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Home and Community-Based Services (HCBS)

For Providers

Welcome to the resource page for providers. Here, you will find support and information to help you get someone the support they need. If you are seeking home and community-based services for a patient or client, this page is designed to guide you to the resources and assistance you need.

To be eligible for the services, a person must:

  • Be enrolled in Medicaid,
  • Be 21 years of age or older,
  • Have a mental illness diagnosis,
  • Have a need for one or more services at least monthly, and
  • Need daily help with at least two activities because of mental health needs.

Eligibility Process

Comagine Health will assess if the person is eligible for HCBS during the eligibility determination process listed below.

Step 1: Start Referral Process Here 

In this step, you will start the process of getting the services you need.

If you do not have Medicaid, you can use the ONE System to apply for Medicaid benefits before submitting the required forms.

If you already have Medicaid, work with your provider or by yourself to complete the referral form and submit to Comagine Health.

Step 2: Get Initial Eligibility Check 

In this step, a case manager from Comagine Health contacts you to complete the required paperwork to determine if you are eligible for HCBS. This part of the process is called the functional eligibility determination.

Step 3: Get Services Approved 

In this step, your case manager from Comagine Health submits the required paperwork to Oregon Health Authority for authorization and approval.

Once Comagine Health completes the 1915i eligibility process and determines the service level, Comagine Health sends a referral to the community mental health program (CMHP).

Step 4: Coordinate Services 

In this step, you will work with your CMHP to coordinate services and supports based on your needs.

Your CMHP will and offer you choices of available placements and/or of services.

Relevant Resources

Resources to help you understand HCBS policies and access key program information:

  1. Process to enroll as a provider
  2. Supports for HCBS providers
  3. Oregon Administrative Rules for 1915(i) Home and Community-Based Services (Chapter 410, Division 173)
  4. Support for providers of Home and Community-Based Services for Oregon Department of Human Services programs
  5. Tools for providers such as guides, rates, and cost reports
  6. Secure residential treatment facility (STRF) medical necessity process map
  7. Claim adjustment handbook
  8. Professional billing instructions

Frequently Asked Questions

​An IQA is the contractor who is responsible for reviewing and reporting to OHA for designated programs and services. The IQA is responsible for reviewing, assessing, and developing service plans for qualified individuals in a program. Comagine Health is the IQA for Oregon and has been since July of 2020.​

​Comagine Health is the IQA for the entire state of Oregon and they conduct the 1915(i) assessment. You can also ask for an assessment through your county Community Mental Health Program (CMHP), or a local doctor.​

​To get services, a person must:

  • Be financially eligible for Medicaid,
  • Need the services mainly because of a mental health issue,
  • Meet the functional needs assessment criteria, and
  • Meet the Level of Care Utilization System (LOCUS) assessment criteria.

Comagine Health assesses individuals requesting services. 

​There are several ways a person can be referred to get 1915(i) HCBS. Some examples include:

  • The individual, guardian, or family member
  • Certified Mental Health Provider (CMHP)
  • An Exceptional Needs Care Coordinator (ENCC)
  • The person's Personal Care Provider (PCP)

​Employment services are not provided under 1915(i). There are other ways to get employment services. This need should be identified in and supported through the Person-Centered Service Plan (PCSP).​

​Yes, after someone is found eligible for 1915(i) services, Comagine Health will support them. They will set up a meeting to create a Person-Centered Service Plan (PCSP) based on the individual and their needs.​

​There is a 10-day period for reconsideration when more documentation can be submitted. There is also a “changing condition process" if something has changed and it has been 30 days or more. 

For more information, view the Oregon Administrative Rules “OAR 410-172-0705" 14 & 15 or visit Comagine Health's provider webpage.

​If a person qualifies for Medicaid based on their health and finances, and they need a certain service for their health, they can get the services they need in different ways. ​

Related Pages

Oregon Department of Human Services – Home and Community Based Services website

Apply for Oregon Health Plan (OHP)

Find coordinated care organizations (CCOs)

Learn about Oregon's State Medicaid Plan

Understand “Activities of Daily Living" (ADLs) and “Instrumental Activities of Daily Living" (IADLs)

Contact Us

Do you have questions about Home and Community-Based Services? Email us at 1915i.MedicaidPolicy@odhsoha.oregon.gov.

Thank you for visiting the Home and Community-Based Services pages. The HCBS pages are work in progress, with updates coming soon! If you have any feedback, please email mail us at 1915i.MedicaidPolicy@odhsoha.oregon.gov. We look forward to hearing from you!

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