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Flexible services are cost-effective items and/or services delivered to an individual OHP member to supplement covered benefits and improve their health and well-being. Flexible services are intended to meet immediate social needs, stabilize crisis situations and support a sustainable plan for ongoing needs. These are commonly referred to as flex requests.
The Oregon Administrative Rules restrict health-related services to items not paid for with grant money, funding separate from CCO contract revenue, normal clinical service billing, and payor of last resort. In other words, health-related services may be used only if other funding is not available.
Any primary care or behavioral health provider or care team, care coordination staff member working directly with members, or other subcontractors of Columbia Pacific’s network, may make a flex request for a member. Members
are not able to submit flex requests on their own. Columbia Pacific encourages our community-based organization (CBO) partners to help our shared members access flexible services. CBOs can work with members and their treatment providers to identify
the need, and the provider can submit a request.
If you are a CBO and need help connecting a member to a provider, please complete the Care Coordination referral form.
These funds can be used for items or services that aren’t covered under Oregon’s Medicaid plan but will improve a person’s health.
Flexible services funds cover services like:
This is not an exhaustive list. Any requests will be evaluated for consistency with a member’s health needs and treatment plan.
Flexible services do not cover anything that can be billed with a CPT or HCPCS code that is a covered benefit. Some specific examples include:
Columbia Pacific evaluates all completed request forms based on:
We will provide members with a written outcome (mailed to the address on file with the CCO) and copy the requesting provider (and the member’s representatives, if applicable).
For non-hotel requests, for individual members:
For stays in hotels for individual members:
To submit a request for a hotel:
There are two different options for submitting hotel requests. Please note, both options do still require medical documentation (care plan, progress notes, chart notes, etc)
If a member needs an extension, please note:
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.
We recognize that providers frequently feel there is a small window of opportunity to provide some services for members, so we’ve made some of these items that are commonly needed and have a clear benefit available via our bulk reimbursement process. This allows providers to have them on hand and give them to members as needed.
There is one option for procuring bulk items:
Below are some examples of items available via bulk reimbursement.
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