Community Supports Data Sharing and Access
Provider Type
- Physicians and Practitioners
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Bidirectional data sharing between Health Net and Community Supports (CS) providers is an important component of effective member interaction in the California Advancing and Innovating Medi-Cal (CalAIM) program. In addition to data confidentiality provisions under the Participating Provider Agreement (PPA) and requirements set forth in relevant state and federal laws, the following sections establishes the terms and conditions for sharing data bidirectionally between the two parties. The manner in which data are shared and accessed by both Health Net and the CS provider includes the following information:
1) Terminology and Common Language – In order to ensure clarity and effective communication, this program establishes the use of common language and terminology between Health Net and the CS provider. Both parties shall make reasonable efforts to use consistent terminology and eliminate any ambiguity when referring to shared data and related concepts.
2) Types of data include, but are not limited to:
The data to be shared will vary depending on the criteria established by the Department of Health Care Services (DHCS) policy for each of CS services:
- Asthma Remediation
- Housing Transition Navigation Services
- Housing Deposit
- Housing Tenancy and Sustaining Services
- Short-Term Post-Hospitalization Housing
- Recuperative Care (Medical Respite)
- Respite Services
- Day Habilitation Services
- Nursing Facility Transition/Diversion to Assisted Living Facility Services
- Personal Care and Homemaker Services
- Environmental Accessibility Adaptation (Home Modification)
- Medically Supportive Food/Meals/Medically Tailored Meals
- Sobering Centers
- Transitional Rent
Parties will de-identify data when applicable. Health Net prioritizes data based sharing on the criteria outlined in the DHCS Community Supports Policy Guide. Additionally, data elements defined by DHCS encounter data reporting standards will be shared with CS providers.
3) Specific circumstances, when Health Net grants the CS provider access to the shared data, include, but are not limited to:
Based on the new DHCS CalAIM Data Guidance for CS member information sharing, Health Net is required to grant access to, and share member-level data with CS providers through a Community Supports Authorization Status File (CSASF), which lists members who have been assigned to that provider for service delivery and members whome the CS provider referred to Health Net for authorization consideration (as applicable).
4) Specific circumstances, when the CS provider grants Health Net access to the shared data, include, but are not limited to:
The CS provider is required to share timely updates about service delivery to Health Net through the Community Supports Provider Return Transmission File (CSPRTF).
5) Individuals or staff roles within Health Net and the CS provider who will have authorized access to the shared data.
a) Health Net individuals or staff roles who will have authorized access to CS provider’s shared data include, but are not limited to:
- Director, Reporting & Business Analytics
- Supervisor, Reporting & Data Analysis
- Data analyst II
b) CS provider individuals or staff roles who will have authorized access to Health Net’s shared data includes, but are not limited to:
- Chief Executive Officer/Executive Director
- Chief Operating officer/Director of Operations
- CS Program Director
- CS Program Manager
6) Tracking Referral Status – The methods and/or tools to be used for tracking referral status (i.e., shared database or software system), the responsibilities of each party for updating and maintaining the referral status information, and the frequency with which updates are shared between the parties.
a) Methods and/or tools used by Health Net to track referral status include :
Partnership with findhelp, (formerly known as Aunt Bertha) to support CS providers to access a closed-loop referral process. The findhelp platform serves as a centralized tool to initiate, track, monitor and document referral outcomes.
Findhelp is a national social service platform that connects members, providers, and community-based organizations to local resources. Through this partnership, Health Net has developed program cards for contracted CS providers, enabling visibilityinto available services and facilitating referral and tracking. The platform creates efficiencies by enabling providers and members to search directly for no-cost or low-cost CS programs to support members with social determinants of health needs.
In addition, Health Net leverages the Community Supports Provider Return Transmission File (CSPRTF) to support referral tracking and monitoring. The file is used by providers to submit referral status updates and outcomes back to Health Net after an authorization has been submitted, supporting closed-loop referral.
These tools enable Health Net to track referrals from initiation through authorization and final outcome, while monitoring member progress to ensure completion of the closed-loop referral process.
b) Methods and/or tools used by CS providers to track referral status include:
- Findhelp (primary tool): Used by CS providers to receive referrals, track status, manage referrals through their dashboard, and update outcomes to support closed-loop referral completion. Providers are encouraged to log referrals received outside the platform (e.g., phone, fax, email) into findhelp to ensure consistent tracking and reporting.
- CSPRTF: Used by CS providers to submit referral status updates and outcomes to Health Net after an authorization has been submitted, supporting monitoring and compliance reporting.
c) Health Net’s updating and maintaining of referral status information includes the following:
- Findhelp includes built-in data analytics that are updated regularly, enabling Health Net to routinely monitor referrals activities and referral statuses.
- Health Net, in collaboration with findhelp, provides ongoing provider engagement, training, and technical assistance to support providers in timely updating and maintain referral statuses within the platform.
- Contracted providers can access the Health Net Provider Portal to confirm authorization status and identify which CS service(s) a member is currently approved to receive.
d) CS provider’s updating and maintaining of referral status information includes the following:
Within the findhelp platform, CS providers are responsible for updating statuses of the member, which notifies the referring entity. Each referral includes status options that providers use to document progress and outcomes. There are several statuses available to use on the platform. A few examples are provided below:
- Eligible – The member is eligible to receive services but has not received them yet.
- Pending – This status is usually applied by a program and often means that the referral is being processed.
- No longer interested – The member has indicated that no longer need or are interested in this program. The next step is to follow up with the member to ensure their underlying needs have been met.
- Got help – The member received services and assistance needed.
e) The frequency at which Health Net will update and share referral status updates include the following.:
- Findhelp: As part of the findhelp functionality, if a referral status has not been updated within one week, the provider and member will receive a referral reminder email when email is the preferred and/or most appropriate method of contact.
- Ongoing Monitoring: Health Net also routinely monitors referral data and status updates within findhelp to track referral progress and conduct follow‑up activities as needed to support timely completion of referrals.
- Provider Outreach: Health Net develops and distributes a monthly utilization report to Community Supports (CS) provider points of contact to support performance monitoring, provider education and provide technical assistance.
f) The frequency at which the CS provider will update and share referral status updates.
CS providers are trained and expected to update referral statuses in real-time, or as soon as a change occurs to inform the referring entity of the member’s progress and current status. In addition, Health Net has the ability to access and monitor referral data directly from findhelp through the platform’s analytic features.
7) Collaborative Evaluation
Both Health Net and the CS provider will engage in a yearly bidirectional evaluation aimed at supporting joint quality improvement objectives. The partnership evaluation process will provide an opportunity for both organizations to assess and improve the effectiveness of the partnership for both staff and the individuals they serve. Collaborative improvement will involve both Health Net and the CS provider in the evaluation process.
a) Health Net and the CS provider will collaborate to evaluate the effectiveness of its partnership:
There are several ways Health Net partners with CS providers to evaluate necessary improvements to the program.
- Each CS provider is assigned a point of contact where they meet regularly to discuss referrals, authorization, claims/billing, etc. This provides an opportunity for CS providers to raise challenges and propose potential solutions or recommendations to improve processes.
- Health Net has hosted monthly office hours on several topics (i.e., findhelp, authorization and claims) for CS providers, which allow providers to ask questions, get clarification and make recommendations for improvements.
- Health Net engages CS providers through an anonymous survey to capture areas where it is effective in supporting providers and where improvements are needed.
b) Upon completion of the collaborative evaluation of the effectiveness of the partnership, Health Net and the CS provider may use findings to inform any necessary improvements to the partnership to drive continuous quality improvement. Improvements may include but are not limited to:
Improvements focused on the infrastructure of the program specifically around IT infrastructure, including but not limited to authorization and billing as well as improvements and interoperability with findhelp. Additional improvements to the CS infrastructure includes ensuring adequate staffing and training to support providers.