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Health-Related Services

Overview

Health-related services are non-covered services that are offered as a supplement to covered benefits under Oregon’s Medicaid State Plan to improve care delivery and overall member and community health and well-being. Health-related services include:

  • Flexible services, which are cost-effective services offered to an individual member to supplement covered benefits, and

  • Community benefit initiatives, which are community-level interventions focused on improving population health and health care quality. These initiatives include members, but are not necessarily limited to members.

Health-related services must meet requirements for:

a) Activities that improve health care quality (45 CFR 158.150);
- or -
b) Expenditures related to health information technology and meaningful use requirements to improve health care quality (45 CFR 158.151).


Health-related services are defined by Oregon Administrative Rules (OAR 410-141-3100 and 410-141-3150), the 1115 waiver special terms and conditions, and federal regulations. See the OHA brief below for more details.

Resources

Oregon Health Authority Health-Related Services Brief – Defines health-related services, describes examples of health-related services used among CCOs, and explains how OHA incorporates health-related services into CCO payments.

Contact

Health.RelatedServices@dhsoha.state.or.us

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