Select language
Select language
If you are a member looking for information on how to make a flex request or find other health related services, please visit our Social Needs Assistance page.
Health-related social needs (HRSN) refer to social and economic needs that contribute to health and well-being. They include food security, transportation, interpersonal violence, education, income/employment, stable housing, social support, and utility assistance. When one or multiple of these needs are unmet, an individual can experience poor health outcomes.
There are two ways members may be eligible to receive the social needs supports described above: Health Related Social Needs (HRSN) or Health Related Service Fund (HRSF).
When a request is submitted, CareOregon will review it to determine whether the request meets eligibility criteria for one of these two sources, based upon the information provided.
Members may be eligible for one of each device every three (3) years. They are allowed one replacement device in that time frame if their item stops working.
To be eligible for a climate device, all of the following must be true for a patient:
Not all requested items or services are granted/funded. Our team evaluates each request on a case-by-case basis and makes the final funding determination, including the amount(s) of funding rewarded if members meet eligibility criteria. Please review the following Social Needs Assistance Guidelines for more information about qualifying medical conditions and life situations and the commonly funded supports for each.
Social Needs Assistance Guidelines (PDF)If the member meets the eligibility standards listed above and want to request a climate device, simply click the button below to fill out the digital Climate Device Request Form.
Digital Climate Device request formYou can also download and fill out the Climate Device request form (PDF) and submit it to 211 by email or fax.
If you have questions or would like help filling out the request form with a member, call 211's direct line at 503-468-5375.
| Support | Limitations |
| Rent support | Three to six months (depending on eligibility), available once every three years, including back rent |
| Utilities | No more than six (6) months, including any arrears, available once every three years |
| Home modifications | Available as needed to help medical conditions such as ramps, grip bars, cabinet handles |
| Home remediations | Available once. For methods or actions taken to address and fix issues or problems in a home. |
| Hotel stays |
|
| Storage fees | Up to six (6) months every three years |
| Housing deposits | Available once |
| Moving fees | Available once |
Exclusions include mortgage payments and payments related to the construction of new physical structures.
To be eligible for a housing support, all of the following must be true for a patient:
Not all requested items or services are granted/funded. Our team evaluates each request on a case-by-case basis and makes the final funding determination. Please review the following Social Needs Assistance Guidelines for more information about qualifying medical conditions and life situations and the commonly funded supports for each.
Social Needs Assistance Guidelines (PDF)If a member meets the eligibility standards listed above and want to request a housing support, simply click the button below to fill out the secure digital Housing Request Form.
Digital Housing Request FormYou can also download and fill out the Housing request form (PDF) and submit it to 211 by email or fax.
If you have questions or would like help filling out the request form with a member, call 211's direct line at 503-468-5375.
Here are some examples of common support for social needs. This list isn't comprehensive. If a member needs something for their health that isn't listed, just submit a form and we'll consider the request.
To be eligible for other supports, all of the following must be true for a patient:
Not all requested items or services are granted/funded. Our team evaluates each request on a case-by-case basis and makes the final funding determination. Please review the following Social Needs Assistance Guidelines for more information about qualifying medical conditions and life situations and the commonly funded supports for each.
Social Needs Assistance Guidelines (PDF)If a member meets the eligibility standards listed above and wants to request a housing support, simply click the button below to fill out the secure digital social needs request form.
Digital social needs request formYou can also download and fill out the Health-related services Flex Form (PDF) and submit it to 211 by email or fax.
If you have questions or would like help filling out the request form with a member, call 211's direct line at 503-468-5375.
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 purchasing programs. This allows providers to have them on hand and give them to members as needed.
If your clinic or organization is interested in using the Bulk Purchasing Program, please reach out to socialhealth@careoregon.org to get information about signing up. Here are some highlights of the program:
As part of the state’s recent 1115 waiver, Oregon was approved to offer the new health-related social needs (HRSN) benefit. The health-related social needs (HRSN) benefit was developed to provide social support to OHP members who are experiencing certain life transitions, to improve their health during this specific time. The HRSN benefit will provide three types of support; housing, nutrition, and climate-related devices. Some examples of life transitions include:
As an integral part of the community, HRSN Service Providers help connect members with the HRSN benefit. These can be public or private social service organizations or clinics who work with Columbia Pacific CCO to identify eligible members, help them complete requests for support and directly provide HRSN services for the member.
CPCCO will utilize OHA’s HRSN fee schedule to reimburse HRSN Service Providers. During the contracting process, we will work together to establish reporting and invoicing processes, which may look different depending on the type of services or financial needs of the HRSN Service Provider. Those who want to participate as HRSN Service Providers will get proper training on reporting and invoicing prior to any deadlines.
Listed below are the types of information that HRSN Service Providers may be required to submit. This list is subject to change:
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
S5165 – Home modifications; per service
U1 – HRSN Waiver Program
V1 – Air conditioner
Medically necessary – Air conditioner, including delivery
Per Item
660
Actual cost, subject to maximum allowable
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
T2029 – Specialized medical equipment, NOS, waiver
U1 – HRSN Waiver Program
Medically necessary – Air filtration device, including delivery
Per Item
500
Actual cost, subject to maximum allowable
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
S5165 – Home modifications; per service
U1 – HRSN Waiver Program
TS – Follow up service
Medically necessary – Air filter replacement, including delivery
Per Item
70
Actual cost, subject to maximum allowable
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
S5165 – Home modifications; per service
U1 – HRSN Waiver Program
V3 - Generator
Medically necessary – Portable power supply, including delivery
Per Item
1590
Actual cost, subject to maximum allowable
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
S5165 – Home modifications; per service
U1 – HRSN Waiver Program
V4 – Heater
Medically necessary – Heater, including delivery
Per Item
290
Actual cost, subject to maximum allowable
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
S5165 – Home modifications; per service
U1 – HRSN Waiver Program
V2 – Refrigeration
Medically necessary – Mini refrigerator, including delivery
Per Item
170
Actual cost, subject to maximum allowable
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
S5165 – Home modifications; per service
U1 – HRSN Waiver Program
NU – New Equipment
Medically necessary climate device installation
Per Service
28
Actual cost, subject to maximum allowable
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
T1017 – Targeted case management, each 15 minutes
U1 – HRSN Waiver Program
UD – Outreach and engagement
Outreach and Engagement by CBO or HRSN provider3
Per 15 minutes
20
20
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
N/A
N/A
CCO variable administrative load4
Per Device
NA
78
Closed loop referrals refer to the process of exchanging information between and among the CCO and HRSN Service Providers to make referrals and communicate about the status of referrals for a member. This can occur through multiple different avenues including email, community information exchange (CIE), direct mail, and/or phone calls. This process with our network and in the community is still under development. More concrete workflows and procedures will be available later this year.
Health-related services (HRS) are non-covered services under Oregon’s Medicaid plan that are not administrative requirements and are intended to improve care delivery and overall member and community health and well-being. One of the purposes of HRS is to allow coordinated care organizations (CCOs) an opportunity to address the social determinants of health and equity (SDOH-E), including the health-related social needs, of their members. For CCOs to use Oregon’s Medicaid funds to pay for HRS, they must comply with state and federal criteria.
The HRS section on the Oregon Health Authority (OHA) website has the most up-to-date information, including more information on using HRS to address SDOH-E.
Questions? Email us at social.determinants@careoregon.org.
Budget worksheet
Often evaluating requests involves asking for more information about the member, which may include the member's budget information. If more details about the budget are indicated, this form can be used to provide that information.
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 is the payor of last resort. In other words, health-related services may be used only if other funding is not available.
CareOregon 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).
Any primary care or behavioral health provider or care team, care coordination staff member working directly with members, or other subcontractors of CareOregon’s network, may make a flex request for a member. CareOregon 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. Members can also now submit requests themselves on our member-facing Social Needs Assistance page.
If you are a CBO and need help connecting a member to a provider, please complete the Care Coordination referral form.
HRSF Standard requests now have a minimum TAT of 4+ weeks
HRSF Urgent requests now have a minimum TAT of 2+ weeks
Please note this does include fulfillment time for approved requests.
To ensure timely review of a request, please ensure the following items are met and included in the request submission:
Submitting requests with incomplete forms or missing required documentation will significantly delay the processing of requests.
In addition to CareOregon’s Health Related Services, there are other local resources that offer social needs assistance in our community. If a member finds that they do not qualify for our program, they may be able to access what they need from one of the links below.
Website feedback
Help us improve our website
Having trouble finding what you’re looking for? Want to tell us about your website experience? Take our feedback survey and let us know!
