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Traditional health workers

Welcome to the traditional health worker (THW) resources page for Columbia Pacific CCO providers. A traditional health worker is a person who has similar life experiences with the people they work with. They can assist members in getting services and care that support their health and wellbeing by helping with things like:

  • Navigating the health system.
  • Understanding benefits.
  • Connecting to community resources.
  • Cross-cultural communication.
  • Connecting to health care providers.

There are five types of THWs licensed in Oregon:

  • Doulas are trained birth companions. They provide support to pregnant people and families during pregnancy, birth and beyond.
  • Peer support specialists give support services to people who are or have been in mental health or substance use treatment.
  • Peer wellness specialists have personal experience with psychiatric conditions plus intensive training. They’re part of a home health team that combines mental health with primary care.
  • Personal health navigators provide tools to help patients make the best health care choices.
  • Community health workers are public health workers who are trusted members of a community and have a close understanding of it.

THWs can be found in community-based organizations and in primary care and behavioral health clinics. They are a free benefit to members and do not require a referral or prior authorization from Columbia Pacific. However, organizations with THWs may have their own referral requirements to access care. Not all THWs are contracted with Columbia Pacific or provide services to Medicaid Members. To learn more about your THW network and access for Columbia Pacific members you serve, contact your regional THW Liaison listed below.

The OHA Office of Equity and Inclusion has identified Best and Promising Practices & Other Resources for THWs. This information is available on the OHA-OEI THW website:
oregon.gov/oha/OEI/Pages/Information-for-Health-Systems,-Providers,-and-THW%27s.aspx

Please direct questions related to THWs to: colpacthwliaison@careoregon.org

This guide outlines the process and covered benefits for doulas interested in serving Columbia Pacific members 

Get the details on becoming eligible to bill for THW services, how to submit claims and more:

Columbia Pacific CCO External peer billing guide
Columbia Pacific CCO CHW Billing Guide

Use these documents to assist with integration of THWs into your network:

Columbia Pacific wants to help you and your patients have the best experience, which is why we help you coordinate live interpreters for patients who speak a language other than English. Click here to learn about our resources.

Non-emergent medical transportation to medical appointments is a benefit to OHP members.

Columbia, Clatsop and Tillamook counties

NW Rides Ride scheduling: 503-861-0657, toll-free: 888-793-0439, TTY 711

NW Rides is the non-emergent medical transportation (NEMT) program for Columbia Pacific CCO members. It is a benefit through OHP members’ coverage that helps them get transportation services — based on their needs — to their health care appointments including medical, behavioral health and dental appointments.

Members can contact NW Rides to talk about transportation services. Their phone number is 503-861-0657, toll-free: 888-793-0439.

NW Rides is available only for services covered by the Oregon Health Plan. Some appointments may require members to call or get approval before trips can be scheduled. For trips beyond the Columbia Pacific CCO service area, members may need prior authorization to use NW Rides.

Trip requests can be made as many as 30 days or as few as 48 business hours in advance of the transportation need. Same-day and next-day visits may be approved if they are medically necessary and urgent.

NW Rides offers three services:

  1. The first is reimbursement for members who have access to a vehicle, can have a friend or family member drive them, or are staying out of area.
  2. The second is public transportation. Members can receive bus fare to use public transit to get to their health care appointments.
  3. The third service is vehicle-provided rides. This is for members who are unable to use mileage reimbursement or transit services.

Check out our Riders Guide for details about the NW Rides transportation program. Feel free to share it with your patients.

If you want printed copies of the Rider's Guide, please contact Columbia Pacific CCO Customer Service at 855-722-8206 or TTY 711. We will send you the printed Rider's Guide within five business days.

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.

Providers who would like to learn more about the basic framework of Health-Related Services flex process, regulatory requirements and how to access this resource, please watch this webinar by clicking here. 

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:

  1. 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 and click here to download our hotel request checklist.
    • If a member lives in an area being impacted by a current state of emergency and needs a hotel, our State of Emergency Flex Request may be the quickest way to assist the member. Please see the instructions for more information.
  2. 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 CCO (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 CCO 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.

Depending on the nature of the request, if more details about the budget is indicated, this form can be used to provide that information.

Questions? Email us at social.determinants@careoregon.org.

What is a Regional Care Team?

The Columbia Pacific CCO Regional Care Team (RCT) offers providers a community of resources with a single point of contact for you and your patients. The RCT works closely with providers and members – through both telephonic and community-based support – to smooth the way to better care and better outcomes. Click here to view our Regional Care Team overview in PDF format.

Our purpose

With care coordination through the RCT, we will deliver
the right care, at the right time, in the right place, with the right team.

Members will have a consistent care team that will collaborate across disciplines to develop and implement a member-centric care plan through telephonic, electronic or community-based interventions to resolve identified needs and promote healthy outcomes.

The RCT is made up of care coordinators with a variety of backgrounds and experience, including:

  • Nursing
  • Mental health
  • Substance use treatment
  • Pharmacy
  • Health system navigation
  • Local community resources
  • And others

How the RCT is structured:

How can the RCT help my patients?

Each patient is assigned to a care team that is familiar with the patient’s history, strengths, needs and support system. The team will:

  • Reduce confusion for patients by navigating them through the health care and social services system.
  • Help patients get access to the right care at the right time, and make sure they stay connected to their providers.
  • Reduce barriers to patient care and treatment compliance and connect them to support services.

How can the RCT help me?

Your dedicated RCT will work closely with your clinic to:

  • Smooth workflows with coordination and support for primary care, behavioral health, oral health and other network providers.
  • Assist with patient transitions between levels of care, such as hospital to primary care.
  • Help with provider navigation, including targeted high-risk case management.
  • Engage in formulary-specific medication review and communication for support of adherence.
  • Address social determinants of health. 

How are RCTs assigned?

RCTs are assigned based on the county the patient’s PCP clinic is in or the county where the patient lives.

When do I call the RCT?

The RCT offers care coordination and support for patients with multiple or complex needs, such as:

  • Multiple chronic conditions
  • High or special health care needs
  • Chronic pain needs
  • In-home care needs
  • Daily living or social needs
  • Medication review and support
  • End-of-life support
  • Substance use
  • Behavioral health concerns

How do I make a care coordination referral?

Online: Submit a completed Care Coordination Referral form and we’ll route it to your assigned RCT.

Email: Send your completed form to ccreferral@careoregon.org.

Fax: Print and send your completed form to 503-416-3676.

Collective (PreManage): If your clinic uses this online platform, check the RCT tag after searching for your patient.

Call: You can reach your RCT directly at 503-416-3743.

Download a PDF summary of this information here.

This document provides information about dental care benefits for members, including provider options and contact details.

The “Oral Health Training for Traditional Health Workers” is an OHA approved training for continuing education units available for free by CareOregon. To access the training, please navigate to the link below. Once you have completed the training, please email colpacthwliaison@careoregon.org with your name to receive a certificate of completion.

 

Register for this free training.