Overview
Health-related services (HRS) give coordinated care organizations (CCOs) a way to address social determinants of health. For CCOs to use federal Medicaid funds to pay for HRS, they must comply with state and federal criteria, including the
OHA HRS Brief, Oregon Administrative Rules (OARs
410-141-3500 and
410-141-3845), and the Code of Federal Regulations (
45 CFR 158.150 and
45 CFR 158.151). The history of HRS and how it has evolved is detailed in the
OHA HRS Brief.
HRS are non-covered services that complement covered benefits under Oregon's Medicaid State Plan to improve member and community health and well-being. There are two types of health-related services:
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Flexible services, which are cost-effective services provided to a member to complement covered benefits, and
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Community benefit initiatives, which are community-level interventions focused on improving population health and health care quality. These initiatives include members, but are not necessarily limited to members.
HRS spending
CCOs are required to report annual HRS spending to OHA through their Exhibit L Financial Reports (template available on the
CCO Contract Forms webpage). OHA reviews the annual CCO Exhibit L HRS expenditures to ensure expenditures meet HRS criteria. The most recent spending summaries are available here, and prior year summaries can be requested by reaching out to
health.relatedservices@oha.oregon.gov: