PROGRAM PARTICIPATION REQUIREMENTS BY PROVIDER TYPE

Physicians
  1. Physicians must be:
    1. Licensed as a physician and surgeon by the Medical Board of California or by the Osteopathic Medical Board of California; and
    2. Physicians who are not board certified but who are eligible for the certifying examination may participate in the CCS program for not more than three years. A verification letter of eligibility from the applicable member board is required. If the physician does not have a board verification letter, he or she shall submit other evidence regarding eligibility to take the board examination such as a letter from the Medical Director of his or her residency program verifying satisfactory completion of training.
  2. Family practice physicians must meet the requirements of number 1 above and have documented experience treating children with CCS eligible medical conditions for at least five years, or have treated 100 or more such children or meet the following conditions:
    1. The physician has an active Medi-Cal provider number;
    2. The physician is licensed by the Medical Board of California or the Osteopathic Medical Board of California;
    3. The physician is certified by the American Board of Family Medicine; and
    4. The physician is enrolled as a Child Health and Disability Prevention Program (CHDP) provider.
      Documented experience means providing the CCS program with a list of cases indicated by a numeric value instead of a name, their CCS-eligible medical condition and the range of dates during which services were rendered. Do not provide the names of the children or any other specific identifiers in your report.

Podiatrists
Podiatrists must meet all of the following requirements:
  1. Be licensed to practice podiatric medicine by the California Board of Podiatric Medicine;
  2. Be certified by the American Board of Podiatric Surgery or the American Board of Podiatric Orthopedics; and
  3. Have documented experience treating children with CCS-eligible medical conditions for at least five years, or have treated 100 or more such children.
    Documented experience means providing the CCS program with a list of cases indicated by a numeric value instead of a name, their CCS eligible medical condition, and the range of dates during which services were rendered. Do not provide the names of the children or any other specific identifiers in your report.

Audiologists
Audiologists must be licensed by the California Speech-Language Pathology, Audiology and Hearing Aid Dispenser Board, Department of Consumer Affairs (SLPAHADB). If the audiologist has a master's degree, they must also have two years of professional clinical experience providing audiology services, one of which must have been with infants, children, and adolescents. The experience may include the supervised Required Professional Experience (RPE) required for licensure by the CSLPAB as specified in Business and Professions Code, Section 2532.2(d). If the audiologist has a doctorate degree (Au.D), and their California Required Professional Experience (RPE) includes one year of pediatric experience, this is sufficient to satisfy the pediatric clinical experience for CCS empanelment. The Audiologist CCS candidate must be able to show documentation of pediatric experience during RPE.

Dietitians
Dietitians/Nutritionists must:
  1. Be registered by the Commission on Dietetic Registration of the American Dietetic Association;
  2. Have at least two years of fulltime or equivalent clinical nutrition/diet therapy experience participating as a Registered Dietitian/Nutritionist as part of a multidisciplinary team providing nutrition assessment and counseling for acute or chronically ill patients; and
  3. Have one year of the required clinical experience specified in 2 must include providing services to infants, children, or adolescents with one or more CCS-eligible medical condition.

Occupational Therapists (OTs)
OTs must:
  1. Be certified by the National Board for Certification in Occupational Therapy; or
  2. Be licensed by the California Board of Occupational Therapy; and
  3. Have at least one year of paid clinical experience, beyond fieldwork, that meets either or a combination of the following requirements:
    1. Experience in any setting providing occupational therapy services directly to infants, children, or adolescents who have any medical condition that qualifies for the Medical Therapy Program; or
    2. Experience in an acute care hospital providing occupational therapy services directly to infants, children, or adolescents who require rehabilitation services as an adjunct to their medical care and who have any CCS eligible medical condition, except a medical condition that qualifies for the Medical Therapy Program.
  4. Fieldwork means the supervised fieldwork experience that is part of an occupational therapy education program that is accredited by the American Occupational Therapy Association, the World Federation of Occupational Therapy, or another nationally recognized accrediting agency.

Orthotists
Orthotists must meet all of the following requirements:
  1. Be certified by the American Board for Certification in Orthotics and Prosthetics or the Board for Orthotist/Prosthetist Certification; and
  2. Submit a letter from a CCS paneled physician specializing in physical medicine and rehabilitation or orthopedics that documents the orthotist's experience providing orthotics to infants, children, or adolescents with a CCS eligible medical condition.

*Pediatric Nurse Practitioners (PNPs)
  1. Participation in the CCS program as a PNP is limited to serving as a designated core member of a multidisciplinary, multispecialty team in an outpatient department or clinic of an acute care hospital providing services to children with CCS eligible medical conditions.
  2. A PNP must meet all of the following requirements:
    1. Be certified as a nurse practitioner by the California Board of Registered Nurses;
    2. Be certified as a PNP by the National Certification Board of Pediatric Nurse Practitioners and Nurses or the American Nurses Association; and
    3. Have a minimum of two years of experience as a PNP which shall include providing services to children with CCS eligible medical conditions. The required experience may be obtained prior to being certified as a PNP. In this case, the individual must have been, for a minimum of two years, a designated registered nurse core member of a multidisciplinary, multispecialty team in an outpatient department or clinic of an acute care hospital providing care to children with CCS eligible medical conditions.

Physical Therapists (PTs)
PTs must meet the following requirements:
  1. Be licensed by the Physical Therapy Board of California; and
  2. Have at least one year of paid clinical experience, beyond internship, that meets either or a combination of the following requirements:
    1. Experience in any setting providing physical therapy services directly to infants, children, or adolescents who have any of the medical conditions that qualifies for the Medical Therapy Program; or
    2. Experience in an acute care hospital providing physical therapy services directly to infants, children, or adolescents who require rehabilitation services as an adjunct to their medical care and who have any CCS eligible medical condition, except a medical condition that qualifies for the Medical Therapy Program.
  3. Internship means the clinical internship that is part of a physical therapy education program.

Prosthetists
A prosthetist must meet all of the following requirements:
  1. Be certified by the American Board for Certification in Orthotics and Prosthetics or the Board for Orthotist/Prosthetist Certification; and
  2. Submit a letter from a CCS-paneled physician specializing in physical medicine and rehabilitation or orthopedics that documents the prosthetist's experience providing orthotics to infants, children, or adolescents with a CCS-eligible medical condition.

Psychologists
Psychologists must be:
  1. Licensed by the California Board of Psychology; and
  2. Have a minimum of two years of experience which shall include counseling or testing children with special health care needs.
  3. Individuals who are licensed as an educational psychologist by the California Board of Behavioral Sciences may be considered for participation in the CCS program as a psychologist. Such individuals shall also possess the experience specified in this section.

*Registered Nurses (RNs)
  1. Participation in the CCS program as an RN is limited to serving as a designated core member of a multidisciplinary, multispecialty team in an outpatient department or clinic of an acute care hospital providing services to children with CCS-eligible medical conditions.
  2. An RN must meet all of the following requirements:
    1. Be licensed by the California Board of Registered Nursing;
    2. Have a minimum preparation of a baccalaureate degree in nursing from a program having requirements equal to or greater than a baccalaureate level nursing program approved by the California Board of Registered Nursing;
    3. Have a minimum of two years of clinical nursing experience of which one year shall be in pediatrics;
    4. Currently be a designated core member of a multidisciplinary, multispecialty team as specified in 1. The RN's responsibilities in the outpatient clinic must include nursing assessment and intervention related to the implementation of the team care plan for outpatient services such as coordination of the patient's care between hospitalizations, community services, and team conferences. Responsibilities related to routine outpatient care are not valid for meeting the requirements of this section. Routine outpatient care must include, but not be limited to, regularly scheduled blood draws, monitoring of vital signs, administration of medication and scheduling return appointments; and
    5. Must be working in an Approved Outpatient Special Care Center (SCC) in order to apply.

*Respiratory Care Practitioners (RCPs)
  1. Participation in the CCS program as a respiratory care practitioner shall be limited to serving as a designated core member of a multidisciplinary, multispecialty team in an outpatient department or clinic of an acute care hospital providing services to children with CCS-eligible medical conditions.
  2. An RCP must meet all of the following requirements:
    1. Be licensed by the Respiratory Care Board of California;
    2. Have a current Registered Respiratory Therapist credential issued by the National Board for Respiratory Care;
    3. Have a minimum of two years of respiratory care experience of which one year shall be in pediatrics;
    4. Currently be a designated core member of a multidisciplinary, multispecialty team as specified in 1 and have responsibilities in the outpatient clinic that include individualized diagnostic and therapeutic respiratory care procedures, and patient education, related to the implementation of the team care plan for outpatient services; and
    5. Must be working in an Approved Outpatient Special Care Center (SCC) in order to apply.
  3. An RCP may also be referred to as a respiratory therapist or inhalation therapist.

Social Workers
  1. Social workers must:
    1. Be licensed as a clinical social worker by the California Board of Behavioral Sciences; or
    2. Have a master's degree in social work from a school accredited by the Council on Social Work Education and five years of fulltime social work experience that shall include providing social work services to children with CCS-eligible medical conditions and their families.
  2. Individuals who have less than the required five years of experience specified in 1b of this section shall submit either of the following:
    1. A certificate from the California Board of Behavioral Sciences verifying registration as an Associate Clinical Social Worker; or
    2. A written letter on the letterhead of the individual's employer, signed by the individual's supervisor or social work department director and containing verification of all of the following requirements:
      1. A certificate from the California Board of Behavioral Sciences verifying registration as an Associate Clinical Social Worker; or
      2. A written letter on the letterhead of the individual's employer, signed by the individual's supervisor or social work department director and containing verification of all of the following requirements:
  3. Supervision of the work of the individual specified in 2 of this section shall be provided by a social worker who meets the requirements of 1a or 1b of this section.

Speech-Language Pathologists (SLP) and Auditory Verbal Therapist (AVT) and Listing and Spoken Language Specialist (LSLS)
Speech/language pathologists must be licensed by the California Speech/Language Pathology, Audiology and Hearing Aid Dispenser Board (SLPAHADB) and have two years of clinical experience providing speech/language pathology services, one year of which must have been with infants, children, or adolescents with CCS-eligible medical conditions. The experience may include the supervised Required Professional Experience (RPE) for licensure by the CSLPAB as specified in Business and Professions Code, Section 2532.2(d). An AVT and LSLS must be certified by the Alexander Graham Bell Association for the Deaf and Hard of Hearing and show pediatric habilitation and rehabilitation experience during their RPE or have 1 year of pediatric clinical after training.

Other
Provider Types not listed require professional and/or business licensure, certification, registration, or other approval to provide health care services.

Note:  Provider Types with an asterisk (*) have program participation limitations. Refer to the Provider Type for details.