Documentation must prove the requested service is the most appropriate and cost-effective treatment.
CCS is usually the primary authorizer for the specific eligible condition. 123929
Families have the right to request a Fair Hearing or an informal grievance review if they disagree with the authorization decision. 5. Interaction with Medi-Cal For children who are dually eligible for Medi-Cal and CCS: Documentation must prove the requested service is the
The service must directly treat the CCS-eligible condition or a complicating condition associated with it. This means that before a medical service, piece
Section 123929 establishes that services provided to a child through the CCS program generally require from the department or its designated agency. This means that before a medical service, piece of equipment, or treatment is provided, a Service Authorization Request (SAR) must be submitted and approved. 2. The SAR Process
If CCS denies a service because it is not for the eligible condition, the provider may then need to seek authorization through the standard Medi-Cal process (e.g., via a Treatment Authorization Request).
The denial must state the specific reason (e.g., "service does not treat the CCS eligible condition").