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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.
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. Some examples of life transitions include:
The HRSN benefit will provide three types of support; housing, nutrition, and climate-related devices.
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.
To be eligible members must meet all of the following 4 criteria:
1Is a current OHP member.
2Has a social health need.
3Has experienced at least one of the following:
4Has a clinical health need. some examples include:
Available starting on March 1, 2024. Items include:
Additional eligibility criteria for climate benefit
Requesting a climate device
If a member meets the eligibility standards listed above, the following Climate Device request form can be filled out by the individual, a parent, caregiver, trusted friend, or clinic staff.
Climate Device request formand submit it to CareOregon by email or fax.
If they have questions or would like help filling out the request form, contact Columbia Pacific CCO Customer Service at 855-722-8206 or TTY 711, or send us a secure message at colpachealth.org/portal.
Tentatively available starting in November 2024
More details coming soon!
Tentatively available starting in January 2025
More details coming soon!
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