Form Dhcs 4515 - California Children'S Services Program Individual Provider Paneling Application For Allied Health Care Professionals - Health And Human Services Agency Page 5
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6California Children’s Services (CCS) Program
Page 5
Individual Provider Paneling Application for
ALLIED HEALTH CARE PROFESSIONALS
CCS PROGRAM PARTICIPATION REQUIREMENTS
BY PROVIDER TYPE
Note: Provider Types with an asterisk (*) have program participation limitations. Refer to the Provider Type for details.
Audiologists
Audiologists must be licensed by the California Speech/Language Pathology and Audiology Board (CSLPAB) and 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).
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:
a. 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
b. 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:
a.
Be certified as a nurse practitioner by the California Board of Registered Nurses;
b. Be certified as a PNP by the National Certification Board of Pediatric Nurse Practitioners and Nurses or the American Nurses
Association; and
c. 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:
a. 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
b. 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.
DHCS 4515 (11/07)
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