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FAQ

 

This page holds answers to frequently asked questions about flexible services (individual and bulk flex requests). Click on the questions below to expand or collapse the response to each question.

Eligibility

Members who have CareOregon Medicaid health insurance and members who have both CareOregon Medicaid and CareOregon Advantage Medicare plans are eligible. Additionally, CareOregon Medicaid plans include the following networks:

  • Jackson Care Connect
  • Columbia Pacific CCO
  • Health Share of Oregon with CareOregon physical health coverage
  • Health Share of Oregon with CareOregon dental health coverage
  • Health Share of Oregon behavioral health coverage

To check a member’s eligibility, access MMIS first or call CareOregon's Provider Customer Service at 503-416-4100 or 800-224-4840. Press option 3 for help to determine eligibility.

Yes, as long as the requested item supports the member’s overall treatment plan.

Types of requests

No. Billable items or services are not eligible for flexible services funding. 

Please see the appropriate provider manual for more details about how to request a billable item or service:

There is no list of diagnoses. However, the requested items or services must show support of the member’s overall treatment plan. 

For example, it may be easy to see how an AC unit or air purifier would be supported by a physical health diagnosis, but that doesn’t mean it’s not applicable for someone with a behavioral health diagnosis — we just may need more justification to showcase that alignment. We’re looking for a correlation between the request and the diagnosis, clinical documentation and the sustainability plan. If you want examples of items, please click here for examples from Oregon Health Authority (OHA).

There is no monetary cap or specified duration per member, as flexible service funding requests are based on the needs required for the intended outcome and support. However, flex services are not intended for long-term support. Longer-term requests can be approved with sufficient justification at CareOregon’s discretion. A sustainability plan for reasonable long-term support must be outlined at the time of request.  

Multiple quotes are not required. A cost estimate and/or a website link to the item for purchase will suffice.

All the information requested on the hotel form is required to avoid any additional need for communication and delays in processing. This includes the individual flex request form, the code of conduct (Liability form) and the hotel checklist (or the hotel request form that combines these documents). Please see the hotel section on our flex request page for more details.  

The NEMT benefit includes some funding for hotel stays and meals when medical appointments require four or more hours of travel. If additional support beyond the NEMT benefit is needed, a flex request for a hotel can be made to help with additional costs.  Please let us know if you are working with NEMT. More information about NEMT for Jackson Care Connect members can be found here:

TransLink – 541-842-2060 or 888-518-8160

Health-related services cannot fund trips to OHP covered services (emergent or non-emergent) as these types of trips are covered by the members’ OHP transportation benefit. Non-Emergency Medical Transportation (NEMT) includes mileage reimbursement, public transportation or vehicle-provided rides. For more information about NEMT, visit the website or contact the call center:

TransLink – 541-842-2060 or 888-518-8160

Yes, a request can be submitted for things like insurance, car payments, vehicle registration, back payments, or car repairs if it would increase a member’s access to resources with the use of their own transportation. Requests for funding for fuel would fall under the member’s NEMT benefit (mileage reimbursement) if it is for medical appointments.

Currently, CareOregon does not have a preferred list of vendors, but we do encourage providers to utilize specific partners when possible:

  • Hotels: Our payment processing vendor (PANOW) has contracted hotels and we encourage requesters to use them when possible, as non-contracted hotels require a third-party authorization process. 
  • Furniture or household goods: For members in the Portland metro area, we encourage requesters to use our local furniture bank, Community Warehouse, when possible.
  • Specific items vs. gift cards: Specify the vendor, vendor contact information and type of item (e.g., food, clothing), and the dollar amount being requested for the gift card, if applicable.  

Heath-related services - Flexible services funding request form

Please submit all relevant documents that identify the plan of care in the last six months, including chart notes, or care coordination notes that show your justification for the request.

CareOregon does not have access to members’ health records. Therefore, we require recent records to determine the connection between the item/service and the plan of care.

Process

Due to the need to process a high volume of requests in a timely manner, we can start processing requests once they are complete. Incomplete requests are closed after five business days. You may resubmit a new request with all the required materials once you have gathered the required documents. Because our team is not member-facing, we ask that the requestor communicates with the member as needed. Completed requests are then triaged and assigned to a team member for processing.

A letter is sent by fax or email to the requester and another letter is sent to the address provided for the member by OHA. We strongly encourage requesters to follow up and notify the member about the determination since the requester will know the outcome before the member.

Some of the common reasons include:

  • A member may not be actively covered by CareOregon, OHP plan or
  • An item/service may be billable
  • The form is incomplete, and no response was received within 5 business days
  • The direct connection to the members’ care plan is not clear
  • There is no sustainability plan or indication that this request can be supported in the future (if applicable)
  • Funding may be limited to a “share of cost” to be coupled with member contribution and/or alternative sources of community funding.

HRSF is not a benefit, so there is no appeal process. That said, we can and will allow requesters to re-submit the same request with additional information speaking to any questions we may have raised in initial review.

Due to the high volume of requests, follow-up questions about specific requests can be sent to our HRSF processing department by email at: social.determinants@careoregon.org. You may contact CareOregon Provider Customer Service at 503-416-4100 or 800-224-4840 by phone for general questions about HRSF.  

Since the requester is not included in the review process, we welcome the requester, provider, and treatment team to include all pertinent information in the actual request. Please include as many attachments or addendums to support the request as you deem necessary. 

Timeline

Emergent requests: CCO health-related services are not available as an emergency or crisis funding option. Any request submitted within less than one business day of the date needed will be processed on the urgent timeline described below.

Urgent requests: All urgent requests must be submitted two to five business days before the date the requested item/service is needed. Any request submitted less than two business days prior may not be reviewed by the date the item/service is needed. Our team will prioritize the following urgent requests: eviction prevention shut-off notices and hotels.

Non-urgent requests: All non-urgent requests must be submitted 10 to 14 business days before the date the requested item/service is needed.

Requested items will be purchased and sent to the address requested on the flex form (this can be any safe place for the member to receive the item, including a provider’s office). If there are any difficulties in getting an item delivered to the original delivery address provided, either the requestor or CareOregon may ask for an alternate address to ensure safe delivery.

Requested services will be arranged directly with the merchant. If any additional information is needed for the service, we will reach out to the requester to coordinate.

We need:

  • An itemized receipt if it’s a reimbursement.
  • The name of the person or organization the check should be made out to.
  • The address where the check should be sent.
    • Please note that the check will be sent via our payment processing vendor (Project Access NOW) except for bulk reimbursements. Please include any information needed in the memo field of the check to ensure that the proper account or vendor gets credited. 

Please also make sure whoever receives the check knows that the check will come from our vendor, Project Access Now, not CareOregon (except for bulk reimbursements).

Please contact our team. We will consult with the necessary parties to determine next steps. Most of the time for bigger purchases the merchant will ask that the item be shipped back and once they’ve confirmed that they’ve received the original item either they will send a replacement or CareOregon will order one if applicable.

CareOregon receives many requests daily and we appreciate your patience. We understand the urgency of some of these requests and work towards reviewing and responding in a timely way. Our current process involves several steps to ensure the requests are tracked, reviewed, communicated and monitored to support meeting regulatory requirements. Additionally, external factors such as issues with supply chains and product scarcity may result in delays.

Bulk requests

The items available for bulk ordering are listed on the bulk form and in our bulk request tracker. At this time, we only support the listed items. If your clinic needs an item not listed, please complete a flex request on a per-member basis.

You can order more of an item when your inventory is down to five or fewer of that item remaining. This limit is in place to help our vendor with inventory management. If five items will not last until the new supply order comes in, you can purchase additional items and submit a reimbursement request to fill the gap.

Please see the provided tracker on the bulk request form. You may also submit your own spreadsheet. If you do use your own, ensure that it contains the following information: 

  • Date purchased/distributed (both are needed for reimbursement, only date distributed is needed for a supply order)
  • Member name
  • Medicaid ID
  • Member date of birth
  • Item distributed (one item per row – if a member was distributed multiple types of items, include multiple rows for each of the item types distributed)
  • Quantity of items distributed in previous box
  • Total cost of the items distributed (this is not needed if this is a supply order except for phone cards)

Please fax it to 503-416-4728 or mail it to:

Attn: HRSF Clinical Operations Team
CareOregon
315 SW Fifth Ave
Portland, OR 97204

Yes. Please see our instruction form for more details about this type of request. You may also see the next question about what documentation is needed for checks.

We need:

  • An itemized receipt that includes the item type(s), quantities and price per item.
  • The name of the organization to which the check should be made out.
  • The address where the check should be sent.
  • Please note that the check will be sent from CareOregon for bulk reimbursements. Please include any information needed in the memo field to ensure that the proper account or vendor gets credited. 
  • In most instances a W-9 for the landlord or property management company is required for rental supported payments 

Items should generally be delivered to the clinic requesting the bulk items. If needed, it may be possible to pick items up from our vendor, Project Access NOW.

Please contact our team. We will consult with the necessary parties to determine next steps. Most of the time for bigger purchases the merchant will ask that the item be shipped back and once they’ve confirmed that they’ve received the original item either they will send a replacement or CareOregon will order one if applicable.

You currently need to ask CareOregon or our vendor, Project Access Now (PANOW), for an update. Please contact us if you’re interested in more visibility and willing to learn how to submit orders directly in the PANOW portal.