123929 < EXCLUSIVE • Cheat Sheet >

CCS is usually the primary authorizer for the specific eligible condition.

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:

While "prior" authorization is the rule, certain emergency services may be authorized retroactively if they meet specific criteria defined in the CCS Manual of Procedures. 4. Denials and Appeals If a SAR is denied under Section 123929: 123929

Below is a guide to understanding the requirements and implications of this section based on the CCS Administrative Case Management Manual. 1. The Core Mandate: Prior Authorization

In the context of California health and safety laws, concerns the prior authorization process for services provided under the California Children's Services (CCS) program. CCS is usually the primary authorizer for the

The service must directly treat the CCS-eligible condition or a complicating condition associated with it.

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 Interaction with Medi-Cal For children who are dually

Documentation must prove the requested service is the most appropriate and cost-effective treatment.