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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 guidance

Events and other learning opportunities

Health-related services webinar: Community benefit initiatives

HRS community benefit initiatives (CBIs) are community-level interventions supported by CCOs that are focused on improving population health and health care quality. A media campaign to increase immunization rates is an example of a CCO CBI investment. Topics include:
  • What CBIs are and how are they reported
  • Common CBI investments by CCOs, and their potential impact
  • Ways to align CBIs with other CCO and community priorities
  • Snapshots of promising CCO CBI programs
November 18, noon-1 p.m.
Register for the webinar here
Audience: CCO staff, contracted providers, and organizations wishing to better understand how CBIs can be used to improve population health

Health-related services 101 webinar

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

HRS and the Path Ahead

November 2019 event materials

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.

Contact

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



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