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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 410-141-3500 and 410-141-3845), the 1115 waiver special terms and conditions, and federal regulations. See the OHA brief below for more details.

CCOs are required to report annual HRS spending to OHA through their Exhibit L Financial Reports (template available on the CCO Contract Forms webpage). OHA reviews the annual CCO Exhibit L HRS expenditures to ensure expenditures meet HRS criteria. Reporting and spending summaries are available here:

HRS office hours

CCO staff may join at any point during the scheduled times:
  • 7/12/22, 11-11:30 a.m.
  • 10/11/22, 11-11:30 a.m.

Join meeting (same link for all)
Or call in: +1 971-277-2343
Phone conference ID: 700 217 258#

HRS information for OHP members

If you are an Oregon Health Plan (OHP) member who is enrolled in a coordinated care organization (CCO), you may be able to receive support for items or services that are not covered by Medicaid, but that can help you stay healthy or become healthier.
Flexible services are not available to OHP members who are enrolled in fee-for-service or Open Card Medicaid.

HRS guidance

General guidance Topic-specific resources
Reporting and evaluation

HRS learning opportunities

Webinars

​This webinar focuses on centering equity in CCO HRS flexible services, including opportunities to promote equity in selecting services, strategy and planning of service delivery, reaching members experiencing the greatest inequities, communicating with providers and members, and monitoring efforts. Yamhill Community Care Organization also shares an example of how, in response to the public health emergency, transportation to day-to-day essential services were offered to address the increased social needs of members. 

This webinar covers the basics of housing in Oregon, and health-related services (HRS) investments in housing. The webinar features panelists from Oregon Housing and Community Services, Eastern Oregon CCO, and Health Share. Topics include current statewide trends in housing, how housing is built and financed, and how CCOs can meaningfully invest in housing through community partnerships. 

​HRS community benefit initiatives (CBIs) are community-level interventions supported by CCOs that are focused on improving population health and health care quality. This webinar includes how CBIs are reported; common CBI investments by CCOs; ways to align CBIs with other priorities; and examples of promising CCO CBI programs.

  • Audience: CCO staff, contracted providers, and organizations wishing to better understand how CBIs can be used to improve population health
  • View slides
  • Watch recording​​​

​This recorded webinar is ideal for those who are new to or wishing to brush up on HRS basics.

Events

9/20/2022

​This virtual convening is sponsored by the OHA Transformation Center in partnership with Oregon Rural Practice-based Research Network (ORPRN) in an effort to support CCOs in implementing Supporting Health for All through REinvestment (SHARE), health-related services (HRS) and in lieu of services (ILOS).​

  • ​What: Annual convening for CCOs on OHA spending initiatives, focused on housing
  • When: Tuesday, September 20–Friday, September 23 (9 a.m.–1:15 p.m. each day)
  • Who should attend: CCOs interested in sharing and learning from others about how HRS, SHARE and ILOS can support their work to address housing as a social determinant of health and equity. CCOs are strongly encouraged to invite their community partners involved in this work.
  • Register in advance (required)
  • Interested in presenting? Please submit a presentation proposal here by June 22, 2022 
  • See full save-the-date and RFP details
Contact: Anne King (kinga@ohsu.edu), Nancy Goff (nancy055@gmail.com) or the Transformation Center (Transformation.Center@dhsoha.state.or.us)

Evidence base to support use of specific interventions as HRS

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: OHA has also identified the following resources to support CCOs in calculating return on investment (ROI) for health-related services expenditures. Note: Calculating an ROI is not required for reporting HRS expenditures to OHA, but it may support CCOs' long-term HRS expenditure planning.
  • Commonwealth Fund ROI Calculator. This calculator is designed to help health systems and their community-based organization partners plan sustainable financial arrangements to fund the delivery of social services to high-need, high cost patients. To help users of this ROI calculator, the Commonwealth Fund has provided a summary assessment of available evidence of health care impact for interventions related to addressing health-related social needs for high-need adults.
  • Center for Health Care Strategies ROI Forecasting Calculator: This web-based tool is designed to help Medicaid state agencies, health plans and other stakeholders assess and demonstrate the cost-savings potential of efforts to improve quality.

CCO HRS Policy and Procedure (P&P) Submissions

Contact

If you have questions, please email the OHA health-related services team at Health.RelatedServices@dhsoha.state.or.us

Note: The OHA staff who manage this email account do not have access to OHP member information and are not able to help request health-related services for members.