Central California Alliance For Health

 

California Children’s Services (CCS) Whole Child Model (WCM) Provider Information

On July 1, 2018, the Central California Alliance for Health (the Alliance) assumed responsibility for California Children’s Services (CCS) for Alliance Medi-Cal members. This transition is called the Whole Child Model (WCM).


The goals of the WCM are to:


 • Implement a family centered approach to care

 • Improve care coordination with individualized care planning

 • Streamline care delivery

 • Improve family and provider satisfaction


CCS provides coverage for children under age 21 with CCS-eligible medical conditions for the following services. County CCS offices will continue to determine eligibility for the program. Providers should send program referrals to their respective county CCS office.


 • Medical and behavioral health treatment

 • Diagnostic services

 • Medical case management

 • Physical and occupational therapy services


CCS Quick Reference Guide

   CCS Integration and the Whole Child Model: Quick Reference Guide


CCS FAQs

   CCS Integration FAQ (PDF)


Workshop and Webinar Resources

   Hospital Workshop Presentation

   Provider Webinar Presentation


Department of Health Care Services Links

   The Whole Child Model

   How to Become a Provider

   DHCS CCS Resources


Pharmacy

The Alliance will cover most ongoing pharmaceutical treatments for CCS members dispensed prior to July 1, 2018. However, prior authorization may be required in cases where the Alliance has not received historical CCS pharmacy claims data from the State to determine continuity of care.


For dates of service on or after July 1, 2018, no prior authorization is required for medications with no restrictions listed on the Alliance pharmacy formulary. Prior authorization will be required for requests exceeding quantity limits, for most specialty medications, and non-formulary medications per the Alliance pharmacy formulary. If you have any questions, please contact the Alliance Pharmacy department at (831) 430-5507 Monday through Friday, 8AM-5PM. Diplomat Specialty is the Alliance contracted pharmacy for specialty medications and can be contacted at (877) 977-9118.


Providers can submit prior authorization requests via the Alliance Provider Portal or by faxing a Prior Authorization form to the Alliance at (831) 430-5851.


Behavioral Health

CCS members are covered for the evaluation and treatment of behavioral health diagnoses when related to a CCS medically-eligible condition. The Alliance partners with Beacon Health Options to provide these services. Members can be referred by their provider, or can call Beacon directly at (855) 765-9700.


Behavioral health services covered include:

 • Individual assessment and psychotherapy

 • Psychological and neuropsychological testing

 • Family therapy with the child present

 • Group therapy

 • Crisis intervention


Key Contact Information:

   Alliance Pharmacy department: (831) 430-5507

   Fax medication list and/or chart notes to (831) 430-5851

   Diplomat Specialty Pharmacy: (877) 977-9118


Utilization Management

 • Authorizations and Concurrent Review: phone (831) 430-5506,
   fax (831) 430-5850

 • CCS Liaisons:

   – Santa Cruz County (800) 700-3874, x4144

   – Monterey County (800) 700-3874, x5562

   – Merced County (800) 700-3874, x5360


Care Management

 • Adult Case Management Line: (800) 700-3874 x5512

 • Pediatric Case Management Line: (800) 700-3874 x5513

 • Health Education Line: (800) 700-3874 x5580

 • Translation/Interpreter Services: (800) 700-3874 x5580


Provider Services: (800) 700-3874 ext. 5504




 


Members | Miembros | Cov Tswvcuab | Providers | Community | About Us | 2018 Central California Alliance for Health®