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
), the 1115 waiver special terms and conditions
, and federal regulations. See the OHA brief below for more details.
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.
Sources to support a health-related service
In addition to other resources a CCO may identify, OHA has identified the following resources as acceptable sources for published studies or evidence to support a health-related service: