Application for CCS Services.

22 CCR 41514

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17 segments

22 CCR 41514

§ 41514. Application for CCS Services.

(a)

Anyone may make a referral to CCS including the patient or family.

(b)

The parents, legal guardian of a minor child, or applicant 18 years of age or older shall submit a written application to the county.

(c)

The county shall, upon receipt of a referral, within five calendar days, mail or deliver to the parents, legal guardian of a minor applicant or applicant 18 years of age or older, written notification of a minimum of information which shall include:

(1)

The source and date of referral of the patient.

(2)

A blank application form which is either provided by the State or prepared by the county and requests identifying information such as name and address of applicant and parents or legal guardian and a request for CCS coverage. The application form must contain a privacy notification meeting the requirements of Civil Code Section 1798.17.

(3)

A statement that a completed application is required for CCS coverage.

(4)

A statement that receipt of a completed and signed application by CCS within 20 calendar days of the mailing date of the notice is required for the referral date to be considered the application date.

(5)

A brief description of CCS.

(d)

If the county does not receive the application within 20 calendar days of the mailing date the county shall send a second notification with five more calendar days containing a minimum of information which shall include:

(1)

A statement that a completed application is required for CCS coverage.

(2)

A statement that the county has not received an application.

(e)

If the county does not receive the application within 20 calendar days after the second notice a third written notification shall be sent by the county within five (5) more calendar days after the second due date. That notice shall contain, at a minimum, the following information:

(1)

A statement that the county has not received a completed application to CCS.

(2)

A statement that the county has not opened the applicant's case and that no services shall be paid for by CCS.

(3)

A statement that if the county receives a completed application within 20 calendar days of the date the county sent either the first or second notice, the referral date shall be considered the application date and that if the completed application is not received by the county within 20 calendar days after the second notice is mailed the date the application is received by the county shall be considered the application date.

(f)

A copy of the third and final letter shall be sent to the referral source.

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