California Children’s Services

Cal. HSC § 123929

California Statutes

(

a) Except as otherwise provided in this

section and

Section 14133.05 of the Welfare and Institutions Code, California Children’s Services Program services provided pursuant to this

article require prior authorization by the department or its designee. Prior authorization is contingent on determination by the department or its designee of all of the following:

(1) The child receiving the services is confirmed to be medically eligible for the CCS program.

(2) The provider of the services is approved in accordance with the standards of the CCS program.

(3) The services authorized are medically necessary to treat the child’s CCS-eligible medical condition. (

b) The department or its designee may approve a request for a treatment authorization that is otherwise in conformance with subdivision (

a) for services for a child participating in the Medi-Cal program pursuant to

Section 14005.26 of the Welfare and Institutions Code or the Medi-Cal Access Program pursuant to

Chapter 2 (commencing with

Section 15810) of

Part 3.3 of Division of the Welfare and Institutions Code, received by the department or its designee after the requested treatment has been provided to the child. (

c) If a provider of services who meets the requirements of paragraph (2) of subdivision (

a) incurs costs for services described in paragraph (3) of subdivision (

a) to treat a child described in subdivision (

b) who is subsequently determined to be medically eligible for the CCS program, as determined by the department or its designee, the department may reimburse the provider for those costs. Reimbursement under this

section shall conform to the requirements of

Section 14105.18 of the Welfare and Institutions Code. (d)

(1) By July 1, 2016, or a subsequent date determined by the department, requests for authorization of services, excluding requests for authorization of services submitted by dental providers enrolled in the Medi-Cal Dental program, shall be submitted in an electronic format determined by the department and shall be submitted via the department’s Internet Web site or other electronic means designated by the department. The department may implement this requirement in phases.

(2) The department shall designate an alternate format for submitting requests for authorization of services when the department’s Internet Web site or other electronic means designated in paragraph (1) are unavailable due to a system disruption.

(3) Notwithstanding

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code, the department may, without taking regulatory action, implement, interpret, or make specific this subdivision and any applicable waivers and state plan amendments by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions. Thereafter, the department shall adopt regulations by July 1, 2017, in accordance with the requirements of

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code. The department shall consult with interested parties and appropriate stakeholders in implementing this subdivision.

Document details

CollectionCalifornia Statutes
CitationCal. HSC § 123929
Date2017-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierHSC123929.20167335

California Children’s Services

Cal. HSC § 123929

California Statutes

California Children’s Services

Cal. HSC § 123929

California Statutes

(

a) Except as otherwise provided in this

section and

Section 14133.05 of the Welfare and Institutions Code, California Children’s Services Program services provided pursuant to this

article require prior authorization by the department or its designee. Prior authorization is contingent on determination by the department or its designee of all of the following:

(1) The child receiving the services is confirmed to be medically eligible for the CCS program.

(2) The provider of the services is approved in accordance with the standards of the CCS program.

(3) The services authorized are medically necessary to treat the child’s CCS-eligible medical condition. (

b) The department or its designee may approve a request for a treatment authorization that is otherwise in conformance with subdivision (

a) for services for a child participating in the Medi-Cal program pursuant to

Section 14005.26 of the Welfare and Institutions Code or the Medi-Cal Access Program pursuant to

Chapter 2 (commencing with

Section 15810) of

Part 3.3 of Division of the Welfare and Institutions Code, received by the department or its designee after the requested treatment has been provided to the child. (

c) If a provider of services who meets the requirements of paragraph (2) of subdivision (

a) incurs costs for services described in paragraph (3) of subdivision (

a) to treat a child described in subdivision (

b) who is subsequently determined to be medically eligible for the CCS program, as determined by the department or its designee, the department may reimburse the provider for those costs. Reimbursement under this

section shall conform to the requirements of

Section 14105.18 of the Welfare and Institutions Code. (d)

(1) By July 1, 2016, or a subsequent date determined by the department, requests for authorization of services, excluding requests for authorization of services submitted by dental providers enrolled in the Medi-Cal Dental program, shall be submitted in an electronic format determined by the department and shall be submitted via the department’s Internet Web site or other electronic means designated by the department. The department may implement this requirement in phases.

(2) The department shall designate an alternate format for submitting requests for authorization of services when the department’s Internet Web site or other electronic means designated in paragraph (1) are unavailable due to a system disruption.

(3) Notwithstanding

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code, the department may, without taking regulatory action, implement, interpret, or make specific this subdivision and any applicable waivers and state plan amendments by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions. Thereafter, the department shall adopt regulations by July 1, 2017, in accordance with the requirements of

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code. The department shall consult with interested parties and appropriate stakeholders in implementing this subdivision.

Document details

CollectionCalifornia Statutes
CitationCal. HSC § 123929
Date2017-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierHSC123929.20167335