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26-1204 California Children's Services Referral and Care Coordination Requirements
Effective date
Oct 21, 2026
Identified
Oct 22, 2026
Summary
CalViva Health (HealthNet California) has implemented new mandatory requirements for same-day referrals to California Children's Services (CCS) and Medical Therapy Program (MTP) when providers identify members with eligible conditions. Providers must complete clinical evaluations, document qualifying conditions, and submit referrals to county CCS programs on the same day of evaluation. Additionally, transition planning procedures are now required for CCS members aging out of the program, beginning at age 17 with a finalized exit summary by age 20.
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What to do
Action · 10 steps
01Effective immediately (as of 2026-10-21): Providers and billing teams must implement the following workflow changes.
02When a member with a CCS-eligible or MTP-eligible condition is identified, ensure the practice completes a health assessment and diagnostic evaluation on the same day.
03Submit a referral to the member's county CCS program on the same day the evaluation is completed using the appropriate SAR form (New CCS/GHPP Client Service Authorization Request or Established CCS/GHPP Client Service Authorization Request), ensuring compliance with county-specific submission methods.
04Verify that an in-person evaluation by a CCS-paneled physician was completed within the previous 12 months documenting qualifying conditions.
05Beginning at age 17, collaborate with county CCS programs to develop a transition plan including an adult specialist/medical group, authorized representative if applicable, and PCP coordination, and complete the CalViva Health Care Management Referral form.
06By age 20, finalize an exit summary and transition plan, sharing it with the member, authorized representative/guardian, and PCP.
07Billing teams should update internal processes and provider education materials to enforce same-day referral submission requirements.
08Contact CCS Liaison Team at 844-925-0962 for questions about referral procedures, paneling requirements, or PEDI system access requests.
09Failure to submit same-day referrals may result in delays in CCS authorization and service coordination.
10This applies to physicians, practitioners, participating physician groups, hospitals, and ancillary providers in Fresno, Kings, and Madera counties.
Original notice
26-1204 California Children's Services Referral and Care Coordination Requirements
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
Related changes
See all Health Net changes →26-1205 California Children's Services Referral and Care Coordination RequirementsHighEffective Oct 21, 2026 · Prior Authorization26-1203 California Children's Services Referral and Care Coordination RequirementsHighNo effective date · Prior AuthorizationBrowse every Health Net change in the policy list