Traditional health workers 

Please direct questions related to THWs to:

CareOregon: metrothw@careoregon.org

Jackson Care Connect: jccthw@careoregon.org

Columbia Pacific CCO: colpacthwliaison@careoregon.org

Use these documents to assist with integration of THWs into your network:

CareOregon HIPAA and THWs notice
Jackson Care Connect HIPAA and THWs notice
Columbia Pacific CCO HIPAA and THWs notice

Columbia Pacific CCO THW scope by worker type

Non-emergent medical transportation to medical appointments is a benefit to OHP members.

Multnomah, Clackamas and Washington counties

Ride to Care Ride scheduling: 503-416-3955, Toll-free: 855-321-4899, TTY 711 Website: ridetocare.com

Ride to Care is the non-emergent medical transportation (NEMT) program. It is a benefit through OHP members’ coverage that helps them get transportation services — based on their needs — to their health care appointments including medical, behavioral health and dental appointments.

Members can contact Ride to Care to talk about transportation services. Ride to Care’s phone number is 503-416-3955.

Ride to Care is available only for services covered by the Oregon Health Plan. Some appointments may require members to call or get approval before trips can be scheduled. For trips beyond the Health Share of Oregon service area, members may need prior authorization to use Ride to Care.

Trip requests can be made as many as 30 days or as few as 48 business hours in advance of the transportation need. Same-day and next-day visits may be approved if they are medically necessary and urgent.

Ride to Care offers three services:

1. The first is reimbursement for members who have access to a vehicle, can have a friend or family member drive them, or are staying out of area.
2. The second is public transportation. Members can receive bus fare to use public transit to get to their health care appointments.
3. The third service is vehicle-provided rides. This is for members who are unable to use mileage reimbursement or transit services.

When members have health needs that aren’t covered by a health plan or other services, CareOregon offers funds for health-related services (HRS). HRS must be consistent with a member’s treatment plan, as developed by their primary care team or other treatment providers. The services will be documented in the member’s treatment plan and clinical record. For that reason, members without a current provider relationship need to establish one in order to receive health-related services funds.

Providers who would like to learn more about the basic framework of Health-Related Services flex process, regulatory requirements and how to access this resource, please watch this webinar by clicking here. 

What HRS covers

These funds cover items or services that aren’t covered under standard health plan services but will improve a person’s health. Health plans cover provider visits, pharmacy benefits and durable medical equipment. Durable medical equipment (DME) is a covered benefit, which means equipment that would be covered as DME is not eligible for HRS funds. (For a list of items covered by DME with no authorization required, click here.)

Health-related services funds cover services like:

• Helping a person get a cell phone if having one will give them better access to their providers.
• Transit passes for members who need transportation for health-related needs beyond covered appointments.
• Buying an air conditioner for a person whose health is affected by the warmth and airflow in their home.
• Vouchers for a yoga studio for a person whose back pain will be helped by an exercise class.
• A class on cooking healthy meals for a person with diabetes.

This is not an exhaustive list. Any requested items will be evaluated for consistency with a member’s health needs and treatment plan.

Requesting HRS funds

Limitations of health-related services: The Oregon Administrative Rules restrict health-related services to items not paid for with grant money, funding separate from CCO contract revenue, or normal clinical service billing. In other words, health-related services may be used only if other funding is not available. Before you make a request, please be sure there is no other funding available.

Making a health-related services request: Any health care provider, primary care team, care coordination staff member working directly with members, or other subcontractors of CareOregon’s network may request the use of HRS for a member. CareOregon encourages our community-based organization (CBO) partners to help our shared members access HRS. CBOs can work with members and their treatment providers to identify the need, and the provider can submit a request.

All HRS requests must include medical documentation (care plan, progress notes, chart notes, etc.) and information about the member’s diagnosis.

Evaluating requests

CareOregon evaluates all completed request forms based on:

• The member’s eligibility and whether the request fits their treatment plan.
• A sustainability plan to support the member’s ongoing needs, because CCOs may not be able to support these needs in the long term.
• Whether other community resources or safety net funds (besides HRS) were pursued before the request was made.

We provide members with a written outcome and copy the requesting provider (and member representatives, if applicable). Often, this involves asking for more information about the member, which may include the member's budget information. Requests cannot be fulfilled until all information is received.

Depending on the nature of the request, if more details about the budget is indicated, this form can be used to provide that information.

Questions? Email us at social.determinants@careoregon.org.

What is a Regional Care Team?

CareOregon Regional Care Teams (RCTs) offer providers a community of resources with a single point of contact for you and your patients. RCTs work closely with providers and members – through both telephonic and community-based support – to smooth the way to better care and better outcomes. Click here to view our Regional Care Team overview in PDF format.

Our purpose

With care coordination through RCTs, we will deliver the right care, at the right time, in the right place, with the right team.

Members will have a consistent care team that will collaborate across disciplines to develop and implement a member-centric care plan through telephonic, electronic or community-based interventions to resolve identified needs and promote healthy outcomes.

Each RCT is made up of care coordinators with a variety of backgrounds and experience, including:

• Nursing
• Behavioral Health
• Substance Use Disorders
• Pharmacy
• Health system navigation
• Local community resources
• And others

How do I make a care coordination referral?

Online: Submit a completed Care Coordination Referral form and we’ll route it to your assigned RCT.

Email: Send us a completed form to ccreferral@careoregon.org.

Collective (PreManage): If your clinic uses this online platform, check the RCT tag after searching for your patient.

Call: Check the list below to see where your clinic is assigned, and call that number.

Not sure which RCT to contact? Call our general care coordination line at 503-416-3731 or Customer Service at 503-416-4100 and we’ll connect you to your assigned team.

How RCTs are structured

Find your local RCT

Download a PDF summary of this information here.

These documents provide information about dental care benefits for members, including provider options and contact details:

CareOregon
Jackson Care Connect
Columbia Pacific CCO