When members have health needs that aren’t covered by a health plan or other services, Columbia Pacific CCO offers funds for health-related services (HRS). HRS must be consistent with a member’s treatment plan, as developed by their primary care team or other treatment providers. The services will be documented in the member’s treatment plan and clinical record. For that reason, members without a current provider relationship need to establish one in order to receive health-related services funds.
What HRS covers
These funds cover items or services that aren’t covered under standard health plan services, but will improve a person’s health. Health plans cover provider visits, pharmacy benefits and durable medical equipment. Durable medical equipment (DME) is a covered benefit, which means equipment that would be covered as DME is not eligible for HRS funds. (For a list of items covered by DME with no authorization required, click here.)
Health-related services funds cover services like:
- Helping a person get a cell phone if having one will give them better access to their providers.
- Transit passes for members who need transportation for health-related needs beyond covered appointments.
- Buying an air conditioner for a person whose health is affected by the warmth and airflow in their home.
- Vouchers for a yoga studio for a person whose back pain will be helped by an exercise class.
- A class on cooking healthy meals for a person with diabetes.
This is not an exhaustive list. Any requested items will be evaluated for consistency with a member’s health needs and treatment plan.
Requesting HRS funds
Limitations of health-related services: The Oregon Administrative Rules restrict health-related services to items not paid for with grant money, funding separate from CCO contract revenue, or normal clinical service billing. In other words, health-related services may be used only if other funding is not available. Before you make a request, please be sure there is no other funding available.
Making a health-related services request: Any health care provider, primary care team, care coordination staff member working directly with members, or other subcontractors of Columbia Pacific's network may request the use of HRS for a member. Columbia Pacific encourages our community-based organization (CBO) partners to help our shared members access HRS. CBOs can work with members and their treatment providers to identify the need, and the provider can submit a request.
All HRS requests must include medical documentation (care plan, progress notes, chart notes, etc.) and information about the member’s diagnosis.
There are two ways to submit requests for health-related services:
- Use our standard Health-Related Services Flexible Services Funding Request form to make requests for cell phones, hotel rooms or other health-related services for individual members:
- Items that are needed on a repeating basis — like monthly transit passes or gym memberships, extensions of hotel stays, etc. — require the submission of a Funding Request form each month.
- Urgent requests will be fulfilled in two to five business days. Standard requests will be fulfilled in 10-14 business days.
- For hotel stays, click here to download our hotel liability form that members must fill out.
- Bulk items are available to help clinics and providers ensure a constant supply of the following items:
- Cell phones and phone minutes
- Transit passes
- Sleeping bags
- Shelter materials (tents and tarps)
- City Team shelter vouchers
- Personal hygiene products
- This includes (but is not limited to) shampoo, conditioner, body and face washes, soap and feminine hygiene products
- Some items are not included, like (but not limited to) PPE, incontinence supplies, diapers, sunscreen, sanitary wipes, disinfectant wipes, thermometers, durable medical equipment (DME) or COVID-19-specific items, as described above
If these bulk items are purchased by providers/clinics, you must submit a Bulk Request Tracking document and itemized invoices to be reimbursed. To request that items be purchased by Columbia Pacific (and then delivered to providers or clinics), fill out our Bulk Purchase Request form.
- Bulk requests may take up to 14 business days for review and delivery.
- Clinics and county teams may make bulk requests one time per month.
- Requests should be submitted by supervisors or managers.
- Clinics/teams are required to submit a Bulk Request Tracking document with member details before new orders can be fulfilled.
Evaluating requests
Columbia Pacific evaluates all completed request forms based on:
- The member’s eligibility and whether the request fits their treatment plan.
- A sustainability plan to support the member’s ongoing needs, because CCOs may not be able to support these needs in the long term.
- Whether other community resources or safety net funds (besides HRS) were pursued before the request was made.
We provide members with a written outcome and copy the requesting provider (and member representatives, if applicable). Often, this involves asking for more information about the member, which may include the member's budget information. Requests cannot be fulfilled until all information is received.
Questions? Email us at social.determinants@careoregon.org.