The Future of CCS:
SB 586 and Protections for
Children and Families
Laurie A. Soman
Lucile Packard Children’s Hospital/CRISS
Family Voices of California Summit
February 27, 2017
CCS Redesign:
SB 586 and the Whole Child
Model
 As DHCS Proposed to Move Responsibility for
Care Management from CCS to Managed Care
Plans in 21 “COHS” Counties Families and
Advocates Asked…..
 Are There Critical Elements of CCS that Must
be Preserved for Children and Families?
 Coalition of Advocates, Family Groups, and
Providers Agreed..... Yes, There Are
CCS Redesign:
SB 586 and the Whole Child
Model
CCS Coalition
 Advocates (e.g. Children Now, Western Center on Law
and Poverty, SEIU, Children’s Defense Fund, Hemophilia
Council, March of Dimes)
 Family Organizations (Family Voices of CA)
 Provider Groups (e.g. CA Children’s Hospital Association,
Children’s Specialty Care Coalition, American Academy of
Pediatrics)
 County CCS Programs
 CRISS and Other Child-Focused Organizations
SB 586 Advocates Coalition
CCS Redesign:
SB 586 and the Whole Child
Coalition Developed Model
Principles for Implementation of
Whole Child Model – April, 2016
1. Implementation in Limited Number of Counties that Must Meet
Robust Readiness Requirements
2. Independent Evaluation Before Expansion to Additional
Counties
3. Maintenance of CCS Standards in ALL Counties, with or
without Redesign/Whole Child Model
4. Plan Requirement to Use Staff with Appropriate Pediatric
Training and Experience for Care Management
5. Plan Accountability via CCS-Appropriate Access and Quality
Standards and Benchmarks
CCS Redesign:
SB 586 and the Whole Child
Model
Coalition Developed Principles for Implementation of
Whole Child Model – April, 2016
6. Strong Oversight of Implementation and Plans by DHCS
with Timely Release of Access and Quality Data
7. Plans Paid Distinct, Separate CCS Rate
8. Payment Rates Adequate to Recruit and Retain
Providers with Appropriate Pediatric Expertise
9. Requirement for Robust Youth and Family Engagement
10. Continuity of Care for Length of Child’s Condition or 12
Months, Whichever Is Greater
CCS Redesign:
SB 586 and the Whole Child
Model




Coalition Goal: State Legislation
Coalition Sought Champion and Legislative
Vehicle for Redesign Protections Based on
Principles
SB 586, Senator Ed Hernandez, Chair, Senate
Health Committee
Negotiations with DHCS by Senator Hernandez,
Staff, and Coalition Advocates for Final Bill
SB 586 Signed by Governor in September, 2016
CCS Redesign:
SB 586 and the Whole Child
Model
What’s in the Bill: How Well Do Protections for Children
and Families Match Advocates’ Principles?
1. Implementation in Limited Number of Counties: 21 “COHS”
Counties with Readiness Requirements 
2. Evaluation Required Before Expansion Beyond 21 COHS
Counties: Independent Evaluation Required and Current CCS
Managed Care Carve-Out Now Ends 1/1/2022 
3. Maintenance of CCS Standards: State Must Retain CCS
Quality Standards and Provider Approval Process and
Children Must Receive Treatment from CCS-Approved
Providers– including Special Care Centers and Tertiary
Hospitals-- According to State CCS Guidelines 
CCS Redesign:
SB 586 and the Whole Child
Model
What’s in the Bill: How Well Do Protections for Children
and Families Match Advocates’ Principles?
4. Plan Requirement to Use Staff with Appropriate Pediatric Training
and Experience: Plans Must Ensure Expert Case Management via
Family Option for Continued Access to CCS Nurse Case Manager or
Plan Staff with Clinical Experience with CCS Population or Pediatric
Patients with Complex Medical Conditions. 
5. Plan Accountability via Access and Quality Standards and
Benchmarks: DHCS to Develop Pediatric Performance Standards,
including Outcome Measures 
6. Plans Must be Paid Distinct, Separate CCS Rate: DHCS to
Develop and Pay Plans Rate Specific to CCS Children and Youth 
CCS Redesign:
SB 586 and the Whole Child
What’s in the Bill: HowModel
Well Do Protections for Children
and Families Match Advocates’ Principles?
7. Provider Payment Rates Adequate to Recruit/Retain Providers:
Rates Must be Equal to or Greater than Current CCS Rates 
8. Requirement for “Meaningful” Family Engagement at State and Local
Levels: Participation Ensured in State CCS Advisory Group and
Plan-Level Family Advisory Councils 
9. Continuity of Care with Current Providers for Length of CCS
Condition: 12 Months Continuity with Family Right to Appeal Directly
to DHCS Director If Plan Denies Continuity Beyond 12 Months X
10. Strong Oversight of Implementation and Plans by DHCS with Timely
Release of Access and Quality Data: DHCS Creation of
Readiness/Monitoring Requirements with Annual Reports 
CCS Redesign:
SB 586 and the Whole Child
Model
Additional Protections for Children and Families in SB
586
 Children and Youth Retain Access to CCS Maintenance and
Transportation Services
 Children Have Continued Access to Medications Already Prescribed
Even If Not in Plan Formulary
 Medical Therapy Program Remains with County CCS Program
 Plans Must Provide Families with Information on Managed Care, How
to Navigate Plan Processes, and How to Contact Local Family
Support Organizations
 Plans Must Identify and Track Children/Youth with CCS Conditions
while in Whole Child Model and Track Youth Aging into Adult MediCal for Three Years into Adulthood
CCS Redesign:
SB 586 and the Whole Child
Model
What Happens Now?
 12-Month Delay in Implementation Means More Time to Plan
 Opportunities for Family Engagement
o Review CCS Enrollee Materials (e.g. Notices, FAQs) for
Content and Family-Friendliness
o Participate in Plan-Level Family Advisory Councils
o Assist Families Seeking Extended Continuity of Care
o Monitor Access to Current CCS Nurse Case Manager
o Participate in Evaluation (e.g. Family Experience and
Satisfaction)