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:

• 2019 CCO Reporting and Spending Analysis
  
• 2018 CCO Reporting and Spending Analysis
  

HRS guidance

• Health-Related Services Brief (updated August 2021) – Defines health-related services, describes examples of health-related services used among CCOs, and explains how OHA incorporates health-related services into CCO payments.
• Health-Related Services FAQ (updated August 2021) – Answers frequently asked questions (FAQ) about health-related services. This FAQ will be updated as additional questions are addressed.
• Health-Related Services and Housing (updated August 2021) – Focuses on how housing-related services and supports can qualify as health-related services under requirements in OAR and CFR. 
• CCO Guidance for Exhibit L Financial Reporting Template: Health-Related Services Expenditures (updated March 2021) – Provides guidance to help CCOs complete the annual tab L6.21 and tab L6.22 of the Exhibit L reporting template.
• Addressing Social Determinants of Health through Health-Related Services (March 2021)
• Health-Related Services Community Benefit Initiatives (updated August 2021)
• Examples of Approved HRS Expenditures (March 2021)
• 2021 HRS CCO Policy Requirements and Evaluation Criteria (August 2021)
  

HRS learning opportunities

Webinars

Office hours

CCO staff are invited to participate in general HRS office hours starting in fall 2021. CCO staff may join the calls at any point during the scheduled times.

Events

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:

• Centers for Disease Control and Prevention (CDC):
  • CDC Community Health Improvement Navigator: Expert-vetted tools and resources for health system, hospital, public health agency and other community organization staff leading community health improvement efforts.
  • CDC Health Impact in 5 Years (HI-5): Highlights non-clinical, community-wide approaches that have evidence reporting 1) positive health impacts, 2) results within five years, and 3) cost effectiveness or cost savings over population lifetime.
  • CDC Social Determinants of Health: Resources for social determinants of health data, tools for action, programs and policy.
• Community Preventive Services Task Force Findings: What works to promote healthy communities.
• Healthy People 2030: Resources, organized by domain, to help learn how communities across the country are addressing the social determinants of health.
• Leveraging the Social Determinants of Health: The Massachusetts Foundation’s report on what works for interventions addressing social determinants of health.
• Social Interventions Research & Evaluation Network (SIREN): University of California, San Francisco’s SIREN works to improve health and health equity by advancing high quality research on health care sector strategies to improve social conditions.
  • SIREN Evidence & Resource Library: Includes both peer-reviewed and other types of resources, such as webinars and screening tools/toolkits on medical and social care integration.
• OHA Health Evidence Review Commission: Multisector intervention reports on population-based health interventions or other types of interventions that happen outside of clinical settings.

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.

2020 CCO HRS Policy and Procedure (P&P) Submissions