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 while referring to shared data and related concepts.

2) Types of data include, but are not limited to:

Data to be shared will vary depending on the criteria set by the Department of Health Care Services (DHCS) policy for each of the CS services:

Parties de-identify data when applicable. Health Net prioritizes the data based on the criteria 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 is granted 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 and share member-level data with CS providers through a Community Supports Authorization Status File (CSASF), which will list members who have been assigned to that provider for service delivery and members 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 is granted 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:

b) CS provider individuals or staff roles who will have authorized access to Health Net’s shared data include, but are not limited to:

6) Tracking Referral Status – The methods and/or tools to be used for tracking referral status (i.e., shared database or software system, etc.), the responsibilities of each party in updating and maintaining the referral status information, and the frequency of sharing updates with each party.

a) Methods and/or tools used to track the status of referrals by Health Net include but are not limited to:

Health Net expanded its partnership with findhelp, formerly known as Aunt Bertha, to support CS providers to access a closed-loop referral process. Findhelp is a network of social programs across the United States and is the largest online platform used to identify local resources, support staff, and community partners when searching for local services. Through our partnership, Health Net developed program cards for contracted CS providers and their services for visibility, referral and tracking. The platform helps create an efficiency for providers and members to search directly for no-cost or low-cost CS programs to support members with social determinants of health needs.

b) Methods and/or tools used to track the status of referrals by CS Provider include but are not limited to:

The CS provider can track all of its referrals through findhelp which is the primary referral tools for providers. Health Net encourages providers who receive referrals through phone, fax or email, to log their referrals in findhelp for tracking and reporting purposes.

c) Health Net’s updating and maintaining referral status information include:

Findhelp has built-in data analytics that is updated daily where Health Net has the ability to monitor referrals and statuses on a regularly basis. Health Net and findhelp provide technical assistance and support to help providers update and maintain their referral statues.

d) CS provider’s updating and maintaining referral status information include:

Within the findhelp platform, CS providers are required to and have the ability to update the statuses of the member which notifies the referring entity. There are several statuses that are available to use on the platform. A few examples below:

e) The frequency at which Health Net will update and share referral status updates:

As part of the findhelp functionality, if statuses of a referral haven’t been updated in a week, the provider and member would receive a referral reminder email, if email was the preferred and/or best way to reach them. Health Net also references the data on a regular basis to track referral status and follow up as needed. Additionally, Health Net developed a utilization report monthly to share with points of contacts for CS providers as another way to educate and provide technical assistance.

f) The frequency at which the CS provider will update and share referral status updates:

CS providers are trained and encouraged to update the status as soon as a status needs to be updated or changed to inform the referring entity the status of the member. Health Net has the ability to pull that data directly from findhelp through the site’s analytic feature.

7) Collaborative Evaluation

Both Health Net and the CS provider will engage in a yearly bidirectional evaluation process 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 who Health Net and the CS provider serve. Collaborative improvement will involve both Health Net and the CS provider organizations 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.

b) Upon completion of the collaborative evaluation on the effectiveness of the partnership, Health Net and the CS provider may use findings to inform any necessary improvements of 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 adequate staffing and training to support providers.