CalAIM Resources for Providers

• Claims/Invoice Submission Process
• Payor ID/Clearing House/EDI

• CS Reference Guide – Health Net – English (PDF)
• CS Reference Guide – CalViva Health – English (PDF)
• CS Reference Guide – Community Health Plan of Imperial Valley – English (PDF)
• Refer Members to CS Services Quick Reference – Health Net – English (PDF)
• Refer Members to CS Services Quick Reference – CalViva Health – English (PDF)

• Enhanced Care Management (ECM) Provider Guide – Health Net – English (PDF)
• Enhanced Care Management (ECM) Provider Guide – CalViva Health – English (PDF)
• Enhanced Care Management (ECM) Provider Guide – Community Health Plan of Imperial Valley – English (PDF)

• Apply to Become a Health Net Doula Provider: Unlock New Opportunities – Health Net – English (PDF)
• Apply to Become a Health Net Doula Provider: Unlock New Opportunities – CalViva Health – English (PDF)
• Apply to Become a Health Net Doula Provider: Unlock New Opportunities – Community Health Plan of Imperial Valley – English (PDF)

• Gain Additional Revenue for Services You May Already Offer – Health Net – English (PDF)
• Gain Additional Revenue for Services You May Already Offer – Community Health Plan of Imperial Valley – English (PDF)

• Transitional Rent Authorization Guide > Community Supports
• Transitional Rent Authorization Form > Community Supports
• Transitional Rent Benefit Overview Training > Required Onboard Training
• Frequently Asked Questions > Transitional Rent
• List of Transitional Rent Providers

• Get Help and Support for Your Healthcare Needs – Health Net – English (PDF)
• Get Help and Support for Your Healthcare Needs – CalViva Health – English (PDF)
• CS Member Brochure – Health Net – English (PDF)
• ECM Member Guide – Health Net – English (PDF)
• ECM Member Guide – CalViva Health – English (PDF)

These member resources are available in other languages on the member Enhanced Care Management, Community Supports and Community Health Worker pages.

Federal, state and local disaster assistance are available to Californians and undocumented immigrants impacted by disasters. Refer to the Guide to Disaster Assistance Services for Immigrant Californians (PDF) for services to help with housing, food, basic needs, health care and counseling, insurance, replacing documents, and employment.

Data Sharing

• Community Supports sFTP Details Request Form (Excel)
• Community Supports Authorization Status File (CSASF) – Data Dictionary (Excel)
• Community Supports Provider Return Transmission File (CSPRTF) – Data Dictionary (Excel)

Authorization/Referral Forms

Complete and submit a referral form when requesting prior authorization for Community Supports (CS) services.

Health Net

• Assisted Living Facility (ALF) Transitions Referral Form – English (PDF)
• Asthma Remediation Authorization Form – English (PDF)
• Asthma Preventive Services Authorization Request Form – English (PDF)
• Environmental Accessibility Adaptations (Home Modifications) Provider Order Form – English (PDF)
• Housing Deposit Authorization Form – English (PDF)
• Security Deposit Landlord Exemption Attestation Form – English (PDF)
• Housing Navigation and Tenancy Authorization Form – English (PDF)
• Medically Tailored Meals/Medically Supportive Food Referral Form – English (PDF)
• Provider Order Form for Medically Tailored Meals – English (PDF)
• Personal Care and Homemaker Services Authorization Form – English (PDF)
• Recuperative Care Referral Form – English (PDF)
• Respite Services (for Caregivers) Authorization Form – English (PDF) UPDATED
• Short-term Post-Hospitalization Housing Referral Form – English (PDF)
• Day Habilitation Referral Form – English (PDF)
• Transitional Rent Authorization Form – English (PDF)

CalViva Health

• Assisted Living Facility (ALF) Transitions Referral Form – English (PDF)
• Asthma Remediation Authorization Form – English (PDF)
• Asthma Preventive Services Authorization Request Form – English (PDF)
• Environmental Accessibility Adaptations (Home Modifications) Provider Order Form – English (PDF)
• Housing Deposit Authorization Form – English (PDF)
• Security Deposit Landlord Exemption Attestation Form – English (PDF)
• Housing Navigation and Tenancy Authorization Form – English (PDF)
• Medically Tailored Meals/Medically Supportive Food Referral Form – English (PDF)
• Provider Order Form for Medically Tailored Meals – English (PDF)
• Personal Care and Homemaker Services Authorization Form – English (PDF)
• Recuperative Care Referral Form – English (PDF)
• Respite Services (for Caregivers) Authorization Form – English (PDF) UPDATED
• Short-term Post-Hospitalization Housing Referral Form – English (PDF)
• Day Habilitation Referral Form – English (PDF)
• Transitional Rent Authorization Form – English (PDF)

Community Health Plan of Imperial Valley

• Assisted Living Facility (ALF) Transitions Referral Form – English (PDF)
• Asthma Remediation Authorization Form – English (PDF)
• Asthma Preventive Services Authorization Request Form – English (PDF)
• Environmental Accessibility Adaptations (Home Modifications) Provider Order Form – English (PDF)
• Housing Deposit Authorization Form – English (PDF)
• Security Deposit Landlord Exemption Attestation Form – English (PDF)
• Housing Navigation and Tenancy Authorization Form – English (PDF)
• Medically Tailored Meals/Medically Supportive Food Referral Form – English (PDF)
• Provider Order Form for Medically Tailored Meals – English (PDF)
• Personal Care and Homemaker Services Authorization Form (PDF)
• Recuperative Care Referral Form – English (PDF)
• Respite Services (for Caregivers) Authorization Form (PDF) UPDATED
• Short-term Post-Hospitalization Housing Referral Form – English (PDF)
• Day Habilitation Referral Form – English (PDF)
• Transitional Rent Authorization Form – English (PDF)

Authorization Guides

Community Supports (CS) authorization guides were developed to provide guidance to CS providers based on the Department of Health Care Services (DHCS) eligibility criteria. We encourage all CS providers to use the guides to help determine member eligibility for DHCS pre-approved CS services.

Health Net

• Assisted Living Facility (ALF) Transitions – English (PDF)
• Asthma Remediation – English (PDF)
• Asthma Preventive Services – English (PDF)
• Day Habilitation Programs – English (PDF)
• Home Modifications – English (PDF)
• Housing Deposit – English (PDF)
• Housing Deposit Item List Example – English (PDF) UPDATED
• Housing Tenancy and Sustaining Services – English (PDF)
• Housing Transition Navigation – English (PDF)
• Medically Tailored Meals/Medically Supportive Food – English (PDF) UPDATED
• Personal Care Services and Homemaker Services – English (PDF)
• Recuperative Care – English (PDF)
• Respite Services – English (PDF)
• Short-Term Post-Hospitalization Housing – English (PDF)
• Sobering Centers – English (PDF)
• Transitional Rent – English (PDF)

CalViva Health

• Assisted Living Facility (ALF) Transitions – English (PDF)
• Asthma Remediation – English (PDF)
• Asthma Preventive Services – English (PDF)
• Day Habilitation Programs – English (PDF)
• Home Modifications – English (PDF)
• Housing Deposit – English (PDF)
• Housing Deposit Item List Example – English (PDF) UPDATED
• Housing Tenancy and Sustaining Services – English (PDF)
• Housing Transition Navigation – English (PDF)
• Medically Tailored Meals/Medically Supportive Food – English (PDF) UPDATED
• Personal Care Services and Homemaker Services – English (PDF)
• Recuperative Care – English (PDF)
• Respite Services – English (PDF)
• Short-Term Post-Hospitalization Housing – English (PDF)
• Sobering Centers – English (PDF)
• Transitional Rent – English (PDF)

Community Health Plan of Imperial Valley

• Assisted Living Facility (ALF) Transitions – English (PDF)
• Asthma Remediation – English (PDF)
• Asthma Preventive Services – English (PDF)
• Day Habilitation Programs – English (PDF)
• Home Modifications – English (PDF)
• Housing Deposit – English (PDF)
• Housing Deposit Item List Example – English (PDF) UPDATED
• Housing Tenancy and Sustaining Services – English (PDF)
• Housing Transition Navigation – English (PDF)
• Medically Tailored Meals/Medically Supportive Food – English (PDF) UPDATED
• Personal Care Services and Homemaker Services – English (PDF)
• Recuperative Care – English (PDF)
• Respite Services – English (PDF)
• Short-Term Post-Hospitalization Housing – English (PDF)
• Sobering Centers – English (PDF)
• Transitional Rent – English (PDF)

Findhelp is used to identify local resources, supports staff and community partners when searching for local services. The platform will create an efficiency for staff and Enhance Care Management (ECM) providers to search for Community Supports (CS) programs and/or free or low cost, direct services to support members with social determinants of health (SDOH) needs. The platform increases visibility to CS programs for ECMs, providers and community partners, making it easy to use when referring members to CS providers and closing the loop on referrals.

• Findhelp for Health Net
• Findhelp for CalViva Health

The Findhelp How-To Guide is a step-by-step tool to help CS and ECM providers navigate the findhelp platform. Use the guide to help you with account setup, find CS providers and services, make referrals, connect with the members to provide services, view and update referral status, invoice and billing and more.

• Use findhelp to Connect Members to Community Supports Services – Health Net – English (PDF)
• Use findhelp to Connect Members to Community Supports Services – CalViva Health – English (PDF)
• Use findhelp to Connect Members to Community Supports Services – Community Health Plan of Imperial Valley – English (PDF)
• Findhelp How-To Guide – Health Net – English (PDF)
• Findhelp How-To Guide – CalViva Health – English (PDF)
• Findhelp How-To Guide – Community Health Plan of Imperial Valley – English (PDF)

Complete the following form to add or remove ECM user accounts on findhelp. Submit the completed form to the email address on the form.

• Findhelp ECM Provider Request Form – Health Net – English (PDF)
• Findhelp ECM Provider Request Form – CalViva Health – English (PDF)
• Findhelp ECM Provider Request Form – Community Health Plan of Imperial Valley – English (PDF)

Refer to the flyer for information on how to make Enhanced Care Management (ECM) referrals.

• Use findhelp to Submit ECM Referrals – Health Net – English (PDF)
• Use findhelp to Submit ECM Referrals – CalViva Health – English (PDF)
• Use findhelp to Submit ECM Referrals – Community Health Plan of Imperial Valley – English (PDF)

Data Sharing

• ECM sFTP Details Request Form (Excel)
• ECM Member Information File (MIF) – Data Dictionary (Excel)
• ECM Mini MIF – Data Dictionary (Excel)
• ECM Outreach Transmission File (OTF) – Data Dictionary (Excel)
• ECM Return Transmission File (RTF) – Data Dictionary (Excel)

ECM Referral

Adult

• Enhanced Care Management (ECM) Benefit Referral Form – Adult – Health Net – English (PDF)
• Enhanced Care Management (ECM) Benefit Referral Form – Adult – CalViva Health – English (PDF)
• Enhanced Care Management (ECM) Benefit Referral Form – Adult – Community Health Plan of Imperial Valley – English (PDF)

Child & Youth

• Enhanced Care Management (ECM) Benefit Referral Form – Child & Youth – Health Net – English (PDF)
• Enhanced Care Management (ECM) Benefit Referral Form – Child & Youth – CalViva Health – English (PDF)
• Enhanced Care Management (ECM) Benefit Referral Form – Child & Youth – Community Health Plan of Imperial Valley – English (PDF)

ECM Eligibility Quick Reference Guide

• Enhanced Care Management (ECM) Eligibility Quick Reference Guide – Health Net – English (PDF)
• Enhanced Care Management (ECM) Eligibility Quick Reference Guide – CalViva Health – English (PDF)
• Enhanced Care Management (ECM) Eligibility Quick Reference Guide – Community Health Plan of Imperial Valley – English (PDF)

ECM Assessments

Children and Youth Assessment

• Children and Youth (C/Y) Enhanced Care Management Comprehensive Assessment – Health Net – English (PDF)
• Children and Youth (C/Y) Enhanced Care Management Comprehensive Assessment – Health Net – En Español (Spanish) (PDF)
• Children and Youth (C/Y) Enhanced Care Management Comprehensive Assessment – CalViva Health – English (PDF)
• Children and Youth (C/Y) Enhanced Care Management Comprehensive Assessment – CalViva Health – En Español (Spanish) (PDF)
• Children and Youth (C/Y) Enhanced Care Management Comprehensive Assessment – Community Health Plan of Imperial Valley – English (PDF)
• Children and Youth (C/Y) Enhanced Care Management Comprehensive Assessment – Community Health Plan of Imperial Valley – En Español (Spanish) (PDF)

Adult Assessment

• Adult Enhanced Care Management (ECM) Comprehensive Assessment – Health Net – English (PDF)
• Evaluación Integral de la Administración Mejorada de la Atención – Health Net – En Español (Spanish) (PDF)
• Adult Enhanced Care Management (ECM) Comprehensive Assessment – CalViva Health – English (PDF)
• Evaluación Integral de la Administración Mejorada de la Atención – CalViva Health – En Español (Spanish) (PDF)
• Adult Enhanced Care Management (ECM) Comprehensive Assessment – Community Health Plan of Imperial Valley – English (PDF)
• Evaluación Integral de la Administración Mejorada de la Atención – Community Health Plan of Imperial Valley – En Español (Spanish) (PDF)

ECM Program Completion Assessment

Health Net

• Enhanced Care Management Program Completion Questionnaire – Health Net – English (PDF)

CalViva Health

• Enhanced Care Management Program Completion Questionnaire – CalViva Health – English (PDF)

Community Health Plan of Imperial Valley

• Enhanced Care Management Program Completion Questionnaire – Community Health Plan of Imperial Valley – English (PDF)

Doctors, Hospitals and Other Providers

• Health Net Provider Directory
• CalViva Health Provider Directory
• Community Health Plan of Imperial Valley Provider Directory

• Doula Services Benefit flyer – English (PDF)
• Medi-Cal Doula Services Documentation of Doula Visit – Health Net – English (PDF)
• Medi-Cal Doula Services Documentation of Doula Visit – CalViva Health – English (PDF)
• Medi-Cal Doula Services Documentation of Doula Visit – Community Health Plan of Imperial Valley – English (PDF)
• Medi-Cal Member Recommendation for Postpartum Doula Services – Health Net – English (PDF)
• Medi-Cal Member Recommendation for Postpartum Doula Services – CalViva Health – English (PDF)
• Medi-Cal Member Recommendation for Postpartum Doula Services – Community Health Plan of Imperial Valley – English (PDF)

• Medi-Cal Member Recommendation for Community Health Worker Services – Health Net – English (PDF)
• Medi-Cal Member Recommendation for Community Health Worker Services – CalViva Health – English (PDF)
• Medi-Cal Member Recommendation for Community Health Worker Services – Community Health Plan of Imperial Valley – English (PDF)

Providers are required to submit staffing and capacity reports at minimum on a quarterly basis or as update is needed.

• CS Staffing and Capacity Report (XLXS)
• ECM Staffing and Capacity Report (XLXS)

Coming soon

Q: How do I request a secure file transfer protocol (sFTP) account?
A: Request an sFTP account by filling out the ECM sFTP Details Request Form. You can find the form at CalAIM Resources for Providers, under Forms & Tools > Enhanced Care Management (ECM).

Q: Where do we submit the Return Transmission File (RTF)?
A: RTFs are submitted via the sFTP site. If your sFTP connection is not yet set up, you can send in the RTFs via secure email to ECM_sFTP_Request@healthnet.com.

Q: For those with an sFTP account, will files be delivered via secured email as well?
A: No. Files will be transmitted via sFTP on the 15th of each month.

Q: What do we do if our Member Information File (MIF) includes patients who are not enrolled in our program?
A: In addition to your enrolled members, members/patients labeled with status code 1 – Pending Outreach are included in the MIF. Providers can reach out and enroll them in the program if they qualify based on provider assessment.

Q: Will we receive cobranded letters or packets to use as part of our outreach efforts?
A: Member facing ECM materials are available on the provider resource page for download in English and all Medi-Cal threshold languages on the CalAIM Resources for Providers page, under CalAIM General Information > Member Resources.

Q: Who can I contact for information regarding an outreach list or an ECM guide?
A: Each ECM provider is assigned an operational point of contact. You can find your operational point of contact in the Delegation Oversight Interactive Tool (DOIT) profile for your organization or by emailing CALAIM@Centene.com.

Q: Do I enter one row on the Outreach Tracker File (OTF) for each outreach attempt?
A: Yes.

Q: Can I round up the outreach time spent or does it need to be the exact number?
A: Yes. You can round it up to the nearest minute in the OTF.

Q: How do we count the total number of encounter in the RFT?
A: You can count total number of in-person encounters via the data element labeled In-Person. You can count total number of telephonic encounters via the data element labeled Telephonic. The values in each RTF should include the number of each outreach types for that file reporting period.

Q: Is the RTF due by the 5th regardless of when the MIF was received?
A: Yes. The MIF is sent no later than the 15th of the month and the RTF is due by the 5th of the following month. If for some reason the RTF is not submitted on time, the updates can be included in following month's RTF.

Q: What is the phone number for the Community Supports (CS) team?
A:

• Health Net Provider Services Center: 800-675-6110
• CalViva Health Provider Services Center: 888-893-1569
• Community Health Plan of Imperial Valley Provider Services Center: 833-236-4141

Q: If outreach is performed for a patient already in a board and care home/assisted living facility or skilled nursing facility, is that considered a successful outreach?
A: Yes.

Q: Are ECM providers responsible for adding all previously enrolled patients to the RTF?
A: The RTF should include information on all members included in your most recent MIF that do not have a "termed" status.

Q: If a member enrolls and then decides to not participate in the program, what would the code be?
A: The member can be marked with status code 4 – Declined. The date of enrollment should be populated under ECM Enrollment Start Date. The date the member decided not to participate in the program should be populated under ECM Enrollment End Date.

Q: If the outreach attempt is by mail, which code should be used?
A: This can be captured under Telephonic/Electronic and Time Spent. This should be defaulted to 1 minute.

Q: Will the Plan keep and provide historical data submitted by providers on the monthly RTF? Or will we need to re-enter details every month?
A: Yes. Provider updates sent on the monthly RTF will be included in the next month's MIF.

Q: Will there be ongoing office hours for questions?
A: Yes. ECM office hours are scheduled to occur at least once a month. Please visit the CalAIM Provider Trainings and Webinars page for upcoming training opportunities.

Q: Is there training for the ECM data exchange files?
A: Yes. ECM data exchange training is available on the CalAIM Provider Trainings and Webinars page.

Q: What if I get a blocked content message when uploading my file?
A: This is most likely due to your organization's firewall settings. Contact your IT department for help to whitelist the website or webpage.

Q: Will we get an email notification notifying us of new files uploaded to sFTP?
A: Yes. You should receive an email when a new file is uploaded to sFTP. You should check your sFTP folder on a daily basis to download any files transmitted.

Q: I have received a file response for the RTF submission that it was declined due to being uploaded after the 10th. What do I do?
A: RTF files are only accepted until the 10th of each month. If you are not successful in transmitting your file timely, you will need to be sure to do so during the next month's reporting window.

Q: What file type should the RTF and OTF be submitted as (i.e., macro enabled, etc.)?
A: You can enable macros or not in your final submitted file, but the file extension must be xlsx or xlsm.

Q: For acuity level, is there a definition of low, medium or high with examples?
A: We do not prescribe acuity level. We ask that our providers evaluate this based on their interactions with the member. Guidelines are available in the ECM provider guide.

Q: For acuity, is it a required field?
A: The acuity field, while not officially required in the data dictionary, will give you an error message if you try to submit. Please default blank cells to "low" for acuity.

Q: For the most recent encounters with members, including telehealth and in person encounters, are those specifically for successful encounters with the members (not including outreach attempts with members)?
A: The "date of most recent encounter with member" column should list the date of the most recent successful encounter with the member. You can include the count of both successful and unsuccessful encounters in the "In Person" and "Telephonic/Video" columns.

Q: Can we do outreach for 90 days, not 60?
A: Yes. Outreach should be completed for 90 calendar days (60 business days) at least 5 times using a minimum of 3 outreach modalities before a member is excluded for inability to contact.

Q: Are we referring patients (patients not in MIF) into the ECM program through the RTF?
A: For patients identified in the community (not on your MIF), you must submit a referral through the provider portal or fax to enroll the member.

Q: What's the difference between ECM Enrollment End date and Discontinuation date?
A: The Discontinuation date column and Enrollment End date column are populated based on whether the member was enrolled in the program or not prior to their exclusion. An enrolled member that is being excluded from ECM should have the date listed in the Enrollment End date column and Discontinuation Date column. A member who was never enrolled in ECM should have the date listed in the Discontinuation date.

Q: What happens if our RTF and OTF data is not submitted by the 5th of the month?
A: There are many implications for failing to submit timely data. Without this data, we are unable to update our records.

• Claims can be denied due to incorrect member status in our system.
• Incentive payments are unable to be calculated.
• Member assignments for the next month may be turned off due to inaccurate capacity assumptions and lack of member information.
• MIF file for the following month will contain outdated member information.

To avoid any of these scenarios, please submit your data as soon as possible following the first of the month and send an email to your Plan contacts to validate the file was received successfully.

Q: When will CS providers receive the Community Supports Authorization Status File (CSASF)?
A: Providers will receive the CSASF bi-weekly on the 15^th and 29^th of every month. The CSASF will contain both members with and without authorization. Members without authorization have been identified as "new potential members" for outreach. Members with authorization that you've submitted will also be contained in this file.

Q: How do I request a secure file transfer protocol (sFTP) account?
A: Request an sFTP account by filling out the CS sFTP Details Request Form. You can find the form on this page under Forms & Tools > Community Supports (CS) or reach out to your point of contact.

Q: If I'm a contracted CS provider and also an ECM provider with an existing sFTP set-up, do I have to complete the CS sFTP Detail Request Form?
A: Yes, ECM providers who are also CS providers will be required to complete the request form, column A-H, leaving columns I-L blank since we will be hosting your sFTP. However, we will be modifying your existing set-up to receive two separate files (one for ECM and one for CS).

Q: Will specs and sample files be shared with CS providers?
A: Yes, you can find the CS Data Sharing Layout on this page under Forms & Tools > Community Supports (CS).

Q: Is the Department of Health Care Services (DHCS) requiring the Community Supports Provider Return Transmission File (CSPRTF)? Where do we submit the CSPRTF
A: Yes, DHCS requires MCPs to collect the CSPRTF from all contracted CS providers. Providers will be required to submit the CSPRTF by the 5^th of every month via the sFTP site. If your sFTP connection is not yet set up, you can send the CSPRTF via secure email to ECM_sFTP_Request@healthnet.com.

Q: Can we call the patients and/or send them texts? I am concerned about following HIPAA Compliant rules.
A: You may call the member for initial engagement. We encourage you to review the Telephone Consumer Protection Act of 1991 (TCPA) (PDF) for texting provisions.

Q: How are you identifying the members that are on the CSASF?
A: Members included on your CSASF are identified based on your capacity report, the member's ZIP code, and the CS service your organization provides.

Q: Are CS providers required to submit authorization for services?
A: Yes, approved authorizations may be required before rendering services. To submit an authorization, you will use the provider portal. Please refer to the CS authorization guides under Forms and Tools > Community Supports for information on the service you provide.

Q: Will there always be members within the file?
A: The file will include any members who are currently authorized for CS under your entity. We will strive to assign "new potential CS members" based on your capacity and members available in your service area who meet CS criteria, but providers should focus on creating community-based referrals for services.

Q: How long does it take to determine eligibility?
A: Members assigned to your organization are new potential members who may meet the eligibility for the CS service. Providers should use the CS Authorization Guides to confirm member eligibility and interest before submitting an authorization.

Q: Will referrals received be specific to our organization, or will multiple entities be calling the same member lists?
A: Referrals will be specific to the organization. If the member potentially qualifies for more than one CS service, then they may appear on more than one CS provider's referral list, but each unique member + CS service combination will only appear for one provider.

Q: Will there be payments for CS outreach like ECM outreach?
A: No, at this time, outreach is not billable. CS services will require authorizations before you can bill for services.

Q: Is there a distinction between obtaining authorization for day rehab services, versus, as an example, Post-Hospital Stay services?
A: Yes, all 14 CS services have distinct authorization requirements. You can find our CS-service specific authorization guide on this page under Forms & Tools > Community Supports (CS), and scroll down to "Authorization Guides."

Q: When it comes to data exchange, this is pertaining only to communication between the MCP and Service providing agency?
A: Correct, it does not go further into data exchange between provider agencies to another provider agency that share a mutual client.

Q: Where do I get the authorization form to fill out for a client?
A: Use the CS referral forms when requesting prior authorization for CS services, located on this page under Forms & Tools > Community Supports (CS). You can find instructions on CS authorization submission at step 6 on the Community Supports End-to-End Process page.

Q: For providers who manage a large number of members, do we need to manually check eligibility of all these members one at a time regularly through the provider portal?
A: We highly encourage you to always verify eligibility prior to rendering the service to the member.

Q: Will CS providers contracted for several CS services receive multiple lists? Does this include the housing trifecta being separated?
A: If your entity is contracted to serve multiple community supports, you will receive a single list of all members currently authorized or assigned to your entity. You will note the service type is listed for each row to note which service the member is authorized or potentially eligible for.

Q: Will the CSPRTF be in the same format as all other MCP's?
A: CSPRTF was designed based on the guidelines provided by DHCS, so all MCP CSPRTFs should be aligned in most cases.

Q: Is there a turnaround time for a CS referral to be approved and/or denied?
A: CS referrals that are sent directly to contracted CS providers should be timely assessed by the CS provider for eligibility and submitted as an authorization to the health plan. Authorization turnaround is within 7 calendar days, and assuming no additional info is needed, it will be approved within that time frame. Some authorizations have quicker response times.

Q: Is the CSASF a rolling list of members, for the ones that we pend will stay on the file month over month until resolved?
A: Yes. The members will remain on the CSASF until they have been resolved.

Q: Do we need an authorization form for ECM?
A: You do not need an authorization for ECM, but each member must be screened for eligibility for the program. If the member is not on your MIF file, please complete the ECM referral form to confirm the member's qualification and submit a referral through the fax or through the authorization tab in the provider portal. The member will be added to an assigned ECM provider's next member information file. Note: Members who were listed on your MIF must also be screened for program eligibility but you do not need to submit this to the Plan. You will need to report the member as enrolled status on your next RTF and store the screening form in the member's record for review during ECM audits.

Q: Do we have an authorization form for Community Supports (CS)?
A: Authorization may be required for CS services. For specific details on what needs to be submitted for authorization for each CS, please refer to the authorization guides under Forms and Tools > Community Supports. There are recommended CS referral forms that can be used when submitting an authorization request, or you can use the Outpatient Medi-Cal Prior Authorization Form (PDF). The recommended method to submit authorization is through the provider portal. Requests may also be submitted via fax or phone.

Q: Is the member's signature needed on the claim form every time, even if we provide services telephonically?
A: If you have the member's signature on file, you don't need to provide it on each claim/invoice. You can indicate "signature on file/SOF" on the claim or invoice when submitting. Signatures can be collected through various methods, such as electronic signatures, telephonic audio recording or documentation in case notes. For reference, please see the Department of Health Care Services (DHCS) letter that gives general guidance on capturing telephonic signatures (PDF).

Q: Should we use point of service (POS) 02 for telehealth visit/over the phone?
A: There is no requirement on POS. Please ensure you follow the billing guidance and add modifier GQ when billing for telehealth.

Q: Can we submit a claim for mailers sent to members as a part of outreach attempts or reaching out to grandfathered members?
A: No. Preparing mass mailing for members is not a billable service.

Q: Can we submit one claim for all members or are individual claims needed?
A: You will need to submit one claim per member.

Q: If we are making phone calls to access services for the member, can these be billed as ECM phone services or can we only bill for phone calls with the member?
A: Yes. You can bill for any time you are doing activities with the member or on behalf of the member to meet their care plan goals and complete interventions.

Q: Do you have to use the provider portal to submit authorization?
A: The provider portal is the preferred and quickest method for submission. You can also submit authorization requests by fax to 800-743-1655, or by calling:

• Health Net: 800-675-6110
• CalViva Health: 888-893-1569
• Community Health Plan of Imperial Valley: 833-236-4141

Q: How will CS authorization approvals and denials be sent back to providers?
A: You can see determinations on the secure portal in real time, otherwise providers will receive a letter/fax with the determination.

Q: Is an authorization needed to submit claims?
A: You do not need to add the authorization number on the claim/invoice. For CS, authorization approval is required before you can provide services and bill.

If you're an ECM provider and if the member is in your MIF, once you enroll the member you can start billing – no authorization is required. If the member is not on the MIF, you will need to first submit a referral by fax or the provider portal (confirm eligibility and confirm member is not already assigned to another ECM provider in the portal before making the referral). The member will be added to your next MIF, but you will not need to wait for the member to appear in your MIF to provide service and bill.

Important note: Before providing services, always make sure the member is currently eligible with the Plan.

Q: How do I know the member is already assigned to another ECM provider?
A: On the provider portal, after checking for the member eligibility, you can click on the member's name to open their eligibility information on the left-hand side. There will be an ECM section that you can reference if the member is currently enrolled or pending outreach by another ECM provider.

Q: Who is allowed to make a referral to CS?
A: All providers are able to refer a member to our contracted CS providers if they have deemed that the member qualifies for CS services. We highly encourage providers to use the CS authorization guides to determine if the member qualifies for CS services. Providers can refer members to CS by referring them through Findhelp:

• Findhelp for Health Net
• Findhelp for Community Health Plan of Imperial Valley members
• Findhelp for CalViva Health members

Alternatively, providers can send the member information to contracted CS providers. For Findhelp, if you have an existing account with Findhelp, we highly encourage you log in before making a referral. If you do not have an account, you can simply "Sign Up" to create an account at the top right corner to track your member referrals.

Members can also self-refer to CS services by calling:

• Member Services Department – Health Net: 800-675-6110
• Member Services Department – CalViva Health: 888-893-1569
• Member Services Department – Community Health Plan of Imperial Valley: 833-236-4141.

Q: What are the rules for rounding claims to a whole unit?
A: In Fee-for-Service billing, there is likely to be rounding as the service may not end at the unit. The following guidelines should be used:

• For services with a 15-minute billing unit, follow the rule of 8 which requires at least eight minutes of treatment/services to occur in order to bill for the first 15-minute increment and for each subsequent 15-minute increment thereafter.
• For services with a 60-minute (one hour) unit:
  • Round up to the first unit of service if an impactful service has been provided less than 60 minutes.
  • For each subsequent unit in a service date:
    • Round down if 30 minutes or less were provided.
    • Round up to the next unit for 31 or more minutes of service.

Q: What Findhelp links should we use to make referrals to CS services?
A: You can easily search for and make a referral to CS services through unique Findhelp sites:

• Findhelp for Health Net
• Findhelp for Community Health Plan of Imperial Valley members
• Findhelp for CalViva Health members

Q: Will CS providers get referrals from medical providers or ECM providers through this system?
A: Yes. There is a "no wrong door" approach with the referral process. Referrals can come from ECM providers; other providers; other entities serving members, family member(s), guardians and caregivers, and/or other authorized support persons. Referrals are not limited to members engaged with an ECM provider.

Q: What is the preferred way to make a referral through Findhelp?
A: All referring individuals should first complete the CalAIM Assessment. Once the assessment is completed and submitted, a list of CS services will appear based on the results of the assessment. If there is more than one CS provider, work with your member to select the provider that will meet their needs.

Q: Is there any particular order in which the ECM provider will see the list of available partners?
A: There is currently no specific order. All of the program cards will be categorized by CS services specific to county and ZIP code.

Q: Are Medi-Cal members able to self-refer?
A: Yes, members can self-refer to a CS provider through Findhelp..

Q: Is there a suggested timeframe to accept a referral as a provider offering CS service?
A: Referrals should be accepted as timely as possible to ensure members get the much needed services that they need. If you are not able to timely support the member, please update Findhelp so that the member can be referred to another entity.

Q: Who is the best person to contact to get set-up as a CS provider in Findhelp?
A: Contact your assigned point of contact or email the Systems of Care team to help you get set up on Findhelp.

Q: Will the Plan be monitoring the number of referrals to each provider to ensure there are no capacity issues or should each provider turn off access to their program once capacity has been met?
A: CS providers will have the ability to update their capacity in the Findhelp platform.

Q: Can I submit claims through the provider portal?
A: Claims cannot be submitted through the provider portal at this time. You can submit claims, as well as access member information, through the Availity platform. Please go to Availity to register for access to the portal for all provider needs. For information on how to bill for ECM and CS services, please refer to our billing guidance page.

Q: We have registered and created an account for the provider portal but are unable to access certain sections (e.g., authorization, medical information). How can we change our access rights?
A: Each organization can have at least one user with Account Management access to the provider portal who will allow them to control access for other members in the organization.

Contact the Provider Services Center to identify the user with Account Management access in your organization if you do not know who it is or need to assign a user with that access.

• Health Net Provider Services Center: 800-675-6110
• CalViva Health Provider Services Center: 888-893-1569
• Community Health Plan of Imperial Valley Provider Services Center: 833-236-4141

In addition, you can contact your assigned point of contact for assistance.

Q: Is a member able to request a specific ECM or CS provider they want to be assigned to?
A: Yes, members can call the Member Services Department to request a specific provider or to switch provider assignment. If the member is new to ECM or CS at the point of the referral, it is the member's choice to select the provider they want to be referred to, based upon our contracted provider directory.

Q: How can we update the contact information listed for our organization in the provider directory?
A: You can contact your assigned point of contact or the Provider Services Center:

• Health Net Provider Services Center: 800-675-6110
• CalViva Health Provider Services Center: 888-893-1569
• Community Health Plan of Imperial Valley Provider Services Center: 833-236-4141

Q: How are ECM member assignments made?
A: ECM members are assigned based on:

• PCP: If the member's PCP is an ECM provider, that is the first choice.
• Qualified Provider: If the PCP is not an ECM provider, the member is assigned to the closest ECM provider to the member that serves their population of focus and has capacity.
• Member Request: At any time, the member can call Member Services and request assignment to a specific provider.

Q: How many ECM members can a provider have?
A: Ratios for Lead Care Managers to members cannot exceed 1:50. Each ECM provider must submit an updated capacity report quarterly, at a minimum, to ensure the Plan has the most current numbers. Assignments are given based on reported capacity numbers.

Q: How long do we have to complete the members initial assessment?
A: Member ECM assessments should be completed as timely as possible once the member has enrolled in the program. If you are unable to complete the assessment at the time of enrollment, be sure to schedule a date and time with the member to complete the assessment. Once completed, a care plan should be created immediately following the assessment. It is a best practice to complete the assessment and care plan within 7 days of enrollment.

Q: What do we do if our Clinical Consultant or Lead Care Managers leave the organization?
A: All ECM programs must have at least one qualified Clinical Consultant (see ECM provider guide for qualifications). If your organization finds itself without a clinical consultant, please contact your operational point of contact and ECM auditor as timely as possible to discuss the path forward.

If you have significant turnover in Lead Care Managers that puts your organization over capacity, please contact your operational point of contact and ECM auditor as timely as possible.

Q: Can CS providers submit multiple Housing Deposit claims for member reimbursement?
A: If there is an original approved authorization request for the member, yes, CS providers can submit multiple authorization requests using the existing authorization number up to the approved dollar amount of the authorization.

Q Can the Housing Deposit pay first and last month's rent as required by landlord for occupancy?
A: No, first and last month's rent are no longer covered.

Q: Can the Housing Deposit pay for a double deposit if required by landlord?
A: In alignment with California Civil Code section 1950.5, a landlord is prohibited from demanding or receiving a security deposit that exceeds an amount of one month's rent (or two month's rent for small landlords renting to non-service members). The exception for small landlords applies to landlords who are natural persons or limited liability companies in which all members are natural persons where the landlord owns no more than two residential properties that collectively include no more than four dwelling units offered for rent. Even for small landlords, service members may not be required to pay a security deposit that exceeds the amount of one month's rent.

Q: Can a member receive both Housing Deposit service and Transitional Rent in support of the same housing placement?
A: Yes, if eligible for both services.

Q: What happens to the rental or utility security deposit if the member moves out?
A: The landlord/owner must return any security deposit amount collected (less any amounts the landlord may withhold under the terms of the lease and state and local law) directly to the member.

Q: Can Housing Deposit requests be submitted for authorization at any time?
A: Housing Deposit service requests must be submitted within 30 days of the member moving into their housing unit as noted in the lease agreement. Providers may request Housing Deposit authorization for services prior to move in, such as application fees or goods, to ensure a smooth transition for the members. Additionally, any further items needed post-move in must be requested within 30 days of the documented lease move-in date (with exception of utility statements limited to 60 calendar days from move-in date).

Q: Can a member receive a refrigerator and stove as part of the housing deposits?
A: No. Effective January 1, 2026, California Assembly Bill 628 requires landlords to maintain stoves and refrigerators in rental units. Please be sure that validating a working refrigerator and stove is included as part of your walk through to ensure that the landlords are following this requirement.

Q: What is the definition of Street Medicine?
A: Street medicine is provided to individuals experiencing unsheltered homelessness in their lived environment, places that are not intended for human habitation.

Q: Is healthcare provided at shelters and mobile units considered Street Medicine?
A: Healthcare services provided at shelters, mobile units/recreational vehicles (RV), or other sites with a fixed, specified location do not qualify as Street Medicine. These fixed, specified locations are considered mobile medicine, as they require people experiencing unsheltered homelessness to visit a healthcare provider at the provider's fixed, specified location.

Please note, mobile units/RVs that go to the individual experiencing unsheltered homelessness in their lived environment ("on the street") are considered Street Medicine.

Q: Who can be a Street Medicine provider?
A: A Street Medicine provider refers to a licensed medical provider (e.g., Doctor of Medicine (MD)/Doctor of Osteopathic Medicine (DO), Physician Assistant (PA), Nurse Practitioner (NP), Certified Nurse Midwife (CNM)) who conducts patient visits outside of the four walls of clinics or hospitals and directly on the street, in environments where unsheltered individuals may be (such as those living in a car, RV, abandoned building, or other outdoor areas).

Q: Can non-physicians provide Street Medicine?
A: For a non-physician medical practitioner (PA, NP, and CNM), MCPs must ensure compliance with state law and contract requirements regarding physician supervision of non-physician medical practitioners. Additionally, given the unique and specialized nature of Street Medicine, a supervising physician must be a practicing Street Medicine provider, with knowledge of and experience in Street Medicine clinical guidelines and protocols.

Q: Who is eligible for Street Medicine services?
A: Street medicine providers are required to verify the Medi-Cal eligibility of individuals they encounter in the provision of healthcare services. Medi-Cal eligible individuals will be covered by either Medi-Cal Fee-for-Service (FFS) or Medi-Cal managed care (with a corresponding MCP) delivery system. For those individuals without Medi-Cal coverage, the Hospital Presumptive Eligibility (HPE) program is one pathway for qualified HPE providers to determine Medi-Cal eligibility.

Q: How does a member receive Street Medicine services?
A: Street Medicine providers go to where the member is physically located. Members do not have to seek out these providers. They just need to be covered by Medi-Cal or HPE.

Q: Are Street Medicine providers mandated reporters who must report when they suspect child or elder abuse has occurred?
A: All licensed health care professionals, including, but not limited to, physicians, nurses, mental health professionals, EMTs, paramedics, medical examiners, all employees at long-term health facilities, social workers, marriage and family counselors, children care custodians, elder or dependent adult custodians, teachers, clergy, employee of protective service or law enforcement agency are all mandated reporters. If a mandatory reporter fails to report suspected abuse, they could be charged with a criminal offense and/or discipline by their regulatory Board.

Q: Is consent required for minors?
A: Minors ages 12 and older may consent to mental health treatment or counseling on an outpatient basis, or to residential shelter services, if both of the following requirements are satisfied:

1. The minor, in the opinion of the attending professional person, is mature enough to participate intelligently in the outpatient services or residential shelter services.
2. The minor:
   • would present a danger of serious physical or mental harm to self or to others without the mental health treatment or counseling or residential shelter services, or
   • is the alleged victim of incest or child abuse.

The professional person offering residential shelter services should make their best attempt to notify the parent or guardian of the provision of services. For mental health treatment or counseling of a minor, the minor's parent or guardian should be involved unless, in the opinion of the professional person who is treating or counseling the minor, the involvement would be inappropriate. Documentation of attempts or contacts to parents and guardian for services should be documented in the minor's record.

Q: Is there compensation for travel time?
A: No.

Q: What are the billing codes?
A: The Centers for Medicare and Medicaid Services (CMS) recently designated POS code 27 for "Outreach Site/Street," which CMS defined as "a nonpermanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic and/or treatment services to unsheltered homeless individuals."

Medi-Cal providers may use POS code 27 for street medicine in addition to the previously announced POS codes for street medicine: 04 (homeless shelter—A facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters), 15 (mobile unit—A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic and/or treatment services), and 16 (temporary lodging—A short-term accommodation, such as a hotel, campground, hostel, cruise ship or resort where the patient receives care, and which is not identified by any other place of service (POS) code). Both street medicine and mobile medicine are reimbursable services in accordance with billing protocols and a provider's scope of practice; however, it remains the expectation that individuals experiencing unsheltered homelessness receive appropriate and applicable services in their lived environment via street medicine.

Any claims for street medicine services provided on or after October 1, 2023, that are denied for using POS code 27 do not need to be resubmitted and will be reprocessed after system changes are updated.

Q: I'm a new provider. How do I bill for Street Medicine services?
A: Submit claims and supporting information via one of the options below:

• Electronic data interchange (EDI) through a clearinghouse or Availity (recommended).
• Submit paper CMS-1500 (version 02/12) form for paper claims. Refer to the Claims Procedures page for more information.

Q: Where can I access provider trainings?
A: Refer to the CalAIM Provider Training and Webinars page.

Q: Can a member get Street Medicine and Community Health Worker services at the same time?
A: Yes.

Q: How do we treat mobile clinics?
A: If you get out of the mobile units/RVs and go to the individual experiencing unsheltered homelessness in their lived environment ("on the street"), that is considered Street Medicine. Health care services provided at shelters, mobile units/RV, or other sites with a fixed, specified location does not qualify as Street Medicine. They are considered mobile medicine, as they require people experiencing unsheltered homelessness to visit a health care provider at the provider's fixed, specified location.

Q: What do we do if multiple Street Medicine providers are seeing the same member?
A: Given the difficulty of knowing if there are multiple Street Medicine providers who are treating the same member, Street Medicine providers should provide medically necessary and non-duplicative services to our members whenever possible.

Q: Do Street Medicine providers need to check eligibility?
A: Yes, you can check the patient's name and DOB through DHCS' Automated Eligibility Verification System (AEVS). If a provider is an HPE provider, they can process for HPE using HPE protocols.

Q: Do Street Medicine providers submit referrals/requests for services?
A: Street Medicine providers will work with the assigned PCP to refer the member to the specialty network for the member's PPG/PCP.

Q: How do Street Medicine providers make referrals to CS?
A: Refer to the CalAIM Resources for Providers for information and instructions for making referrals.

Q: Do Street Medicine providers have an office so we can mail care plans and request medical records?
A: Yes, some Street Medicine providers are existing providers in the Plan's network. Everyone should have a contact address where they can be reached.

Q: Can an individual seek treatment from any Street Medicine provider or only one that is in the MCP's network?
A: An individual may seek treatment from any Street Medicine provider serving their location or encampment. It is up to the Street Medicine provider to understand if the individual is enrolled in the MCP that the Street Medicine provider is contracted with and can bill that MCP for services.

Q: Will we know the locations of Street Medicine providers so we can direct members where they can receive care?
A: Street Medicine providers typically travel to members rather than operating from fixed locations. If a member is staying temporarily in someone's home or another informal setting, they can be referred to ECM, and the Health Plan will notify the Street Medicine team so they can meet the member where they are.

Q: What tools are available to providers in the field to make the appropriate referral to specialty services and how do we coordinate with the PPGs?
A: Street Medicine providers should reach out to the member's PCP for the PCP to coordinate the member's referrals.

Q: If a member moves into a different setting (i.e. recuperative care), can Street Medicine providers still provide services?
A: Yes, Street Medicine providers can follow the member to a more housed location, but it is up to the PCP to provide continuity of care services.

Q: Who is the point of contact for Street Medicine providers?
A: Contact your designated Plan representative.

Q: Would tiny homes, where individuals and families are temporarily housed for a limited period of time, in a rapid rehousing model, fall under mobile (not Street Medicine) in the scope of health care?
A: Yes. Street Medicine is meant to serve people experiencing unsheltered homelessness in their lived environment. Their lived environment may include places like the street, riverbed, car, abandoned buildings or other places not meant for human habitation. Individuals and families in tiny homes, shelters or other interim housing placements are not unsheltered and would fall under mobile medicine or other categories of health care provision as allowed by DHCS.

Q: Can Street Medicine providers provide case management?
A: ECM allows for a type of case management that focuses on ensuring eligible members are supported in navigating their health care. Street medicine providers may want to explore becoming an ECM provider and can contact the Plan for more details.

Q: How will the CS provider connect with the patient? On site? Phone?
A: Both ECM and CS providers make every effort to connect with the patient both on site and by phone with multiple attempts. It is understood that these services are often best provided as in-person services because phones may regularly be lost or stolen. For this reason, street medicine providers are encouraged to help CS providers when referrals are made and as appropriate by sharing contact information or providing specific information about the location of the patient so that the CS provider can make contact as quickly as possible and to support a soft hand off.

Q: How do we know if someone is already enrolled in ECM and how do we connect with their assigned ECM provider?
A: The Plan's provider portal will show ECM enrollment and the assigned ECM provider.

Q: What address should we use on a claim form for a member who is seen on the street or park?
A: Use the provider's billing address.

Q: If the patient's primary care physician (PCP) is different from the Street Medicine provider, a specialty referral can only be done by the patient's PCP, correct? If so, must we always have to refer the patient back to their PCP for referrals?
A: Currently, the Plan is not contracting Street Medicine providers as PCPs. Street Medicine providers should render services, bill the Plan, inform the member's PCP of services rendered, and work with the PCP to get referrals to specialists or institutional services.

Q: Since the Street Medicine provider must put referrals through the PCP, is the street medicine contact considered a "one and done" contact? Who is doing follow-up care?
A: The goal is to ensure closed loop referrals so that the Street Medicine provider can know the status of the referral and services to be provided. Findhelp is especially useful for tracking referrals and will help the Street Medicine provider continue to build a relationship of trust with the patient and can have confidence that services were provided or provide follow up, as needed. Street Medicine providers have a broad scope and opportunity to support access to healthcare. Street Medicine providers should be working together with the PCP and should continue to render services.

Q: Can the member have a Street Medicine PCP and a clinic-based PCP?
A: A member can only be assigned to one PCP.

Q: The DHCS All Plan Letter 22-023 allows Street Medicine to be direct access providers through direct contracting. In other words, are Street Medicine providers able to make referrals, such as specialty referrals, without going through the assigned PCP?
A: The Plan's interpretation of the APL is that it establishes the expectation that the Street Medicine provider will refer members to medically necessary covered services within the proper MCP network, and must coordinate care with the MCP, subcontractor and/or PPG as appropriate. The entree to the PPG and its network of specialists would be the PCP and the Plan expects that the Street Medicine provider and PCP to collaborate. Alternatively, there should be no issue directly contacting the PPG/Management Services Organization (MSO) for a referral, although there may need to be some exchange needed between the PPG/MSO with the Street Medicine provider to establish the relationship of the Street Medicine provider as a treating provider.

Health Net is planning to train and communicate with PPGs and other contracted providers to support building the positive relationships between Street Medicine providers and other contracted providers that are needed for this patient group and other Populations of Focus to be successful.

Q: What are Community Health Workers (CHW)?
A: CHWs are unlicensed, trained health educators who work with individuals who may have difficulty understanding providers due to cultural or language barriers to connect them with the services they need.

Q: What are the qualifications needed to be a CHW?
A: CHWs include individuals known by a variety of job titles, including promotores, community health representatives, navigators, violence prevention professionals, substance use navigators, and behavioral health navigators, among other titles. A CHW:

• Must have lived experience that aligns with and provides a connection between the CHW and the community or population being served.
• Must fulfill either the training pathway or experience pathway, as outlined in the Medi-Cal Provider Manual: Community Health Worker Preventive Services (PDF).
  • CHWs who enter through the experience pathway must earn a CHW certificate within 18 months of rendering CHW services to a Medi-Cal member.

Q: Does the certificate of completion need to be issued or approved by the State of California?
A: No. The certificate of completion does not need to be approved by DHCS, Health Care Access and Information or any other state agency. The certificate of completion can be issued by any organization so long as it covers the core competencies listed in the state plan, Medi-Cal policy, and also satisfies the field experience requirement. Certificates can be issued by a California-based organization, an organization based in another state or even an international organization.

Q: What do CHWs do to support members?
A: CHWs may provide the following services under the Medi-Cal CHW benefit:

• Health education to promote the Medi-Cal member's health or address barriers to healthcare, including providing information or instruction on health topics.
• Health navigation to provide information, training, referrals, or support to assist Medi-Cal members to access healthcare, understand the healthcare system, and engage in their own care and to connect members to community resources necessary to promote their health.
• Screening and assessment that assist Medi-Cal members to connect to appropriate services to improve their health.
• Individual support or advocacy that assists Medi-Cal members in preventing the onset or exacerbation of a health condition or preventing injury or violence.

Q: Who is eligible to receive CHW services?
A: To be eligible for CHW services, Member must be an eligible Medi-Cal member with the Plan. Members must meet the medical necessity criteria for CHW services based on the presence of one or more of the following:

• Diagnosis of one or more chronic health (including behavioral health) conditions, or a suspected mental disorder or substance use disorder that has not yet been diagnosed.
• Presence of medical indicators of rising risk of chronic disease (for example, elevated blood pressure, elevated blood glucose levels, etc., that indicate risk but do not yet warrant diagnosis of a chronic condition).
• Positive Adverse Childhood Experiences (ACEs) screening indicating a need for follow-up services.
• Presence of known risk factors, including domestic or intimate partner violence, tobacco use, excessive alcohol use, and/or drug misuse.
• Results of a social drivers of health screening indicating unmet health-related social needs, such as housing or food insecurity.
• One or more visits to a hospital emergency department within the previous six months.
• One or more hospital inpatient stays, including stays at a psychiatric facility, within the previous six months, or being at risk of institutionalization.
• One or more stays at a detox facility within the previous year.
• Two or more missed medical appointments within the previous six months.
• Member expressed need for support in health system navigation or resource coordination services.
• Need for recommended preventive services; CHW violence preventive services are available to a member who meets any of the following circumstances.
  • The member has been violently injured as a result of community violence.
  • A licensed healthcare provider has determined that the member is at significant risk of experiencing violent injury as a result of community violence.
  • The member has experienced chronic exposure to community violence.

Q: Can a member receive CHW services at the same time as Enhanced Care Management (ECM)?
A: No. The CHW benefit cannot be provided to a member enrolled in ECM.

Q: Is the CHW benefit available for D-SNP members?
A: Yes, based on the Medi-Cal benefit.

Q: Can a member get a doula and CHW services at the same time?
A: Yes.

Q: How does a member get CHW services?
A: A member can be connected to a CHW through the following:

• Member Services – When a member contacts the Plan, we will share a list of local CHW with a member to select their doula.
• Provider Directory – Each CHW is listed in the Health Plan directory which includes contact information for the member or providers to use in connecting with the selected CHW.
• Direct Referrals – Hospitals, clinics, and providers may reach out directly to a CHW to connect them with a member.

Q: Who can contract with the Plan to provide CHW services?
A: An organization must be a supervising provider to contract for CHW services. The supervising provider:

• Must be an enrolled Medi-Cal provider who submits claims for services provided by CHWs.
• Be a licensed provider, hospital, outpatient clinic, local health jurisdiction (LHJ) or community-based organization (CBO).
• Have a National Provider Identifier (NPI).
• Ability to receive referrals from licensed practitioners for CHW benefits.
• Ability to submit claims or encounters to Health Net using standardized protocols.
• Ensure their business license meets industry standards.
• Ability to comply with all reporting and oversight requirements.

Review the full list: Frequently Asked Questions For Medi-Cal Community Health Worker Services - Provider Requirements

Q: Does the supervising provider need to submit evidence of CHW training?
A: No, but CHWs must complete a minimum of 6 hours of additional relevant training annually. The supervising provider must maintain evidence of this training. Supervising providers may provide and/or require additional training, as identified by the supervising provider.

Q: Can a CHW bill for travel time when providing CHW services?
A: No. There are no additional payments for travel time to provide CHW services.

Q: What is a CHW plan of care?
A: The plan of care, also known as a treatment plan, is a written document that is developed by one or more licensed providers that describe services a CHW will provide to address a Medi-Cal member’s ongoing need for CHW services.

• A CHW may assist in developing a plan of care with the licensed provider(s).
• Similar to a written plan of care for physical therapy, it must contain goals and services intended to help the Medi-Cal member meet those goals through ongoing CHW services.
• This requirement does not apply to CHW services provided in the emergency department.
• The written plan of care may not exceed a period of one year.

Q: Is there a template for the CHW plan of care?
A: No. There is not a standard template.

Q: What is required to include as part of the CHW plan of care:
A: The following elements must be included:

• Specify the condition that the service is being ordered for and be relevant to the condition;
• Include a list of other healthcare professionals providing treatment for the condition or barrier;
• Contain written objectives that specifically address the recipient's condition or barrier affecting their health;
• List the specific services required for meeting the written objectives; and
• Include the frequency and duration of CHW services (not to exceed the provider's order) to be provided to meet the plan's objectives.

Q: When does a plan of care need to be created for a CHW member?
A: A written plan of care is required for continued CHW services after 12 units (equivalent to 6 hours) of care per recommendation.

Q: Does the plan of care need to be submitted to the Plan?
A: No. It does not need to be submitted but once the care plan is developed, the supervising provider must go to the provider portal and attest to the creation of the care plan. Access the provider portal here.

• The plan of care should be maintained in the member’s secure record and made available to the Plan or DHCS upon request.

Q: How do we bill for CHW services?
A: Please visit the CHW workflow: Bill for Community Health Worker services using claims/invoice form.

Q: Can a CHW provide and bill for services via telehealth?
A: Yes, CHWs may provide services via synchronous audio-visual or audio-only that are appropriate for telehealth. CHWs may not provide services via asynchronous store and forward. CHWs must follow all existing Medi-Cal policies regarding delivery of covered services via telehealth modalities, including consent requirements, as outlined in the Medicine: Telehealth Provider Manual (PDF). Services rendered by text, email or chat are not eligible for reimbursement.

Q: Can a CHW bill for unsuccessful outreach to a member?
A: No. A CHW can only bill for services that meet the definition of a CHW service when successfully provided. Outreach attempts are not a billable activity.

Q: How do I bill for multiple participants in a session?
A:

• Scenario 1: The CHW provides health education services for 1 patient for 2 hours (4 units). The provider is reimbursed for this service at a rate of $26.66/unit x 4 units. The provider is reimbursed at $106.64 ($26.66 x 4 units).
• Scenario 2: The CHW provides health education services for 3 patients in a group setting for 2 hours (4 units). The provider is reimbursed for each patient at a rate of $50.64 ($12.66 x 4 units) The total reimbursement for 3 patients in that group comes out to $151.92 ($50.64 x 3 patients).
• Scenario 3: The CHW provides health education services for 8 patients in a group setting for 1.5 hours (3 units). The provider is reimbursed for each patient at a rate of $50.64 ($9.46 x 3 units). The total reimbursement for 8 patients in that group comes out to $227.04 ($28.38 x 8 patients).

Q: Can I provide services to more than 8 members in one session?
A: CHWs may render covered services in a group setting to more than 8 Medi-Cal members; however, the maximum number of Medi-Cal members for which CHW services can be billed during one session is 8.

Q: What is not a covered CHW service?
A: The following services are not covered under the Medi-Cal CHW benefit:

• Clinical case management/care management that requires a license
• Child care
• Chore services, including shopping and cooking meals
• Companion services
• Employment services
• Helping a member enroll in government or other assistance programs that are not related to improving their health as part of a plan of care
• Delivery of medication, medical equipment, or medical supply
• Personal Care services/homemaker services
• Respite care
• Services that duplicate another covered Medi-Cal service already being provided to a member
• Socialization
• Transportation
• Services provided to individuals not enrolled in Medi-Cal, except as noted above
• Services that require a license

Q: Where can I find the billing codes and modifiers for CHW services?
A: Please see your CHW contract for additional information on billing codes and modifiers. Additional billing information can be found here: FAQs for Medi-Cal Community Health Worker Services - Billing.

Q: What is the daily limit on CHW services for a member?
A: The maximum frequency is 4 units (2 hours) daily per beneficiary, by a provider. Additional units may be provided with medical necessity only.

For additional information on the CHW benefit, please visit the following links:

• General Information (updated August 6, 2025)
• Billing (updated June 18, 2025)
• Provider Requirements (updated September 11, 2025)
• CHW G Codes (updated June 18, 2025)
• CHW Clinic FAQ (updated May 15, 2025)

Q: What are doulas?
A: Doulas are birth workers who provide health education, advocacy, and physical, emotional, and non-medical support for pregnant and postpartum persons before, during, and after childbirth, including support during miscarriage, stillbirth, and abortion. Doulas are not licensed and they do not require supervision.

Doulas offer various types of support, including health navigation; lactation support; development of a birth plan; and linkages to community-based resources.

Q: Who is eligible for doula services?
A: The member must:

• Be active and enrolled in a Medi-Cal or Commercial Plan (Ambetter HMO/PPO or Employer Group HMO, POS, PPO).
  • Member eligibility can be verified through either of the Plan’s provider portals:
    • Availity Portal
    • Health Net portal
• Be pregnant or have been pregnant within the past 12 months.
• Consent to receiving doula services.

Q: What is included in the initial set of doula services under the standing order on file with DHCS?
A: Services include:

• One initial extended visit up to 90 minutes.
• Eight additional prenatal and/or postpartum visits in any combination.
• Labor and delivery support – including miscarriage, stillbirth and abortion.
• Two extended 3-hour postpartum visits.

These services can be provided virtually or in-person based on the member's preferences.

Q: Can members receive additional services beyond the initial set of services described above?
A: Medi-Cal members can receive an additional 9 visits during the postpartum period with a documented recommendation from a physician or other licensed practitioner of the healing arts acting within their scope of practice. This is not available to Commercial Plan (Ambetter HMO/PPO or Employer Group HMO, POS, PPO) members.

Q: How is the recommendation for additional services documented?
A: You can download the recommendation form from our website under Forms and Tools > Doulas. Keep the recommendation form in the member's record to provide to the Plan upon request.

Q: What specific documentation must a doula complete and maintain for each member?
A: Documentation must include the following:

• Length of time spent with the member, including dates and times.
• information on the service provided to the Member that day.
  • Example: "On MM/DD/YYYY, I discussed childbirth education with the member and developed a birth plan for one hour."
• Documentation should be securely stored in the member's medical record.
• The doula's National Provider Identifier (NPI) number.

Documentation must be provided to the Plan and DHCS upon request. You can download a template for this documentation from our website under Forms and Tools > Doulas.

Q: Are doulas mandated reporters?
A: Doulas are not "mandatory reporters." However, if the doula has another profession where they are mandatory reporters, that requirement supersedes the doula's standards of practice. It is the doula's responsibility to make clear that they have these dual roles when the client engages their services.

Q: What services cannot be provided to members under the doula benefit?
A: The following services are not covered:

• Belly binding (traditional/ceremonial)
• Birthing ceremonies (i.e., sealing, closing the bones, etc.)
• Group classes on babywearing
• Massage (maternal or infant)
• Photography
• Placenta encapsulation
• Shopping
• Vaginal steams
• Yoga

Q: Can doulas bill for travel time?
A: No. There are no additional payments for travel time to provide doula services.

Q: Where can I find the billing codes and modifiers for doula services?
A: Please see your doula contract for additional information on billing codes and modifiers.

Q: Where can I find additional information on billing and payment for doula services?
A: Please review the information on our Electronic Data Interchange billing resource page.

This includes information on the following important topics:

• Electronic claims submission through Availity.
• Details on Electronic Remittance Advice (ERA).
• Signing up for Electronic Funds Transfer (EFT).
• Links to additional resources for billing and claims.

Q: What resources are available to support a doula when experiencing billing and claims issues?
A:

• Provider Services can be reached at the numbers below for assistance.
  • Health Net Provider Services Center: 800-675-6110
  • CalViva Health Provider Services Center: 888-893-1569
  • Community Health Plan of Imperial Valley Provider Services Center: 833-236-4141
• The Plan's claims appeal process is outlined in the provider operations manual.
• Additional assistance can be provided by emailing DoulaSupport@Healthnet.com

Q: How do members get connected to a doula for services?
A: Members are connected to doulas for services through the following:

• Member Services – When a member contacts the Plan, we will share a list of local doulas with a member to select their doula.
• Provider Directory – Each doula is listed in the Health Plan directory which includes contact information for the member or providers to use in connecting with the selected doula.
• Direct Referrals – Hospitals, clinics and providers may reach out directly to doula to connect them with a member.

Q: Can a member get doula and Community Health Worker services at the same time?
A: Yes. These programs are not considered duplicative.

Q: Can a member receive services from a non-contracted doula?
A: No. Members must see doulas contracted for services with the Plan.

Q: How do I become a contracted doula with the Plan?
A: Prospective doulas should first submit a doula application to DoulaSupport@Healthnet.com. These can be found under the Doula Provider Participation Application section. In addition:

• Doulas must complete the Provider Application and Validation for Enrollment (PAVE) process through DHCS. (This must be completed before a contract can be extended).
• Applications will be reviewed regularly. Applicants will be notified of the outcome of the review.
• Doulas approved for contracting with the Plan will receive additional information on next steps via email.
• All doula applications are kept on file for future consideration when not initially selected for contracting.

Q: What are dyadic services and family therapy benefits?
A:

• A family and caregiver-focused model of care intended to address developmental and behavioral health conditions of children as soon as they are identified.
• This benefit and model promote access to preventive care for children, immunization completion, coordination of care, child social-emotional health and safety, developmentally appropriate parenting, and maternal mental health.
• The dyadic services benefit is designed to support implementation of comprehensive models of dyadic services that work within the pediatric clinic setting to identify and address caregiver and family risk factors for the benefit of the child.

Q: Who is eligible?
A:

• Children/youths (members under age 21) and their parent(s)/caregiver(s).
• The child/youth MUST be enrolled in Medi-Cal; the parent(s) or caregiver(s) does not need to be enrolled in Medi-Cal or have other coverage so long as the care is for the direct benefit of the child.
• Prior authorization is not required for dyadic services.

Q: What is covered under dyadic services?
A:

• Covered dyadic services are behavioral health services for children (members under age 21) and/or their parent(s) or caregiver(s), and include:
  • Dyadic Behavioral Health (DBH) Well-Child Visits – the DBH visit must be limited to those services not already covered in the medical well-child visit. When possible and operationally feasible, the DBH visit should occur on the same day as the medical well-child visit. When this is not possible, the DBH visit should be scheduled as close as possible to the medical well-child visit, consistent with timely access requirements.
  • The Plan may deliver DBH visits as part of a DBH program, or in a clinical setting without a certified DBH program as long as all of the following components are included:
    • Behavioral health history for child and parent(s) or caregiver(s), including parent(s) or caregiver(s) interview about parent or caregiver concerns.
    • Developmental history of the child.
    • Observation of behavior of child and parent(s) or caregiver(s) and interaction between child and parent(s) or caregiver(s).
    • Mental status assessment of parent(s) or caregiver(s).
    • Screening for family needs, including tobacco use, substance use, utility needs, transportation needs, and interpersonal safety, including guns in the home.
    • Screening for SDOH such as poverty, food insecurity, housing instability, access to safe drinking water, and community level violence.
    • Age-appropriate anticipatory guidance focused on behavioral health promotion/risk factor reduction, which may include:
      • Educating parent(s) or caregiver(s) on how their life experiences (e.g., adverse childhood experiences (ACEs)) impact their child's development and their parenting.
      • Educating parent(s) or caregiver(s) on how their child's life experiences (e.g., ACEs) impact their child's development.
      • Information and resources to support the child through different stages of development as indicated.
    • Making essential referrals and connections to community resources through care coordination and helping caregiver(s) prioritize needs.
  • Dyadic Comprehensive Community Supports Services, separate and distinct from CalAIM Community Supports, help the child (member under age 21) and their parent(s) or caregiver(s) gain access to needed medical, social, educational, and other health-related services.
    • Assistance in maintaining, monitoring, and modifying covered services, as outlined in the dyad's service plan, to address an identified clinical need.
    • Brief phone or face-to-face interactions with a person, family, or other involved member of the clinical team, for the purpose of offering assistance in accessing an identified clinical service.
    • Assistance in finding and connecting to necessary resources other than covered services to meet basic needs.
    • Communication and coordination of care with the child's family, medical and dental healthcare providers, community resources, and other involved supports including educational, social, judicial, community and other state agencies.
    • Outreach and follow-up with crisis contacts and for missed appointments.
    • Other activities as needed to address the dyad's identified treatment and/or support needs.
• Note: Dyadic caregiver services may be provided by the medical well-child provider, in addition to the following provider types:
  • Dyadic Psychoeducational Services – psychoeducational services provided to the child (member under age 21) and/or parent(s) or caregiver(s). These services must be planned, structured interventions that involve presenting or demonstrating information with the goal of preventing the development or worsening of behavioral health conditions and achieving optimal mental health and long-term resilience.
  • Dyadic Family Training and Counseling for Child Development – family training and counseling provided to both the child (member under age 21) and parent(s) or caregiver(s). These services include brief training and counseling related to a child's behavioral issues, developmentally appropriate parenting strategies, parent/child interactions, and other related issues.
• Dyadic parent or caregiver services are services delivered to a parent or caregiver during a child's visit that is attended by the child and parent or caregiver, including the following assessment, screening, counseling, and brief intervention services:
  • Brief emotional/behavioral assessment
  • ACEs screening
  • Alcohol and drug screening, assessment, brief interventions, and referral to treatment
  • Depression screening
  • Health behavior assessments and interventions
  • Psychiatric diagnostic evaluation
  • Tobacco cessation counseling

Q: What is family therapy as a behavioral health benefit?
A:

• Family therapy is a type of psychotherapy for members under age 21 who are at risk for behavioral health concerns and for whom the risk is significant such that family therapy is indicated but may not have a mental health diagnosis.
• Family therapy comprises at least two family members receiving therapy together provided by a mental health provider to improve parent/child or caregiver/child relationships and encourage bonding, resolving conflicts, and creating a positive home environment.
• All family members do not need to be present for each service. For example, parents or caregivers can qualify for family therapy without their child present, if necessary. The primary purpose of family therapy is to address family dynamics as they relate to the member's mental status and behavior(s).
• Both children and adult members can receive family therapy mental health services that are medically necessary to improve parent/child or caregiver/child relationships and bonding, resolve conflicts, and create a positive home environment.
• Reimbursable family therapy models under this benefit include, but are not limited to, child-parent psychotherapy, Triple P Positive Parenting Program, and parent child interaction therapy.

Q: What is the difference between the existing family therapy benefit and the new dyadic therapy benefit?
A: It is essentially the same benefit and offering. The only difference is as follows:

• Under the existing family therapy benefit, members under age 21 can only receive up to five family therapy sessions before a mental health diagnosis is required.
• Under dyadic services, family therapy must be provided by the Plan without regard to the five-session limit for members under age 21.

Q: Who can provide dyadic services?
A:

• Licensed clinical social workers
• Licensed professional clinical counselors
• Licensed marriage and family therapists
• Licensed psychologists
• Psychiatric physician assistants
• Psychiatric nurse practitioners
• Psychiatrist

These providers may render services under a supervising clinician.

• Associate marriage and family therapists
• Associate professional clinical counselors
• Associate clinical social workers
• Psychology assistant

Community health workers (CHW) can perform these services under the supervision of a supervising provider.

• CHWs can screen members for issues related to SDOH or performing other nonclinical support tasks as a component of the DBH visit, as long as the screening is not separately billed.
• CHWs who meet the qualifications listed in the Community Health Worker (CHW) Preventive Services section of the Provider Manual can assist a dyad to gain access to needed services to support their health, through the CHW benefit for health navigation service.

Note: Network providers, including those that will operate as providers of dyadic services, are required to enroll as Medi-Cal providers, consistent with APL 22-013, or any superseding APL, if there is a state-level enrollment pathway for them to do so.

Q: How are dyadic services administered?
A:

Integrated Provider Sites
Provider sites with integrated physical health and behavioral health models of care, such as community health centers, FQHCs, and some primary care sites, can initiate services by administering both the medical well-child visit and the DBH well-child visit, preferably during the same visit or on the same day.

These provider sites will be able to administer all or most of the required on-going dyadic services as well. If needed, referrals should be made to Behavioral Health Provider Services for coordination and linkage to any on-going dyadic services not provided within the provider site.

Non-Integrated Provider Sites
Primary care providers or sites that don't offer behavioral health services can initiate dyadic services by conducting the medical well-child visit and referring the member to Behavioral Health Provider Services for coordination and linkage to dyadic services providers for the DBH and on-going dyadic services if/as needed.

Q: How do I submit claims?
A: Medical well-child visit encounters/claims should be submitted to Health Net. Use the following information to submit claims and check claim status:

• Claims Procedures & Claims Submission Information
• Medi-Cal claims:
  Confirm claim receipt(s) by calling Provider Services at:
  • Health Net: 800-675-6110 (option 2)
  • CalViva Health: 888-893-1569
  • Community Health Plan of Imperial Valley: 833-236-4141

DBH well-child visit, family therapy, and other dyadic services encounters/claims should be submitted to Health Net. Use the following information to submit claims to Health Net and check claim status:

• Claims status: 844-966-0298 (option 1)
• Electronic payer ID: 95567
• Claims mailing address:
  Health Net Medi-Cal Claims
  PO Box 9020
  Farmington, MO 63640-9020

Q: How do I refer members to behavioral health services?
A: Primary care physicians (PCPs) or sites that do not offer behavioral health services can initiate dyadic services by conducting the medical well-child visit and referring members to contact the member services number listed on the back of their ID card to connect with a dyadic services provider who will conduct the DBH well-child visit and determine needs for ongoing dyadic services:

• 24/7 telephonic support: 888-426-0030. Let members know they can call Behavioral Health Services directly to find a behavioral health provider or specialist, including the best telehealth options. Help the member call the Behavioral Health Services customer service number during an office visit.
  • Press * for mental health crisis.
  • Press 1 for member calls.
  • Press 2 for provider calls including behavioral health and interpreter or language assistance.
• Visit Find a Provider. Find a behavioral health provider through the online provider directory. Members can choose a provider – including one with telehealth service.

Q: What are the appropriate dyadic services billing codes?
A:

Non-Specialty Mental Health Services: Reimbursement Rates and Billing Codes (PDF)

• Multiple dyadic services are allowed on the same day and may be reimbursed at the Fee-for-Service (FFS) rate. The DBH well-child visit must be limited to those services that are not already covered in the medical well-child visit, and any other service codes cannot be duplicative of services that have already been provided in a medical well-child visit or a DBH well-child visit.
• Dyadic caregiver service codes (screening, assessment, and brief intervention services provided to the parent or caregiver for the benefit of the child) may be billed by either the medical well-child provider or the DBH well-child visit provider, but not by both providers, when the dyad is seen on the same day by both providers.
• Tribal health programs (THPs), Rural Health Clinics (RHCs) and Federal Qualified Health Centers (FQHCs) are eligible to receive their All-Inclusive Rate from the health plans if Dyadic services are provided by a billable provider per APLs 17-002 and 21-008, or any superseding APLs.
• Dyadic services may be reimbursed at the FFS rate established for services, if the service provided does not meet the definition of a THP, RHC or FQHC visit, or exceeds frequency limitations. THP, RHC and FQHC providers can bill FFS for the four dyadic services codes (H1011, H2015, H2027, and T1027) delivered in a clinical setting by provider types named in the Non-Specialty Mental Health Services: Psychiatric and Psychological Services section of the Medi-Cal Provider Manual.

Q: Where can dyadic services be offered/administered?
A:

• There are no service location limitations
• Dyadic services benefits can be offered/administered through telehealth or in-person with locations in any setting including, but not limited to:
  • Pediatric primary care settings
  • Doctor's offices or clinics
  • Inpatient or outpatient settings in hospitals
  • Member's home
  • School-based sites
  • Community settings

• THP, RHC and FQHC providers should refer to the telehealth section in Part 2 of the Provider Manual for guidance regarding providing services via telehealth. THP, RHC and FQHC providers cannot double bill for dyadic services that are duplicative of other services provided through Medi-Cal.

Q: Who do I contact if I'm interested in providing dyadic services?

• For Facilities, please submit contracting requests to DNBHC@healthnet.com
• For individual providers, please submit contracting requests to DNBHC@healthnet.com

Q: Links to full benefit details and additional information
A:

• 22-029 Dyadic Services and Family Therapy Benefit (PDF)
• Non-Specialty Mental Health Services: Psychiatric and Psychological Services (PDF)
• Medi-Cal Operations Manual/Provider Manual
• For additional information and/or questions about this benefit, please contact Provider Services at:
  • Health Net: 800-675-6110 (option 2)
  • CalViva Health: 888-893-1569
  • Community Health Plan of Imperial Valley: 833-236-4141

Q: What is the Transitional Rent benefit?
A: Effective January 1, 2026, It will be mandatory for Plans to offer Transitional Rent as the fifteenth Community Supports service and will be implemented in phases for select eligible populations. Transitional Rent provides up to six months of rental assistance in interim and permanent settings to Members who are experiencing or at risk of homelessness, have certain clinical risk factors, and have either recently undergone a critical life transition (such as exiting an institutional or carceral setting or foster care), or who meet other specified eligibility criteria.

Q: Who is eligible?
A:Member meets the access criteria for Medi-Cal Specialty Mental Health Service (SMHS), Drug Medi-Cal (DMC) or Drug Medical Organized Delivery System (DMC-ODS). Check all that apply:

• Member is already receiving or has a history of receiving services in the past 12 months through the SMHS/DMC/DMC-ODS delivery systems.
• Member has utilization of services in either the Managed Care Plan and/or the SMHS/DMC/DMC-ODS delivery systems that indicates the likelihood of SMHS/SUD access criteria.
• Member has been referred to the SMHS/DMC/DMC-ODS delivery systems (including members screened¹ by their Managed Care Plan and referred to the other delivery systems).
• Member is receiving Enhanced Care Management (ECM) and meets the "SMH and/or Substance Use Disorder (SUD) Needs" population of focus.
• Referral is from a qualified health professional who is serving the member or served the member in the last 12 months and has determined that the member has ongoing behavioral health/SUD needs that meet the access criteria.

Q: How do members access the Transitional Rent benefit?
A: If you are a Medi-Cal member and believe you might be eligible, contact Member Services. They can assist with making a referral to a housing navigation provider to start the process.

Q: What does the global cap mean?
A: Effective January 1, 2025, DHCS released guidance that a member may not receive more than a combined six months of Short-Term Post-Hospitalization Housing, Recuperative Care and Transitional Rent within a rolling 12-month period.

Q: What does the Transitional Rent benefit cover?
A: "Transitional Rent may be used to cover the following expenses:

• Rental assistance in allowable settings
• Storage fees, amenity fees, and landlord-paid utilities that are charged as part of the rent payment

Transitional Rent can provide up to six months of rental assistance and rent and housing fees per demonstration, subject to the six-month global cap on Room and Board services within a rolling 12-month period. The six months of Transitional Rent are not required to be continuous.

Q: What if a member leaves halfway through the month?
A: If the plan pays in advance for a full month of housing in a permanent setting, the plan must count the full month toward the global cap, even if the Member moves out of the unit prior to the expiration of the month.

Q: What are the qualifications of a Transitional Rent provider?
A: To be qualified to serve as a Transitional Rent Provider, organizations must have the experience and expertise required to perform the function they will assume in the delivery of Transitional Rent. The required experience and expertise will differ based on whether the provider is directly furnishing the housing, issuing payment for the housing, or contracting with organizations that provide or issue payment for housing.

Q: What if a member switches plans?
A: If a Member switches MCPs and the new MCP has covered the Member for less than 12 months and the Member needs Short-Term Post-Hospitalization Housing, Recuperative Care, or Transitional Rent, the MCP must determine whether the Member utilized one of these Room and Board services from the previous MCP and if so, for how long.

Q: What are the roles and responsibilities of a Transitional Rent provider?
A: Transitional Rent Providers must conduct a basic unit or setting inspection to verify compliance with HUD or state habitability standards. An attestation of compliance, either with the HUD standards or state habitability standards, must be submitted by the Transitional Rent Provider as a condition of authorization by the MCP.

The Transitional Rent Provider is responsible for:

• Identifying an appropriate setting/unit.
• Ensuring the housing unit is habitable.
• Helping the Member to review, understand, and execute the lease agreement, and ensuring the lease agreement is compliant and legal.
• Structing rent payment agreement with landlord or property owner.
• Issuing timely payments to the landlord or other housing provider.
• Coordinating with the supportive services providers, which may include HTNS Provider, Housing Deposits Provider, HTSS Provider, ECM Provider, and/or other Medi-Cal or non-Medi-Cal funded providers who may be involved in service delivery for the Member.

Q: What does a Transitional Rent provider need to submit with the request for authorization?
A: Please review the authorization guide.

Q: What are the components of a housing support plan?
A: The housing support plan must:

1. Identify the permanent housing strategy and solution for the Member, including the payment sources and mechanisms, that will support the Member in maintaining housing after the Room and Board services covered under the Medi-Cal managed care delivery system are exhausted (e.g., the Member's income, BHSA Housing Interventions, or other long-term subsidies).
2. Identify the full range of permanent housing supports that will support the Member in sustaining tenancy (e.g., tenancy sustaining service, utilities).
3. Be informed by Member preferences and needs, and reviewed and revised as needed based on changes in Member circumstances.
4. Be based on a housing assessment that addresses identified barriers, includes short- and long-term measurable goals for each issue, establishes the Member's approach to meeting the goal, and identifies when other providers or services, both reimbursed and not reimbursed by Medi-Cal, may be required to meet the goal.
5. Be developed in a way that is culturally appropriate and trauma-informed.

Q: Where is the Transitional Rent provider training posted?
A: CalAIM Training & Webinars web page.

Q: Can a member receive Housing Deposits and Transitional Housing at the same time.
A: Yes. Member eligible for Transitional Rent may also receive Housing Deposit services.

Q: Can a member receive ECM services and Transitional Rent at the same time?
A: Yes, if a Member is not currently receiving ECM, MCP is required to ensure that the ECM Provider conducts weekly in-person outreach visits until a Member chooses to participate in ECM or declines participation. While ECM is intended to be provided primarily through in-person interactions and DHCS believes in-person visitation is most effective, some Members may request to receive ECM via phone or telehealth, and this is permissible. However, there is an expectation that all ECM Lead Care Managers live close enough to their assigned Medi-Cal members to conduct regular in-person visits as necessary. There is no required minimum frequency of engagement after a Member begins receiving ECM; however, engagement should be regular, sufficient to meet the Member's needs, and tailored to the Member's preferences.

Q: Can Transitional Rent cover past due rent?
A: No.

Q: What's the difference betweem interim and permanent housing?
A: Only county Behaviorial Health can support interim housing based on their limited housing funds and member eligibility. Permanent housing is when a member secures a housing lease with a long term subsidy to support after Transitional Rent ends and meets eligibility criteria.

Q: How do I find a Transitional Rent provider?
A: If a member does not have housing, Member Services will submit a referral for housing navigation support through findhelp. If member has secured housing, then Member Services will submit a referral to a Transitional Rent provider through findhelp. NOTE: Until Transitional Rent providers are loaded in findhelp and the Provider Search, please use attached list for contact info. Reach out directly until the methods are live.

Please complete a form below as it pertains to the service and county(ies) you would like to provide service. Submit the completed form to the email address on the form. If you are interested in providing service in multiple counties, select all applicable counties on the form (only one form is needed).

Health Net

• Community Supports Provider Information Form – English (PDF)
• Enhanced Care Management Provider Information Form – English (PDF)
• Community Health Worker Provider Interest Form – English (PDF)

CalViva Health

• Community Supports Provider Information Form – English (PDF)
• Enhanced Care Management Provider Information Form – English (PDF)
• Community Health Worker Provider Interest Form – English (PDF)

Community Health Plan of Imperial Valley

• Community Supports Provider Information Form – English (PDF)
• Enhanced Care Management Provider Information Form – English (PDF)
• Community Health Worker Provider Interest Form – English (PDF)

• Doula Provider Participation Application – Health Net – English (PDF)
• Doula Provider Participation Application – CalViva Health – English (PDF)
• Doula Provider Participation Application – Community Health Plan of Imperial Valley – English (PDF)

On January 1, 2022, the California Department of Health Care Services (DHCS) implemented the California Advancing and Innovating Medi-Cal (CalAIM) Incentive Payment Program to support CalAIM initiatives. The California state budget allocated $300 million for incentive payments to Medi-Cal managed care plans (MCPs) for state fiscal year (SFY) 2021-2022, $600 million for SFY 2022-2023 and $600 million for SFY 2023-2024.

Incentive program payments are intended to:

• Build appropriate and sustainable Enhanced Care Management (ECM) benefit and Community Support capacity;
• Drive MCP investment in necessary delivery system infrastructure;
• Incentivize MCP take-up of Community Support;
• Bridge current silos across physical and behavioral health delivery;
• Reduce health disparities and promote health equity; and
• Achieve improvements in quality performance.

The incentive program period is January 1, 2022, to June 30, 2024. The program period will be split between three distinct program years (PYs):

• PY 1 (January 1, 2022, to December 31, 2022)
• PY 2 (January 1, 2023, to December 31, 2023)
• PY 3 (January 1, 2024, to June 30, 2024)

Incentive Payment Documents

Per incentive program requirements, in January 2022, the Plan submitted Incentive Payment Program Needs Assessment and Gap Filling Plans to DHCS for each of the counties we serve. The Needs Assessment and Gap Filling Plans were developed based on information from the Plan meeting with county and MCP partners, and fielding surveys of contracted ECM and Community Supports providers to identify ECM and Community Supports gaps and needs.

DHCS will use the CalAIM Incentive Payment Program Needs Assessment and Gap Filling Plans, publicly available on the DHCS website, as the basis to determine the allocated incentive dollar proportion that will be paid to the Plan to invest in infrastructure and capacity to support CalAIM objectives.

Going forward, the Plan will solicit feedback from stakeholders on ECM and Community Supports gaps and needs through local level California Department of Health Care Services (DHCS) PATH Collaborative Planning and Implementation (CPI) Initiatives. The DHCS PATH CPI Initiatives will serve as a vehicle for the Plan to engage stakeholders in each county to inform Incentive Payment Program community-wide investments to optimize Incentive Payment Program funding and ensure non-duplicate investments. To learn more about how to participate in a DHCS PATH CPI Initiative, visit the DHCS PATH CPI website.

Eligible ECM providers can earn incentives through the Plan’s ECM Provider Incentive program when timely outreach and reporting is demonstrated. To learn more, refer to the following communications:

2026 Letters

• 25-987 – 2026 ECM Provider Incentive Letter – Health Net – English (PDF)
• 25-989 – 2026 ECM Provider Incentive Letter – CalViva Health – English (PDF)
• 25-988 – 2026 ECM Provider Incentive Letter – Community Health Plan of Imperial Valley – English (PDF)

2025 Letters

• 25-012 – 2025 ECM Provider Incentive Letter – Health Net – English (PDF)
• 25-010 – 2025 ECM Provider Incentive Letter – CalViva Health – English (PDF)
• 25-011 – 2025 ECM Provider Incentive Letter – Community Health Plan of Imperial Valley – English (PDF)

2024 Letters

• 24-1088 – 2024: ECM Provider Incentive letter – Health Net – English (PDF)
• 24-1087 – 2024: ECM Provider Incentive letter – CalViva Health – English (PDF)
• 24-1089 – 2024: ECM Provider Incentive letter – Community Health Plan of Imperial Valley – English (PDF)

• 24-230 – 2024: ECM Provider Incentive letter – Health Net – English (PDF)
• 24-229 – 2024: ECM Provider Incentive letter – CalViva Health – English (PDF)
• 24-231 – 2024: ECM Provider Incentive letter – Community Health Plan of Imperial Valley – English (PDF)

2023 Letters

• 23-1317 – 2023: ECM Provider Incentive Amendment Letter – Health Net – English (PDF)
• 23-1316 – 2023: ECM Provider Incentive Amendment Letter – CalViva Health – English (PDF)

• 23-288 – 2023: ECM Provider Incentive letter – Health Net – English (PDF)
• 23-289 – 2023: ECM Provider Incentive letter – CalViva Health – English (PDF)

Eligible Community Health Worker (CHW) providers can earn incentives through the Plan's provider incentive program by demonstrating effective and timely outreach to provide services to eligible members. To learn more, refer to the following communications:

2026 Letters

• 25-990 – 2026 CHW Provider Incentive letter – Health Net – English (PDF)
• 25-992 – 2026 CHW Provider Incentive letter – CalViva Health – English (PDF)
• 25-991 – 2026 CHW Provider Incentive letter – Community Health Plan of Imperial Valley – English (PDF)

2025 Letters

• 25-303 – 2025: CHW Provider Incentive letter – Health Net – English (PDF)
• 25-304 – 2025: CHW Provider Incentive letter – CalViva Health – English (PDF)
• 25-305 – 2025: CHW Provider Incentive letter – Community Health Plan of Imperial Valley – English (PDF)

2024 Letters

• 24-747 – 2024: CHW Provider Incentive letter – Health Net – English (PDF)
• 24-748 – 2024: CHW Provider Incentive letter – CalViva Health – English (PDF)
• 24-749 – 2024: CHW Provider Incentive letter – Community Health Plan of Imperial Valley – English (PDF)

Eligible doula providers can earn incentives through the Plan's provider incentive program by showing effective and timely outreach to eligible members. To learn more, refer to the following communications:

2026 Letters

• 25-984 – 2026 Doula Provider Incentive letter – Health Net – English (PDF)
• 25-986 – 2026 Doula Provider Incentive letter – CalViva Health – English (PDF)
• 25-985 – 2026 Doula Provider Incentive letter – Community Health Plan of Imperial Valley – English (PDF)

2025 Letters

• 25-220 – 2025 Doula Provider Incentive letter – Health Net – English (PDF)
• 25-218 – 2025 Doula Provider Incentive letter – CalViva Health – English (PDF)
• 25-219 – 2025 Doula Provider Incentive letter – Community Health Plan of Imperial Valley – English (PDF)