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
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: