项目描述​​ 

CCS 计划为 21 岁以下患有 CCS 合格疾病的儿童提供诊断和治疗服务、医疗病例管理以及物理和职业治疗服务。 符合 CCS 条件的疾病包括但不限于囊性纤维化、血友病、脑瘫、心脏病、癌症、创伤和产生严重后遗症的传染病等慢性疾病。 CCS 还提供在公立学校进行的医疗服务。​​ 

To qualify for the CCS program, a child must have a CCS-eligible condition, reside in California and meet financial eligibility. CCS financial eligibility is not limited to families earning $40,000 or less. Families with an adjusted gross income (AGI) of $40,000 or less may qualify, but those with higher incomes may still be eligible if their child’s medical expenses are very high. Children enrolled in Medi-Cal may qualify for CCS. The Medical Therapy Program does not have an income limit and is available to all children who qualify. 
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CCS 计划由县卫生部门和加州卫生保健服务部 (DHCS) 合作管理。 目前，大约 70% 符合 CCS 资格的儿童也符合 Medi-Cal 资格。 Medi-Cal 计划将报销他们的医疗费用。 其余 30% 儿童的护理费用由 CCS Only 和 CCS Healthy Families 平均分担。 CCS Only 的护理费用由州和县平均承担。 CCS 健康家庭的护理费用由以下资金资助：65% 的联邦第 XXI 章资金、17.5% 的州资金和 17.5% 的县资金。​​ 

In addition, Insurance Code Sections 12693.62, 12693.64 and 12693.66, relating to the California’s Healthy Families Program, provides that the services authorized by the CCS program to treat a Healthy Families plan’s subscriber’s CCS-eligible medical condition are excluded from the plan’s responsibilities. The participating health plan’s responsibility for providing all covered medically necessary health care and case management services changes at the time that CCS eligibility is determined by the CCS program for the plan subscriber. The health plan is still responsible for providing primary care and prevention services not related to the CCS-eligible medical condition to the plan subscriber so long as they are within the Healthy Families program scope of benefits. The health plan also remains responsible for children referred to but not determined to be eligible for the CCS program.​​   

立法权​​ 

CCS 计划的授权立法​​ 

健康与安全法规第 123800 节及以下条款是 CCS 计划的授权法规。 CCS 计划的明确立法意图是为符合 CCS 医疗条件但父母无法全部或部分支付这些服务费用的儿童提供必要的医疗服务。 该法规还要求卫生和儿童服务部 (DHCS) 和县 CCS 计划通过与当地公共或私人机构和医疗保健提供者合作来寻找符合条件的儿童，以便将可能符合条件的儿童带到专家诊断和治疗机构。​​ 

CCS 计划受《福利和机构法规》和《加州法规》（第 22 篇第 51013 节）的授权，作为符合 CCS 医疗条件的 Medi-Cal 受益人的“Medi-Cal 代理人”。 Medi-Cal 必须将所有符合 CCS 资格的客户转介给 CCS 以获得病例管理服务和治疗授权。 该法规还要求所有符合 Medi-Cal 计划资格的 CCS 申请人申请 Medi-Cal。​​ 

项目管理​​ 

In counties with populations greater than 200,000 (independent counties), county staff perform all case management activities for eligible children residing within their county. This includes determining all phases of program eligibility, evaluating needs for specific services, determining the appropriate provider(s), and authorizing for medically necessary care. For counties with populations under 200,000 (dependent counties), the Children’s Medical Services (CMS) Branch provides medical case management and eligibility and benefits determination through its regional offices located in Sacramento and Los Angeles. Dependent counties interact directly with families and make decisions on financial and residential eligibility. Some dependent counties have opted to participate in the Case Management Improvement Project (CMIP) to partner with regional offices in determining medical eligibility and service authorization. The regional offices also provide consultation, technical assistance, and oversight to independent counties, individual CCS paneled providers, hospitals, and the Special Care Centers within their region.​​ 

资金描述​​ 

县级 CCS 计划的资金来源是县级、州普通基金和联邦政府拨款的组合。 1992 年通过的重新调整法案 AB 948 规定，州和县的 CCS 项目必须通过州普通基金和县资金的分配，分担为身体残疾儿童提供专门医疗护理和康复的费用。 每年通过《预算法案》确定可用于 CCS 计划的州政府资金数额。​​