1. 1 Other State Programs: CCS, GHPP and CHDP

2. 2 CCS - California Children Services Started in 1927 California’s program for providing diagnosis, treatment, and rehabilitation services to children diagnosed with certain physically disabling medical conditions What is CCS?

3. 3 Identify children who need specialized medical care. Encourage families with physically handicapped children to obtain health services. The Goals of the CCS program are to: CCS patients must be followed by a CCS-approved physician Patients with CCS conditions are referred to and case managed by the CCS program regardless of their payor source.

4. 4 In San Diego, most of the CCS patients will receive their services at Children’s Hospital and Health Centers. How do we manage these programs at UCSD? The only cases UCSD manages are newborns and children needing dialysis and burn treatment.

5. 5 Under 21 years old Has or may have a medical condition that is covered by CCS Is a resident of California and Has a family income of $40,000 or less as reported as the adjusted gross income on the state tax form or The out-of-pocket medical expenses for a child who qualifies are expected to be more than 20 percent of family income or The child has Healthy Families coverage Who is eligible for coverage? Anyone who is :

6. 6 In general, CCS covers medical conditions that are: physically disabling or require medical, surgical rehabilitative services. What is considered a CCS-eligible condition? There are also some other criteria to see if the patient is eligible but CCS makes the final determination.

7. 7 CCS Identification card Medi-Cal Benefit Identification Card (BIC) Or other health plan identification card (if they have additional coverage) How do I identify the patient? CCS patients will have:

8. 8 Patient’s Name Patient’s Date of birth CCS State File Number Covered Diagnosis Effective Dates What information do I need? CCS card will have the following information:

9. 9 CCS Card Name

10. 10 Hillcrest is a CCS certified facility – (provides diagnostic, treatment, burn and dialysis services to children referred and approved by CCS program) Thornton Hospital is not a CCS certified facility- (therefore the CCS program will not cover services provided there) What coverage is provided at UC San Diego Health System?

11. 11 There are 3 ways to verify CCS eligibility: CCS ID card has the case eligibility dates documented on it. RTE and Medi-Cal Web site Call County CCS Offices (List of phone numbers are on the page) How do I verify if a patient is eligible for services? San Diego County – 619-528-4000 Los Angeles County – 800-288-4584 Orange County – 714-347-0300 Imperial County – 760-482-4434

12. 12 Initial screening does not require authorization. However, prior authorizations are required for scheduled inpatient admissions and some diagnostic treatment, and outpatient procedures. Once CCS has certified a patient’s diagnosis, physicians visits related to that diagnosis DO NOT require separate authorization AS LONG as the patient’s CCS case with the State remains open. What are the authorization requirements?

13. 13 There are no out of pocket expenses for CCS patients. What are the out of pocket responsibilities? If the patient has CCS and Medi-Cal with a Share of Cost, the Medi-Cal program will require that the patient pay prior to paying the claim. Registration SHOULD NOT collect or obligate the patient ‘ s Medi-Cal Share of Cost On the other hand, if the patient has other health care coverage on top of CCS that requires a copayment, then we can collect that amount

14. 14 GHPP – Genetically Handicapped Persons Program A program that generally covers specialty medical expenses for adults with specific genetic diseases What is GHPP? The goals are to help each patient achieve the best level of health and functioning possible through: Early identification and enrollment in the program. Prevention and treatment services from highly skilled comprehensive special care center teams. Ongoing care in the home community provided by qualified physicians and other health professionals.

15. 15 A patient must be: 21 years of age A resident of California Diagnosed with a GHPP covered condition Who is eligible for the coverage? GHPP also serves children under the age of 21 with GHPP eligible medical conditions who are not financially eligible for CCS.

16. 16 GHPP will have a card that will identify that they are covered by the GHPP Program We will need: Identification Card Certification Dates How do I identify the patient and what information do we need?

17. 17 Hospital inpatient and outpatient services (including x-ray, laboratory, and other diagnostic services) Physician Services Prescription medications (including food supplements) Durable Medical Equipment, Prosthetics, and medical supplies Physical, Occupational, and Speech Therapy Psychosocial services and referrals How do I identify what coverage the pt has? All patients covered by GHPP have the following benefits:

18. 18 UCSD is considered a Special Care Center for GHPP conditions. What coverage is provided at UC San Diego Health System? Diagnostic and treatment services including physical and occupational therapy services are provided by UCSD.

19. 19 Standard Medi-Cal Medi-Cal Managed Care Medicare, or a private/group insurance coverage. What other coverage might a patient have? A patient may also have: When the patient has other coverage, it must be billed prior to billing GHPP.

20. 20 GHPP eligibility will show in the Medi-Cal eligibility responses from RTE and the Medi-Cal web-site. How do I verify if a patient is eligible for services?

21. 21 Medi-Cal ID Number or Social Security Number Required information to run RTE

22. 22 CCS & GHPP RTE response