About the program
Health-related services (HRS) are non-covered services under Oregon’s Medicaid plan that are not administrative requirements and are intended to improve care delivery and overall member and community health and well-being. One of the purposes of HRS is to allow coordinated care organizations (CCOs) an opportunity to address the social determinants of health and equity (SDOH-E), including the health-related social needs, of their members. For CCOs to use Oregon’s Medicaid funds to pay for HRS, they must comply with state and federal criteria.
Funding options
There are two ways CCOs can provide health-related services (find out more by clicking the link to each funding option):
- Flexible services (flex requests): Cost-effective non-billable services delivered to an individual OHP member to supplement covered benefits and improve their health and well-being.
- Community benefit initiatives (CBI): CareOregon facilitated community-level partnerships that include — but are not limited to — OHP members and are focused on improving population health and health care quality.
Additional resources
For more resources about HRS, please go to the HRS section on the Oregon Health Authority (OHA) website. It should
have the most up-to-date information, including more information on using
HRS to address SDOH-E.
A few helpful resources we like from the page include:
- HRS FAQ (updated Aug 2021). Highlights include:
- Q1 (pp. 3-4): What are the criteria for being considered under HRS
- Q 12 (pp. 8-9): Categories of HRS commonly used by CCOs
- Q 14 (pp. 9-10): Things that cannot be considered HRS
- Q 18 (p. 11): Non-comprehensive list of sites with sources for evidence-based practices that can be used to justify HRS
- Addressing Social Determinants of Health and Equity through Health-Related Services (updated March 2021)
- Pages 2-5 give examples of ways SDOH-E can be addressed through HRS
- Addressing Housing Needs through Health-Related Services (updated August 2021)
- Pages 6-8 include some guidance on what is/isn’t allowed but there is a lot of room for interpretation, so if you’re unclear if something would be covered, please feel free to contact us.
- Examples of accepted expenditures
Questions? Email us at social.determinants@careoregon.org.
Forms
- Health-related (flex) services instructions
- Health-related (flex) services request form
- Hotel flex request form
- Hotel code of conduct form
- Hotel request checklist
- Budget worksheet
- States of Emergency request form
- States of Emergency request form instructions
- K Plan Letter request
- NEMT provider
