In Lieu of Services (ILOS) are services determined by the state to be medically appropriate and cost-effective substitutes for covered services or settings under the State Medicaid Plan. ILOS must meet requirements outlined in
42 CFR 438.3(e)(2). Coordinated care organizations (CCOs) are not required to offer ILOS to members. A member cannot be required to use the alternative service or setting.
Supporting health system transformation
ILOS can support key services, such as the Diabetes Prevention Program and traditional health care workers, and enables covered services to be provided in non-traditional settings.
ILOS also connects to the larger vision for CCO 2.0 and key transformation objectives by:
- Improving access to services in a more culturally responsive manner;
- Enhancing care coordination for high-need/traditionally underserved members; and
- Reducing hospital care, nursing facility care, and emergency department utilization.
ILOS learning opportunities
Webinar: CCO Introduction to In Lieu of Services:
Recording /
Slides
SHARE, HRS and ILOS comparison document: This document provides an overview of CCO spending programs to meet members’ and communities’ needs, including examples of allowable interventions.
Addressing Oregon’s Housing Crisis through HRS, SHARE, ILOS: CCO Efforts and Opportunities
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).
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What: Annual convening for CCOs on OHA spending initiatives, focused on housing
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When: Tuesday, September 20–Friday, September 23 (9 a.m.–1:15 p.m. each day)
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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.
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Register in advance (required)
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Interested in presenting? Please submit a presentation proposal here by June 22, 2022
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See full save-the-date and RFP details
: Anne King (
kinga@ohsu.edu), Nancy Goff (
nancy055@gmail.com) or the Transformation Center (
Transformation.Center@dhsoha.state.or.us)
ILOS guidance
For ILOS guidance including a coding resource guide, FAQ and more, see the
Health System Division ILOS webpage.
Contact
For questions related to ILOS technical assistance, contact the OHA Transformation Center at
Transformation.Center@dhsoha.state.or.us.
For ILOS program questions, please see the
Health System Division ILOS webpage.