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
), the 1115 waiver special terms and conditions
, and federal regulations. See the OHA brief below for more details.
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:
- 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 2020: 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.
If you have questions, please email the OHA health-related services team at Health.RelatedServices@dhsoha.state.or.us