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26-1205 California Children's Services Referral and Care Coordination Requirements
Effective date
Oct 21, 2026
Identified
Oct 22, 2026
Summary
Community Health Plan of Imperial Valley implemented new California Children's Services (CCS) referral and care coordination requirements, effective immediately. Providers must now submit same-day referrals to county CCS programs when identifying members with CCS-eligible or Medical Therapy Program (MTP)-eligible conditions, and establish transition planning procedures beginning at age 17 and finalizing by age 20.
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What to do
Action · 10 steps
01Providers and billing teams must implement the following immediately.
02Establish workflow to identify members with CCS-eligible or MTP-eligible conditions during evaluation.
03Complete appropriate health assessments and diagnostic evaluations with sufficient clinical documentation.
04Submit separate referrals to the member's county CCS program on the same day evaluation is completed using the appropriate Service Authorization Request (SAR) form—either the New CCS/GHPP Client Service Authorization Request (SAR) for members new to CCS or the Established CCS/GHPP Client Service Authorization Request (SAR) for members already enrolled.
05Verify in-person evaluation by a CCS-paneled physician was completed within the previous 12 months.
06Coordinate with participating physician groups (PPGs), care management teams, and county CCS programs to support continuity of care.
07Beginning at age 17, collaborate with the county CCS program to develop a transition plan including an adult specialist, medical group or medical home, authorized representative or legal guardian if applicable, and coordination with the member's PCP.
08By age 20, finalize an exit summary and transition plan to be shared with the member, authorized representative or guardian if applicable, and the member's PCP.
09Complete the Community Health Plan of Imperial Valley Care Management Referral form for all CCS members, members with complex medical needs, or Enhanced Care Management (ECM)/Community Supports (CS) referrals.
10Contact the CCS Liaison Team at 844-925-0962 for questions regarding CCS referrals, provider paneling requirements, or CCS processes, or Community Health Plan of Imperial Valley at 833-236-4141 for all other questions.
Original notice
26-1205 California Children's Services Referral and Care Coordination Requirements
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
Related changes
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