervous system (cerebral palsy, uncontrolled seizures)
   Diseases of the musculoskeletal system and connective tissues (rheumatoid
    arthritis, muscular dystrophy)
   Severe disorders of the immune system (HIV infection)
   Disabling conditions or poisonings requiring intensive care or rehabilitation (severe
    head, brain, or spinal cord injuries, severe burns)
   Complications of premature birth requiring an intensive level of care
   Diseases of the skin and subcutaneous tissue (severe hemangioma)
   Medically handicapping malocclusion (severely crooked teeth)

There also may be certain criteria that determine if a child’s medical condition is
eligible.
There is a separate list of eligible conditions for the Medical Therapy Program.
The CCS office can answer questions.

				
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posted:12/6/2011
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