Due Process and Appeals
About CCS Due Process:
CCS is obligated to provide services to children who are eligible. Occasionally, the child's family disagrees with the eligibility decision made by CCS. The CCS Due Process procedure allows families to appeal the decision for reconsideration.
How Due Process Works for Denied Cases:
When CCS decides a child is not eligible for a CCS program, the family is notified with an official letter called a Notice of Action. It explains that the child has been determined to be not eligible and the reason for the decision, such as the child does not meet the medical criteria for eligibility. It also provides information on how to appeal the decision. Families need to follow those directions.
How Due Process Works for Specific Requested Services which were Denied:
This is the other situation that the CCS Due Process procedure covers and provides appeal options for families. When a denial of a service request is made the family and requesting health professional are notified and given instructions on making an appeal.
How Due Process Works:
At first, the appeal goes to the appropriate administrator at the County CCS Office. Medical appeals are reviewed by the CCS Medical Director and administrative appeals are reviewed by the CCS Program Manager. They will work with the family to determine how to proceed. Each case is different; so, there is no set of steps that apply to every situation. Occasionally, a medical expert is called upon to render an opinion if the diagnosis is uncertain. Rarely, a fair hearing request is sent to the State Department of Health Services for final determination of the issue.