Each CCS-approved NICU that has its own HRIF Program is required to have a multidisciplinary team of professionals that may include pediatricians or neonatologists, pediatric nurse practitioners (PNPs), nurse specialists, ophthalmologists, audiologists, social workers, psychologists, physical therapists, and occupational therapists. All professionals listed must be CCS-approved. The PNP only requires CCS-approval when functioning in the CCS HRIF Program as the HRIF Coordinator.


As part of the NICU discharge planning process, the NICU must identify and refer to the CCS Program clients identified as potentially eligible for the HRIF Program.

  1. This can be accomplished by submitting Service Authorization Requests (SARs) to the appropriate County CCS Program or State Systems of Care Division (SCD) Office.
  2. The SARs are available online at the CCS Forms website, http://www.dhcs.ca.gov/formsandpubs/forms/Pages/CCSForms.aspx
  3. Click on form DHCS 4488 (New Referral of CCS/GHPP Client SAR or form DHCS 4509, Established CCS/Genetically Handicapped Persons Program Client SAR).
  4. These forms can be completed online. Print and fax to the appropriate county CCS Program or State SCD Office.
  5. The approved or denied SARs for HRIF services will be mailed or faxed to the HRIF provider by the local county CCS Program or SCD Office, if the hospital facility is not approved to access online correspondence via the Provider Electronic Data Interchange (PEDI) system.  
  6. The facility’s designated PEDI Liaison is responsible for distributing copies of the authorization to all relevant facility providers.  
  7. The HRIF Coordinator is responsible for distributing copies of the authorization to HRIF team members and consultants responsible for the infant’s follow-up care.


NICU Program Referral Requirements

  1. It is the responsibility of the discharging to home CCS NICU/Hospital or the last CCS NICU/Hospital providing care to make the referral to the HRIF Program.
  2. The NICU referral process:
  • Upon referring a neonate, infant or child to the HRIF Program, a “RR Form” is completed (except HRIF I.D. Number) and submitted via the web-based HRIF-QCI Reporting System (https://www.ccshrif.org/) by the discharge/referring NICU/ Hospital at time of discharge to home.
  • As noted above, the discharging/referring NICU/Hospital will submit a SAR to the local CCS Program Office for HRIF services. (Service Code Group [SCG] 06 should be requested.)