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{"sheet":"CS RESPONSE","index":0,"n_rows":1,"n_cols":34,"rows_kept":1,"cut":false,"hidden":false,"merged":[]}
["Community Supports Provider Name","Community Supports Provider National Provider Identifier (NPI)","Community Supports Provider TIN","Community Supports Provider Phone Number","Medi-Cal Member Client Index Number (CIN)","Member Last Name","Member First Name","Member New Homelessness Indicator","Member New Address Indicator","Member New Residential Address Line 1","Member New Residential Address Line 2","Member New Residential City","Member New Residential State","Member New Residential Zip Code","Member New Phone Number Indicator","Member New Phone Number","Member Preferred Language (Spoken)","Member Preferred Language (Written)","New Preferred Member Contact Method","Member Date of Birth","Community Supports Service Name","Community Supports Service Delivery Start Date","Current Status of Member Engagement","Discontinuation Reason Code","Community Supports Service Delivery End Date","Community Supports Provider Return Transmission File Production Date","Community Supports Provider Return Transmission File Reporting Period","Primary Payer (MCP) Identifier","MCP Name","Z-codes (25 total)","CLR ID","Referral Status","Date of Referral Status","Reason for Referral Loop Closure"]

{"sheet":"LoopCloseReason","index":1,"n_rows":5,"n_cols":1,"rows_kept":5,"cut":false,"hidden":true,"merged":[]}
["(1) Services Received"]
["(2) Service Provider Declined"]
["(3) Unable to Reach Member"]
["(4) Member No Longer Eligible for Services"]
["(5) Member No Longer Needs Services or Declines Services"]

{"sheet":"MCPCodes","index":2,"n_rows":14,"n_cols":1,"rows_kept":14,"cut":false,"hidden":true,"merged":[]}
["150"]
["315"]
["316"]
["317"]
["352"]
["353"]
["354"]
["361"]
["380"]
["381"]
["382"]
["383"]
["384"]
["533"]

{"sheet":"CSServiceName","index":3,"n_rows":13,"n_cols":1,"rows_kept":13,"cut":false,"hidden":true,"merged":[]}
["1. Asthma Remediation"]
["2. Community Transition Services/Nursing Facility Transition to a Home"]
["3. Day Habilitation Programs"]
["4. Environmental Accessibility Adaptations (Home Modifications)"]
["5. Housing Deposits"]
["6. Housing Tenancy and Sustaining Services"]
["7. Housing Transition Navigation Services"]
["8. Medically Tailored Meals/Medically-Supportive Food"]
["9. Nursing Facility Transition/Diversion to Assisted Living Facilities, such as Residential Care Facilities for Elderly and Adult Residential Facilities"]
["10. Personal Care and Homemaker Services"]
["11. Recuperative Care (Medical Respite)"]
["12. Respite Services"]
["13. Short-Term Post Hospitalization Housing"]

{"sheet":"VALIDATE DATA","index":4,"n_rows":43,"n_cols":4,"rows_kept":43,"cut":false,"hidden":false,"merged":[]}
["RTF Rule Guide"]
[]
[]
[]
[]
[]
[]
[]
["Column Name","Column Index","Required?","Sample Data"]
["Community Supports Provider Name","A (1)","✅ Required","CS Provider Name"]
["Community Supports Provider National Provider Identifier (NPI)","B (2)","✅ Required",1234567890]
["Community Supports Provider TIN","C (3)","✅ Required",123456789]
["Community Supports Provider Phone Number","C (4)","⬜ Optional",8888888888]
["Medi-Cal Member Client Index Number (CIN)","E (5)","✅ Required",123456789]
["Member Last Name","F (6)","⬜ Optional","Smith"]
["Member First Name","G (7)","⬜ Optional","John"]
["Member New Homelessness Indicator","H (8)","⬜ Optional",1]
["Member New Address Indicator","I (9)","⬜ Optional",1]
["Member New Residential Address Line 1","J (10)","⬜ Optional","123 MAIN ST."]
["Member New Residential Address Line 2","K (11)","⬜ Optional","APT 2"]
["Member New Residential City","L (12)","⬜ Optional","SALINAS"]
["Member New Residential State","M (13)","⬜ Optional","CA"]
["Member New Residential Zip Code","N (14)","⬜ Optional",93905]
["Member New Phone Number Indicator","O (15)","⬜ Optional",1]
["Member New Phone Number","P (16)","⬜ Optional",8888888888]
["Member Preferred Language (Spoken)","Q (17)","⬜ Optional","ENGLISH"]
["Member Preferred Language (Written)","R (18)","⬜ Optional","ENGLISH"]
["New Preferred Member Contact Method","S (19)","⬜ Optional","1. Call \nOptions: 1. Call; 2. Text; 3. In Person Outreach; 4. Email; 5. Unknown."]
["Member Date of Birth","T (20)","⬜ Optional","2021-01-01"]
["Community Supports Service Name","U (21)","✅ Required","1. Asthma Remediation\n2. Community Transition Services/Nursing Facility Transition to a Home\n3. Day Habilitation Programs\n4. Environmental Accessibility Adaptations (Home Modifications)\n5. Housing Deposits\n6. Housing Tenancy and Sustaining Services\n7. Housing Transition Navigation Services\n8. Medically Tailored Meals/Medically-Supportive Food\n9. Nursing Facility Transition/Diversion to Assisted Living Facilities, such as Residential Care Facilities for Elderly and Adult Residential Facilities\n10. Personal Care and Homemaker Services\n11. Recuperative Care (Medical Respite)\n12. Respite Services\n13. Short-Term Post Hospitalization Housing\n14. Sobering Centers"]
["Community Supports Service Delivery Start Date","V (22)","⬜ Situational","01/01/2025\nRequired if Current Status of Member Engagement = \"3. Currently Delivering Service\" or if member was receiving Community Service during the reporting period or prior to the reporting"]
["Current Status of Member Engagement","W (23)","✅ Required","Must be one of: \"1. Pending Outreach\", \"2. Currently in Outreach\", \"3. Currently Delivering Service\", \"4. Services Discontinued\""]
["Discontinuation Reason Code","X (24)","⬜ Situational","One reason code per Member. Reason Code: 1. Opted out; 2. Reassigned to other Community Supports Provider; 3. Deceased; 4. Program completed/Graduated; 5. Incarcerated; 6. Declined to participated; 7. Duplicative program; 8. Lost Medi-Cal coverage; 9. Switched health plans; 10. Moved out of the county; 11. Moved out of country; 12. Unable to contact/Lost to follow up; 13. Unsafe behavior or environment; 14. Other"]
["Community Supports Service Delivery End Date","Y (25)","⬜ Situational","01/01/2025\n\n(Required as applicable; Leave blank if Member was receiving Community Supports through the end of\nthe reporting period. Members who cease to receive Community Supports should not be reported in\nsubsequent reports unless Community Supports is reinitiated.)"]
["Community Supports Provider Return Transmission File Production Date","Z (26)","⬜ Optional","2025-01-01"]
["Community Supports Provider Return Transmission File Reporting Period","AA (27)","⬜ Optional","01/01/2023.01/31/2023\nStart and end dates reported as two sets of numbers separated by a period delimiter (i.e., MM/DD/YYYY.MM/DD/YYYY)"]
["Primary Payer (MCP) Identifier","AB (28)","⬜ Optional","DHCS has not included this in Data Sharing Guide but we will request this data element gets added for easy filtering when generating file.\n\nSee Primary Payer (MCP) Identifier in the following tab: PrimaryPayerMCPIdentifier Xwalk"]
["MCP Name","AC (29)","⬜ Optional"]
["Z-codes (25 total)","AD (30)","⬜ Optional"]
["CLR ID","AE (31)","⬜ Optional","XYZ12345AZ55"]
["Referral Status","AF (32)","✅ Required","One of the following - \n(1) Accepted\n(3) Pending\n(4) Outreach Initiated\n(5) Referral Loop Closed"]
["Date of Referral Status","AG (33)","✅ Required","2025-09-01"]
["Reason for Referral Loop Closure","AH (34)","⬜ Situational","One of the following - \n(1) Services Received\n(2) Service Provider Declined\n(3) Unable to Reach Member\n(4) Member No Longer Eligible for Services\n(5) Member No Longer Needs Services or Declines Services"]

{"sheet":"ERROR LOG","index":5,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"CLR RULES","index":6,"n_rows":18,"n_cols":4,"rows_kept":18,"cut":false,"hidden":false,"merged":[]}
["Current Status of Member Engagement","Discontinuation Reason (Col X)","Referral Status (Col AF)","Loop Closure Reason (Col AH)"]
["4. Services Discontinued","1. Opted out","Must be \"(5) Referral Loop Closed\"","Must be \"(5) Member No Longer Needs Services or Declines Services\""]
["4. Services Discontinued","2. Reassigned to other Community Supports Provider","Must be \"(5) Referral Loop Closed\"","Must be \"(2) Service Provider Declined\""]
["4. Services Discontinued","3. Deceased","Must be \"(5) Referral Loop Closed\"","Must be \"(4) Member No Longer Eligible for Services\""]
["4. Services Discontinued","4. Program completed/Graduated"]
["4. Services Discontinued","5. Incarcerated","Must be \"(5) Referral Loop Closed\"","Must be \"(4) Member No Longer Eligible for Services\""]
["4. Services Discontinued","6. Declined to participated","Must be \"(5) Referral Loop Closed\"","Must be \"(5) Member No Longer Needs Services or Declines Services\""]
["4. Services Discontinued","7. Duplicative program","Must be \"(5) Referral Loop Closed\"","Must be \"(4) Member No Longer Eligible for Services\""]
["4. Services Discontinued","8. Lost Medi-Cal coverage","Must be \"(5) Referral Loop Closed\"","Must be \"(4) Member No Longer Eligible for Services\""]
["4. Services Discontinued","9. Switched health plans","Must be \"(5) Referral Loop Closed\"","Must be \"(4) Member No Longer Eligible for Services\""]
["4. Services Discontinued","10. Moved out of the county","Must be \"(5) Referral Loop Closed\"","Must be \"(4) Member No Longer Eligible for Services\""]
["4. Services Discontinued","11. Moved out of country","Must be \"(5) Referral Loop Closed\"","Must be \"(4) Member No Longer Eligible for Services\""]
["4. Services Discontinued","12. Unable to contact/Lost to follow up","Must be \"(5) Referral Loop Closed\"","Must be \"(3) Unable to Reach Member\""]
["4. Services Discontinued","13. Unsafe behavior or environment","Must be \"(5) Referral Loop Closed\"","Must be \"(2) Service Provider Declined\""]
["4. Services Discontinued","14. Other","Must be \"(5) Referral Loop Closed\"","Must be either \"(2) Service Provider Declined\" OR \"(4) Member No Longer Eligible for Services\""]
["3. Currently Delivering Service",null,"Must be \"(5) Referral Loop Closed\"","(1) Services Received"]
["2. Currently in Outreach",null,"Must be \"(4) Outreach Initiated\""]
["1. Pending Outreach",null,"(1) Accepted or (3) Pending"]

{"sheet":"PrimaryPayerMCPIdentifier Xwalk","index":7,"n_rows":15,"n_cols":3,"rows_kept":15,"cut":false,"hidden":false,"merged":[]}
["Primary Payer (MCP) Identifier","County Name","MCP Name"]
["380","Amador ","HEALTH NET"]
["381","Calaveras","HEALTH NET"]
["382","Inyo","HEALTH NET"]
["383","Mono","HEALTH NET"]
["384","Tuolumne","HEALTH NET"]
["533","Imperial","CHPIV"]
["150","Sacramento ","HEALTH NET"]
["315","Fresno ","CALVIVA HEALTH"]
["316","Kings ","CALVIVA HEALTH"]
["317","Madera ","CALVIVA HEALTH"]
["352","Los Angeles","HEALTH NET"]
["353","Tulare ","HEALTH NET"]
["354","San Joaquin ","HEALTH NET"]
["361","Stanislaus ","HEALTH NET"]

{"sheet":"ReferralStatus","index":8,"n_rows":4,"n_cols":1,"rows_kept":4,"cut":false,"hidden":true,"merged":[]}
["(1) Accepted"]
["(3) Pending"]
["(4) Outreach Initiated"]
["(5) Referral Loop Closed"]

{"sheet":"DiscontReasons","index":9,"n_rows":14,"n_cols":1,"rows_kept":14,"cut":false,"hidden":true,"merged":[]}
["1. Opted out"]
["2. Reassigned to other Community Supports Provider"]
["3. Deceased"]
["4. Program completed/Graduated"]
["5. Incarcerated"]
["6. Declined to participated"]
["7. Duplicative program"]
["8. Lost Medi-Cal coverage"]
["9. Switched health plans"]
["10. Moved out of the county"]
["11. Moved out of country"]
["12. Unable to contact/Lost to follow up"]
["13. Unsafe behavior or environment"]
["14. Other"]