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Health Related Social Needs (HRSN)

What are social needs?

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.

What is the health-related social needs (HRSN) benefit?

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: 

  • Involvement with the child welfare system 
  • Recently became eligible for both Medicaid and Medicare (within the past 9 months) 
  • Experiencing homelessness 
  • At risk for homelessness 
  • Released from jail, detention center, Oregon Youth Authority facility, prison, or the Oregon State Hospital within the past 12 months 

The HRSN benefit will provide three types of support; housing, nutrition, and climate-related devices.  

What is an HRSN Service Provider?

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.

  • Be accessible to OHP members in your region.
  • Demonstrate the ability and/or experience of effectively serving at least 1 of OHA’s Priority Populations.
  • Demonstrate qualified services and administrative staff.
  • Provide culturally and linguistically appropriate, responsive and trauma-informed services.
  • Demonstrate a history of responsible financial administration.

  • Meet readiness standards defined above.
  • Demonstrate readiness to send and receive closed loop referrals.
  • Comply with reporting and oversight requirements and applicable laws relating to privacy and security.

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:

  • Member identifying information (name, date of birth, Medicaid ID)
  • Date(s) of service
  • Location where services were provided (e.g., home, in office, in the community)
  • A description of HRSN Services
HRSN Devices Fee Schedule:
Climate-Related Supports
Climate Devices Fee Schedule (Version 7, January 17, 2024)

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

Footer:
  1. Rates listed as “Actual cost, subject to maximum allowable” will have an upper payment limit of 150% of the OHA Expected Unit Costs. The 150% factor is to allow for variation in device and shipping costs over time and across geographies.
  2. A 2% MCO tax load will be added to all payments included in the fee schedule.
  3. Outreach and Engagement applies to activities performed by CBOs and HRSN providers. This activity is only billable for HRSN-eligible members.
  4. Must be billed in conjunction with a climate device.

Download the HRSN Devices Fee Schedule

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.

Who is eligible?

To be eligible members must meet all of the following 4 criteria:

1Is a current OHP member.

2Has a social health need.

  • Food insecurity
  • Housing instability or homelessness
  • Climate-related needs

3Has experienced at least one of the following:

  • Youth involved with the child welfare system, including youth leaving foster care
  • People experiencing homelessness or are at risk of homelessness
  • People released from custody or a residential behavioral health setting
  • People transitioning from Medicaid-only to both Medicaid and Medicare coverage
  • Youth ages 19-26 with special health care needs (starting 1/1/25)

4Has a clinical health need. some examples include:

  • Complex physical health needs
  • Complex behavioral health needs
  • Pregnancy
  • Age (under 6, over 65)
  • Repeated use of crisis services, such as the Emergency Department
  • Needs assistance with Activities of Daily Living (e.g., personal hygiene, eating, dressing)
  • Has experienced interpersonal violence or domestic violence
  • Developmental disability

HRSN benefit categories

Available starting on March 1, 2024. Items include:

  • Air conditioners for individuals at health risk due to significant heat, including installation support as needed
  • Air filtration devices for individuals at increased health risk due to compromised air quality
  • Heaters for individuals at increased health risk due to significant cold
  • Portable power supplies for powering medical devices
  • Mini fridges for medications needing refrigeration

Additional eligibility criteria for climate benefit

  1. They have a health condition that makes extreme heat, cold temperature, poor air quality, or power outage particularly challenging or dangerous to you. 
  2. They are in one of these transitional groups:
    • Be in one of these transitional groups.
    • Become eligible for Medicare in addition to OHP in the next 3 months.
    • Enrolled in Medicare in addition to OHP for the first time no more than 9 months ago.
    • May be homeless soon, spend at least 50% of income on rent, live in a recreational vehicle (RV, trailer).
    • Currently experiencing homelessness, don’t have a regular place to sleep, or are staying at someone else’s home.
    • Received care in the Oregon State Hospital or a large substance use disorder residential treatment or withdrawal management program in the past 12 months.
    • Released from a jail, detention center, Oregon Youth Authority facility, prison in the last 12 months.
    • Involved with child welfare services in Oregon at some point in their life. This includes foster or substitute care, received adoption or guardianship assistance or family preservation services, or has been in court regarding child welfare.
  3. Currently needs one of the above climate devices.

Tentatively available starting in November 2024

More details coming soon!

Tentatively available starting in January 2025

More details coming soon!

How do members request a Health-Related Social Needs (HRSN) Benefit?

A request form needs to be filled out and submitted to Columbia Pacific CCO by email or fax. Members have a couple of options:

  • If the member would like help filling out the HRSN application form, they can contact Customer Service at customerservice@careoregon.org or 503-488-2822
  • The member themselves, an organization or clinic supporting the member, a member’s parent, a caregiver, a guardian/support/trusted friend, or an HRSN Service Provider can fill this form out.
  • The form can be returned to CareOregon by:
Download request form here

If a member does not meet eligibility criteria for the HRSN benefit, they may still use the same form to request climate support through the health-related services flex funding program.

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