Disclosures I have nothing to disclose. Overview & Learning - PDF document

California Children’s Services: Nuts & Bolts Ben Meisel, MD – Medical Director CCS San Francisco 19th Annual Developmental Disabilities: An Update for Health Professionals March 5 ‐ 6, 2020 Disclosures I have nothing to disclose.

Overview & Learning Objectives ◦ History and Basics – What is California Children’s Services ◦ Eligibility ◦ Services ◦ What CCS is NOT! ◦ The Medical Therapy Program ◦ Whole Child Model vs Independent Counties vs Dependent Counties ◦ Who Can Refer to CCS and HOW? ◦ Life After 21 years old? CCS – THE BASICS The The His History ory ◦ 1927 California Crippled Children’s Program ◦ Care for children affected by Polio ◦ Dept of Health Care Services (DHCS) funding to improve medical care of children and mothers ◦ NOT the Department of Developmental Services ◦ Separately created in 1979 – Lanterman Act ◦ Regional Center Funding

CCS – THE BASICS The The Mi Missi ssion ◦ Making Pediatric Subspecialty Medical Care available to children with eligible medical conditions. ◦ Providing expert Physical Therapy and Occupational Therapy to children with qualifying neuromuscular & musculoskeletal conditions. ◦ To arrange, direct, and pay for specialized medical care, equipment, and rehabilitation for children who qualify. ◦ Improving care and decreasing costs in the long run. CCS – THE BASICS Elig Eligib ibility ility  Under 21 years of age.  Permanent resident of the California County where you apply.  Medi ‐ Cal eligible or Family income < $40,000/yr or Cost >20% AGI  Medically eligible condition “Think Chronic, Lifelong Conditions” ◦ Some examples: ◦ Cancers ◦ Sickle cell, Hemophilia, Thalassemia ◦ Intractable seizure disorder ◦ Transplants ◦ Congenital Heart disease

CCS – THE BASICS Ser Servic ices es Pr Provi ovided ◦ Specialized Treatment*: *All medical services must be done by CCS ◦ Board Certified Physician Services approved providers and at CCS approved ◦ Hospital & Surgical Care institutions, including Special Care Centers. ◦ Rehabilitation OT/PT ◦ Skilled Nursing ◦ Lab Tests, Radiology ◦ Medical Equipment, Supplies, & Medicines ◦ Medical Case Management ◦ Medical Therapy Program (MTP) PT & OT separate from public school PT/OT program ◦ High Risk Infant Follow ‐ up (HRIF) CCS – THE BASICS What What CC CCS is is NO NOT! T!  NOT Developmental, Behavioral, or Hypotonic conditions  NOT Primary Care Services  NOT Short term hospitalizations or transient health challenges

Medical Therapy Program (MTP)  Medically Necessary PT & OT services  Specific musculoskeletal or neuromuscular conditions  Not hypotonic CP  Medical Therapy Units (MTU’S) at public school sites  NO COST to the family Eligibility for Services CCS MTP  Reside in San Francisco  Reside in San Francisco  Eligible medical condition  Eligible medical condition  Under 21 yo  Under 21 yo  Financial  Based on Physical Exam by Specialist MD (Ortho/Neuro/Rehab)

CCS Case Management 3 Different Possibilities:  Independent Counties  The County Public Health Department  Whole Child Model Counties  A Contracted Medi ‐ Cal Managed Care Plan  Dependent Counties  State Employees CCS – How to Access Anyone can Refer – Normally subspecialty MD providers  Medical Providers submit a SAR Request Form  https://www.dhcs.ca.gov/formsandpubs/forms/Forms/ChildMedSvcForms/dhcs4488.pdf  Families submit an application  https://www.dhcs.ca.gov/formsandpubs/forms/Forms/ChildMedSvcForms/dhcs4480.pdf  For MTP Referral  Neurologist, Rehab, or Ortho MD note with physical exam

Life After 21yo When CCS Stops?  There is nothing for adults that replaces CCS  Few Adult Medicine offices have Case Management  Medi ‐ Cal is supposed to continue care for eligible clients  Regional Center clients get some case management support Questions

Ben “Dr. Ben” Meisel – Medical Director ◦ (415)575 ‐ 5738 ◦ Ben.Meisel@sfdph.org CONTACT US @ Katie Kim – NURSE MANAGER ◦ (415)575 ‐ 5674 ◦ Katie.Kim@sfdph.org 30 Van Ness Ave, Suite 210 San Francisco, CA 94102 (415)575 ‐ 5700