Traditional health workers

Please direct questions related to THWs to: jccthw@careoregon.org

• Traditional Health Worker enrollment form
• Doula enrollment form

For an outline of the process and covered benefits for doulas interested in serving Jackson Care Connect members, view our Jackson Care Connect doula coverage FAQ

For the most current guidance in billing, view the 2024 Doula Billing Guide

For pre-1/1/2024 billing guidance, please reference the 2023 Doula Billing Guide
PLEASE NOTE: After 7/1/2024, this guide and the codes within will no longer be accepted.

Get the details on becoming eligible to bill for THW services, how to submit claims and more:

Jackson Care Connect CHW Billing Guide
Jackson Care Connect External peer billing guide

Use these documents to assist with integration of THWs into your network:

Jackson Care Connect wants to help you and your patients have the best experience, which is why we help you coordinate live interpreters for patients who speak a language other than English. Click here to learn about our resources.

Non-emergent medical transportation to medical appointments is a benefit to OHP members.

Jackson county

TransLink Ride scheduling: 541-842-2060, toll-free: 888-518-8160, TTY 711 Website: ridetocare.com

TransLink is the non-emergent medical transportation (NEMT) program for Jackson Care Connect members. It is a benefit through OHP members’ coverage that helps them get transportation services — based on their needs — to their health care appointments including medical, behavioral health and dental appointments.

Members can contact TransLink to talk about transportation services. TransLink’s phone number is 541-842-2060, toll-free 888-518-8160.

TransLink is available only for services covered by the Oregon Health Plan. Some appointments may require members to call or get approval before trips can be scheduled. For trips beyond the Jackson Care Connect service area, members may need prior authorization to use TransLink.

Trip requests can be made as many as 30 days or as few as 48 business hours in advance of the transportation need. Same-day and next-day visits may be approved if they are medically necessary and urgent.

TransLink offers three services:

1. The first is reimbursement for members who have access to a vehicle, can have a friend or family member drive them, or are staying out of area.
2. The second is public transportation. Members can receive bus fare to use public transit to get to their health care appointments.
3. The third service is vehicle-provided rides. This is for members who are unable to use mileage reimbursement or transit services.

Check out our Riders Guide for details about the transportation program. Feel free to share this with your patients.

• English
• Spanish

If you or your patients want a printed copy of the Rider's Guide, please contact Jackson Care Connect Customer Service at 855-722-8208 or TTY 711. We will send you the printed Rider's Guide within five business days.

When members have health needs that aren’t covered by a health plan or other services, Jackson Care Connect offers funds for health-related services (HRS). HRS must be consistent with a member’s treatment plan, as developed by their primary care team or other treatment providers. The services will be documented in the member’s treatment plan and clinical record. For that reason, members without a current provider relationship need to establish one in order to receive health-related services funds.

Providers who would like to learn more about the basic framework of Health-Related Services flex process, regulatory requirements and how to access this resource, please watch this webinar by clicking here. 

What HRS covers

These funds cover items or services that aren’t covered under standard health plan services but will improve a person’s health. Health plans cover provider visits, pharmacy benefits and durable medical equipment. Durable medical equipment (DME) is a covered benefit, which means equipment that would be covered as DME is not eligible for HRS funds. (For a list of items covered by DME with no authorization required, click here.)

Health-related services funds cover services like:

• Helping a person get a cell phone if having one will give them better access to their providers.
• Transit passes for members who need transportation for health-related needs beyond covered appointments.
• Buying an air conditioner for a person whose health is affected by the warmth and airflow in their home.
• Vouchers for a yoga studio for a person whose back pain will be helped by an exercise class.
• A class on cooking healthy meals for a person with diabetes.

This is not an exhaustive list. Any requested items will be evaluated for consistency with a member’s health needs and treatment plan.

Requesting HRS funds

Limitations of health-related services: The Oregon Administrative Rules restrict health-related services to items not paid for with grant money, funding separate from CCO contract revenue, or normal clinical service billing. In other words, health-related services may be used only if other funding is not available. Before you make a request, please be sure there is no other funding available.

Making a health-related services request: Any health care provider, primary care team, care coordination staff member working directly with members, or other subcontractors of Jackson Care Connect’s network may request the use of HRS for a member. Jackson Care Connect encourages our community-based organization (CBO) partners to help our shared members access HRS. CBOs can work with members and their treatment providers to identify the need, and the provider can submit a request.

All HRS requests must include medical documentation (care plan, progress notes, chart notes, etc.) and information about the member’s diagnosis.

There are two ways to submit requests for health-related services:

1. Use our standard Health-Related Services Flexible Services Funding Request form to make requests for cell phones, hotel rooms or other health-related services for individual members:
• Items that are needed on a repeating basis — like monthly transit passes or gym memberships, extensions of hotel stays, etc. — require the submission of a Funding Request form each month.
• Urgent requests will be fulfilled in two to five business days. Standard requests will be fulfilled in 10-14 business days.
• For hotel stays, click here to download our hotel liability form that members must fill out and click here to download our hotel request checklist.
• If a member lives in an area being impacted by a current state of emergency and needs a hotel, our State of Emergency Flex Request may be the quickest way to assist the member. Please see the instructions for more information.
2. Bulk items are available to help clinics and providers ensure a constant supply of the following items:
   • Cell phones and phone minutes
   • Transit passes
   • Sleeping bags
   • Shelter materials (tents and tarps)
   • City Team shelter vouchers
   • Personal hygiene products
     • This includes (but is not limited to) shampoo, conditioner, body and face washes, soap and feminine hygiene products
     • Some items are not included, like (but not limited to) PPE, incontinence supplies, diapers, sunscreen, sanitary wipes, disinfectant wipes, thermometers, durable medical equipment (DME) or COVID-19-specific items, as described above
   If these bulk items are purchased by providers/clinics, you must submit a Bulk Request Tracking document and itemized invoices to be reimbursed. To request that items be purchased by Jackson Care Connect (and then delivered to providers or clinics), fill out our Bulk Purchase Request form.
   • Bulk requests may take up to 14 business days for review and delivery.
   • Clinics and county teams may make bulk requests one time per month.
   • Requests should be submitted by supervisors or managers.
   • Clinics/teams are required to submit a Bulk Request Tracking document with member details before new orders can be fulfilled. 

Evaluating requests

Jackson Care Connect evaluates all completed request forms based on:

• The member’s eligibility and whether the request fits their treatment plan.
• A sustainability plan to support the member’s ongoing needs, because CCOs may not be able to support these needs in the long term.
• Whether other community resources or safety net funds (besides HRS) were pursued before the request was made.

We provide members with a written outcome and copy the requesting provider (and member representatives, if applicable). Often, this involves asking for more information about the member, which may include the member's budget information. Requests cannot be fulfilled until all information is received.

Depending on the nature of the request, if more details about the budget is indicated, this form can be used to provide that information.

Questions? Email us at social.determinants@careoregon.org.

What is a Regional Care Team?

The Jackson Care Connect Regional Care Team (RCT) offers providers a community of resources with a single point of contact for you and your patients. The RCT works closely with providers and members – through both telephonic and community-based support – to smooth the way to better care and better outcomes. Click here to view our Regional Care Team overview in PDF format.

Our purpose

With care coordination through the RCT, we will deliver
the right care, at the right time, in the right place, with the right team.

Members will have a consistent care team that will collaborate across disciplines to develop and implement a member-centric care plan through telephonic, electronic or community-based interventions to resolve identified needs and promote healthy outcomes.

The RCT is made up of care coordinators with a variety of backgrounds and experience, including:

• Nursing
• Behavioral Health
• Substance Use Disorders
• Pharmacy
• Health system navigation
• Local community resources
• And others

How the RCT is structured:

How can the RCT help my patients?

Each patient is assigned to a care team that is familiar with the patient’s history, strengths, needs and support system. The team will:

• Reduce confusion for patients by navigating them through the health care and social services system.
• Help patients get access to the right care at the right time, and make sure they stay connected to their providers.
• Reduce barriers to patient care and treatment compliance and connect them to support services.

How can the RCT help me?

Your dedicated RCT will work closely with your clinic to:

• Smooth workflows with coordination and support for primary care, behavioral health, oral health and other network providers.
• Assist with patient transitions between levels of care, such as hospital to primary care.
• Help with provider navigation, including targeted high-risk case management.
• Engage in formulary-specific medication review and communication for support of adherence.
• Address social determinants of health.

How are RCTs assigned?

RCTs are assigned based on the county the patient’s PCP clinic is in or the county where the patient lives.

When do I call the RCT?

The RCT offers care coordination and support for patients with multiple or complex needs, such as:

• Multiple chronic conditions
• High or special health care needs
• Chronic pain needs
• In-home care needs
• Daily living or social needs
• Medication review and support
• End-of-life support
• Substance use
• Behavioral health concerns

How do I make a care coordination referral?

Online: Submit a completed Care Coordination Referral form and we’ll route it to your assigned RCT.

Email: Send your completed form to ccreferral@careoregon.org

Fax: Print and send your completed form to 503-416-3676.

Collective (PreManage): If your clinic uses this online platform, check the RCT tag after searching for your patient.

Call: You can reach your RCT directly at 503-416-3742.

Download a PDF summary of this information here.

This document provides information about dental care benefits for members, including provider options and contact details.

The “Oral Health Training for Traditional Health Workers” is an OHA approved training for continuing education units available for free by CareOregon. To access the training, please navigate to the link below. Once you have completed the training, please email colpacthwliaison@careoregon.org with your name to receive a certificate of completion.

Register for this free training.