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YCCO 2024 Benefit List

Health-Related Social Needs (HRSN)

Health-Related Social Needs (HRSN) refer to barriers to health, like housing or access to food.

Please contact YCCO Customer Service to see what free HRSN Services are available. HRSN Services include:

• Climate Services: Help to get health-related air conditioners, heaters, air filters, portable power supplies, and mini fridges. This began in March 2024.
• Housing Services: Help with rent and utilities, to get or keep housing, moving costs, and home modifications. This will begin no sooner than November 1, 2024 and will be for members at risk of becoming houseless. For others, this service will start at a later date.
• Nutrition Services: Includes nutrition education, medically tailored meals, meals or pantry stocking, fruit and vegetable prescriptions. This will begin January 1, 2025.

You may be eligible to receive some or all of the HRSN Services if you are an OHP Member, and be at least one of the following:

• Are homeless or at risk of being homeless;
• Are being discharged from an Institute for Mental Disease;
• Are being released from incarceration;
• Are a youth transitioning out of the child welfare system;
• Are a Youth with Special Healthcare Needs (cannot receive services until 2025); or
• Are an individual who is transitioning to dual status with OHP and Medicare.

You are able to ask to be screened for eligibility or to deny screening for eligibility. If approved, you can choose to receive or not receive HRSN Services. If approved, HRSN Services are free to you and you can opt out at any time. If you receive HRSN Services, your care coordination team will work with you to make sure your care plan includes the services you receive.  See  the handbook for Care Coordination and care plans information.

Please note that to be screened for and receive HRSN Services, your personal data may be collected and used during referrals. You have the ability to limit the way in which your information is shared.

To request HRSN you need to ask for it. You can ask for HRSN. You can also work with a care manager, or your provider to ask for it. The form to do this is here. There are rules you have to meet to qualify for HRSN this info in on the form.

The YCCO Information Sharing Authorization form must be sent in with your request the form is here. You need to send in both forms.

Reach out to our Care Management Team for more info on HRSN at 833-257-2191

For more info on HRSN Climate Resources:

Frequently Asked Questions  https://www.oregon.gov/oha/HSD/OHP/Tools/Climate-FAQ.pdf

OHP Climate Support Fact Sheet https://www.oregon.gov/oha/HSD/OHP/Tools/Climate-Supports-Fact-Sheet-EN.pdf

Extra services

Health-Related Services

Health-Related Services (HRS) are extra services YCCO offers. HRS help improve overall member and community health and well-being. HRS are flexible services for members and community benefit initiatives for members and the larger community.

The YCCO HRS program aids in the best use of funds to address individual health needs, as well as social risk factors, like where you live, to improve community well-being. Learn more about health-related services at  

• Flexible Services Info for OHP Members in CCOs
• Información de servicios flexibles para los miembros de OHP en CCO

Flexible Services
Flexible services are support for items or services to help members become or stay healthy. YCCO offers these flexible services:

• Housing supports
• Home or living environment items or improvements
• Transportation not otherwise covered by OHP, some examples are rides to the bank or grocery store
• Help with food

Examples of other flexible services:

• Food supports, such as grocery delivery, food vouchers, or medically tailored meals
• Short-term housing supports, such as rental deposits to support moving costs, rent support for a short period of time, or utility set-up fees
• Temporary housing or shelter while recovering from hospitalization
• Items that support healthy behaviors, such as athletic shoes or clothing
• Mobile phones or devices for accessing telehealth or health apps
• Other items that keep you healthy, such as an air conditioner or air filter

How to get flexible services for you or family member
You can work with your provider to request flexible services, or you can call Customer Service at 855-722-8205 and have a request form sent to you in the language or format that fits your needs.

Flexible services are not a covered benefit for members and CCOs are not required to provide them. Decisions to approve or deny flexible services requests are made on a case-by-case basis. If your flexible service request is denied, you will get a letter explaining your options. You can’t appeal a denied flexible service, but you have the right to make a complaint. Learn more about appeals and complaints on page 94.

If you have OHP and have trouble getting care, please reach out to the OHA Ombuds Program. The Ombuds are advocates for OHP members and they will do their best to help you. Please email OHA.OmbudsOffice@odhsoha.oregon.gov or leave a message at 877-642-0450.

Another resource for supports and services in your community is 211 Info. Call 2-1-1 or go to the www.211info.org website for help.

Submit YCCO Flex Fund Request

You can work with your provider to request for Flexible services or you or your representative can submit a request. Attach the Flex Funds Requests:

•  YCCO Flex Funds Request Form.
• Solicitud de fondos YCCO Flex

Fax the form to 503-607-8336 or

Email to caremanagement@yamhillcco.org

You can also call Customer Service and ask for the form to be sent you, in your language, braille, large print, or the format you need, including access to a certified or qualified interpreter, this is free.  If you have any questions call Customer Service at 855-722-8205 and ask to speak to Care Coordination.

After submitting a request, you will receive notice if it is approved or not. You will receive a letter if the request is denied. You cannot appeal or request a hearing with this kind of denial but can file a complaint if you disagree by contacting Customer Service at 855-722-8205. More info about filing a complaint is located in the Grievance System section of the member handbook and on the website here  https://yamhillcco.org/members/.

YCCO does not share member specific HRS info outside of the HRS process. When your request is received it is shared with only those that are noted in the request, this could be your provider, caregiver or the entity related to your request.

Care while you change or leave a CCO

Some members who change plans might still get the same services, prescription drug coverage and see the same providers even if they are not in-network. That means care will be coordinated when you switch CCO plans or move from OHP fee-for-service to a CCO. This is sometimes called “Transition of Care.”

If you have serious health issues, need hospital care or inpatient mental health care, your new and old plans must work together to make sure you get the care and services you need.

When you need the same care while changing plans

This help is for when you have serious health issues, need hospital care, or inpatient mental health care. Here is a list of some examples of when you can get this help:

• End-stage renal disease care.
• You’re a medically fragile child.
• Receiving breast and/or cervical cancer treatment program members.
• Receiving Care Assist help due to HIV/AIDS.
• Post-transplant care.
• You’re pregnant or just had a baby.
• Receiving treatment for cancer.
• Any member that if they don’t get continued services may suffer serious detriment to their health or be at risk for the need of hospital or institution care.

The timeframe that this care lasts is:

*Or until your new primary care provider (PCP) has reviewed your treatment plan.

If you are leaving YCCO, we will work with your new CCO or OHP to make sure you can get those same services listed below.

If you need care while you change plans or have questions, please call YCCO Customer Service at: 855-722-8205 (TTY users, call 711) Hours: Monday through Friday, 8:00 a.m. to 5:00 p.m. PST

YCCO will make sure members who need the same care while changing plans get:

• Continued access to care and rides to care.
• Services from their provider even if they are not in the YCCO network until one of these happen:
  • The minimum or approved prescribed treatment course is completed, or
  • Your provider decides your treatment is no longer needed. If the care is by a specialist, the treatment plan will be reviewed by a qualified provider.
• Some types of care will continue until complete with the current provider. These types of care are:
  • Care before and after you are pregnant/deliver a baby (prenatal and postpartum).
  • Transplant services until the first year post-transplant.
  • Radiation or chemotherapy (cancer treatment) for their course of treatment.
  • Medications with a defined least course of treatment that is more than the transition of care timeframes above.

You can get a copy of the YCCO Transition of Care Policy by calling Customer Service at 855-722-8205.  It is also on our website on the documents and forms page in the member policies section at https://yamhillcco.org/members/documents-and-forms/. Please call Customer Service if you have questions.

If you are changing CCOs and need care transition call Care Management at 971-345-5932 or 833-257-2191 (TTY 711) or Customer Service at 855-722-8205 (TTY 711).

If you want more info or a copy of the YCCO Care Coordination Policy you can call Customer Service at 855-722-8205,  it is also located here P&P pdf. The information above is not currently in the Care Coordination Policy and is available here TOC Additional Info.

If you need the TOC info in your language, large print, braille, or format you prefer, including oral interpretation, at no cost to you call Customer Service. You can reach Customer Service Monday through Friday, 8 a.m. to 5 p.m. at 855-722-8205 or TTY 711.

If we deny, stop, or reduce a service your provider asks for, we will mail you a Notice of Action/Adverse Benefit Determination (NOABD)  letter explaining why we made that decision. If you do not get a NOABD or your provider tells you a service has been denied and you must pay for it you can call Customer Service and ask for one to be sent to you.

Once you receive it you can appeal your denial. You, your provider with your written consent or your authorized representative have a right to ask to change it through an appeal and a state fair hearing. You must first ask for an appeal no more than 60 days from the date on the NOABD letter.

If your appeal decision does not change the denial you can then ask for a state fair hearing. You must ask for a hearing within 120 days from the date on the Notice of Appeal Resolution (NOAR)  letter.

How to appeal a decision

In an appeal, a different health care professional at YCCO will review your case. You can ask for an appeal orally or in writing. Ask us for an appeal by:

•         Calling Customer Service at 855-722-8205 (TTY 711).
•         Writing us a letter.
•         Filling out an Appeal and Hearing Request, form number OHP 3302, it is sent with your NOABD Letter. You can also get one here.
• OHA 3302 Appeal and Hearing Request(English)
  OHA 3302 Appeal and Hearing Request (Spanish)

You can mail, fax, or email your letter of form to:

Yamhill Community Care

Attn: Appeals and Grievance Specialist

P.O. Box 5490

Salem, OR 97304

Fax: 503-765-9675

Email: appeals@yamhillcco.org

If you want help with your appeal, call Customer Service and we can fill out an appeal form for you to sign.

You can ask your authorized representative, a certified community health worker, peer wellness specialist, or personal health navigator to help you. You may also call the Public Benefits Hotline at 800-520-5292 for legal advice and help.

You will get a NOAR from us in 16 days letting you know if the reviewer agrees or disagrees with our decision.

If we need more time to do a good review, we will send you a letter saying why we need up to 14 more days.

Dual-eligible Members And Appeal Rights

If you are enrolled in both YCCO and Medicare, you may have more appeal rights than those listed. Call Customer Service at 855-722-8205 for more info. You can also call Medicare to find out more on your appeal rights with them.

Continuing Benefits During Appeal

If you were getting the benefits we denied prior to the denial, you can keep getting them during your appeal or hearing process.

You must ask for benefits to continue within 10 days of the date on the NOABD letter.

If You Need An Expedited (Fast) Appeal

If you, your provider with your written consent, or your authorized representative believe that you have an urgent medical problem that cannot wait for a regular appeal, tell us that you need a fast appeal. We suggest that you include a statement from your provider or ask them to call us and explain why it is urgent.

If we agree that it is urgent, we will call you with a decision in 72 hours or fast as your health condition requires. If more time is needed to resolve your appeal and it is in your best interest or you ask for it, we will call you or within 2 days we will send you a letter telling you why and resolve your appeal within 14 days.

How To Get An Administrative Hearing

After an appeal, you, your authorized representative, or your provider with your written consent can ask for a state fair hearing with an Oregon Administrative Law Judge.

You will have 120 days from the date on your NOABD to ask the state for a hearing.

Your NOAR letter will have a form that you can send in. You can also ask us to send you an Appeal and Hearing Request form, or call OHP Client Services at 800-273-0557, TTY 711, and ask for form number OHP 3302 or MSC 443.

At the hearing, you can tell the judge why you do not agree with our decision and why the services should be covered. You do not need a lawyer, but you can have one or someone else, like your doctor, with you.

If you hire a lawyer, you must pay their fees. You can ask the Public Benefits Hotline (a program of Legal Aid Services of Oregon and the Oregon Law Center) at 800-520-5292, TTY 711, for advice and possible representation. Info on free legal aid can also be found at oregonlawhelp.org.

A hearing takes more than 30 days to prepare. While you wait for your hearing, you can keep on getting a service that already started before our original NOABD decision to stop it.

You must ask the state to continue the service within 10 days of the date of our NOAR that confirmed our denial.

Once your hearing takes place and is resolved you will receive a letter (called a “Final Order” telling you the results of your hearing.

Expedited (Fast) Hearings For Urgent Healthcare Problems

If you believe your medical problem cannot wait for a review you can ask for a  fast hearing.

Fax your hearing request form to:

OHP Hearings Unit at 503-945-6035

Include a statement on a form (OHP 3302 or MSC 443) from your provider explaining why it is urgent.

OHA will decide if you are entitled to an expedited hearing within, as nearly as possible, two work days from the date they receive your fast request documents. If OHA Hearings Unit denies a fast hearing request, they will make reasonable efforts to give you prompt oral notice and mail a written notice within two days.

If OHA approves your fast hearing, upon receipt of hearing documents, OHA will resolve your fast hearing no later than three work days.

Continuing Benefits During Hearing

If you were getting the services we denied prior to the denial, you can keep getting them during your hearing process. You must ask for benefits to continue within 10 days of the date on the NOAR.

Grievance System Info

If you want more info on our Grievance System, like our policies or member templates call Customer Service or send your request by email from our website https://yamhillcco.org/contact/ or by emailing info@yamhillcco.org.

Advance Directive

Adults 18 years and older can make decisions about their own care, including the right to accept or refuse medical or surgical care. 

An advance directive, also called a living will or durable power of attorney is a written document that allows you to:

• Share your values, beliefs, goals and wishes for health care if you are unable to express them yourself.
• Name a person to make your health care decisions if you could not make them for yourself. This person is called your health care representative and they must agree to act in this role.

YCCO Does Not have any limitations regarding the implementation of an advance directive as a matter of conscience. YCCO is not required to provide care that conflicts with an advance directive.

What you should know about Advance Directives:

•   If you write an Advance Directive be sure to talk to your providers and your family about it and give them copies.
•  Your family and providers can only follow your instructions if they have them.
•  Some providers and hospitals will not follow Advance Directives for religious, moral or as a matter of conscience reasons. You should ask them about this. If you change your mind, you can cancel your Advance Directive anytime. 

If you are awake and alert your providers will always listen to what you want.

How to Make an Advance Directive & More Info

• You can get a form at most hospitals and from many providers.
•  You also can find one online at:
  https://www.oregon.gov/oha/PH/ABOUT/Pages/ADAC-Forms.aspx
•  For questions or more info contact Oregon Health Decisions at 800-422-4805 or 503-692-0894, TTY 711.

If you change your mind, you can cancel your Advance Directive anytime.

How to Cancel an Advance Directive

To cancel your ask for the copies back and tear them up, or write CANCELED in large letters, sign, and date them. For questions or more info contact Oregon Health Decisions at 800-422-4805 or 503-692-0894, TTY 711.

How to complain if your provider did not follow your wishes as stated in your form:

You can make a complaint to the Health Licensing Office if your provider does not do what you ask in your advance directive.

Health Care Regulation and Quality Improvement

Phone: 971-673-0540 (TTY users, please call 711)
Hours: Monday through Friday, 8 a.m. to 5 p.m. PT

Mail a complaint to:
800 NE Oregon St., #465
Portland, OR 97232
Email: mailbox.hclc@odhsoha.oregon.gov

How to Complain if YCCO Did Not Follow Advance Directive Requirements

If you think YCCO did not follow advance directive requirements you can complain. You can call 800-273-0557 or TTY 711.

You can file a complaint online here https://www.oregon.gov/OHA/HSD/OHP/Pages/CSU.aspx

You can complain to OHA by filling out an OHA complaint form. The form is online here: https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/he3001.pdf

You can mail OHA your complaint here:

OHP Client Services

PO Box 14015

Salem, OR 97309

Phone: 800-273-0557 or TTY 711

If you want a paper copy of the OHA complaint form sent to you, call YCCO Customer Service at 855-722-8205 (TTY 711).

More info on filing a complaint with OHA can be found here https://www.oregon.gov/oha/hsd/ohp/pages/complaints.aspx

Physician Orders for Life-Sustaining Treatment (POLST)

The POLST form is for patients who:

• Are expected to die within one year;
• Are likely to have a medical crisis; and
• Want providers to know what emergency treatments they do and do not want.

The patient’s doctor would decide if POLST fits their needs. Learn more about this form on the POLST website here: https://polst.org/frequently-asked-questions-for-patients/

You can read the YCCO Advance Directive Policy and Procedure here: https://yamhillcco.org/members/documents-and-forms/

Oregon has a form called a Declaration for Mental Health Treatment. This form is a legal document.

A Declaration for Mental Health Treatment allows you to make decisions now about future mental health care in case you are unable to make your own care decisions.

If you do not have this form in place, and you are not able to make your own decisions, then only a court or two doctors can decide that you cannot make your own care decisions.

Learn more about a Declaration for Mental Health Treatment

This form allows you to make choices about the kinds of care you want and do not want. It can be used to name an adult to make decisions about your care. The person you name must agree to speak for you and follow your wishes. If your wishes are not known, this person will decide what you would want.

A declaration form is only good for three (3) years. If you become unable to decide during those three years, your declaration will remain good until you can make decisions again. You may change or cancel your declaration when you can understand and make choices about your care. You must give your form to your Primary Care Physician and the person you name to make decisions for you.

More info on Declaration for Mental Health Treatment can be found here: https://www.oregon.gov/oha/hsd/ohp/pages/decisions.aspx

A copy of the form and instructions can be found here: https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le9550.pdf

How to complain if your provider did not follow your wishes as you stated in your form:

You can make a complaint to the Health Licensing Office if your provider does not do what you ask in your advance directive.

Health Care Regulation and Quality Improvement

Phone: 971-673-0540 (TTY users, please call 711)
Hours: Monday through Friday, 8 a.m. to 5 p.m. PT

Mail a complaint to:
800 NE Oregon St., #465
Portland OR 97232
Email: mailbox.hclc@odhsoha.oregon.gov

You can request a copy of the clinical practice guideline that was used to make a decision about your care.

You can also review the Clinical Guidelines on our Provider pages by clicking here. 

You can make your request by doing one of the following:

Email:
Send an email to info@yamhillcco.org

Please include

• Your name
• Your email address
• The reason for your request
• The guideline you are requesting.

All emailed requests will be sent an email response.

Mail:
Send a letter to YCCO Quality Assurance 807 NE 3rd St McMinnville, OR 97128

Please include:

• Your name
• Your address
• The reason for your request
• The guideline you are requesting

YCCO and our providers want you to get the best care possible. If you are unhappy with YCCO, your health care services or your provider, you can complain or file a grievance.  We will try to make things better. Just call Customer Service at 855-722-8205 (TTY 711) or send us a letter.

If you want to put your complaint in writing you can mail, email or fax us a letter. You can also use the YCCO Complaint form here: https://yamhillcco.org/members/documents-and-forms/

• Fax: 503-765-9675
• Mail: Yamhill Community Care
• Attn: Grievance Specialist
  O. Box 5490
  Salem, OR 97304
• Email: complaints@yamhillcco.org

*You may have personal info in your email put “secure” in the subject line so your info is protected.

Once your complaint is received YCCO will resolve it as quickly as your health condition requires and will send you a letter telling you how it was resolved. YCCO will resolve your complaint in 5 workdays, if we cannot, we will send you a letter in that five workdays to tell you why.

We will then resolve your complaint in 30 days and send you a letter telling you how we resolved it. We will not tell anyone about your complaint unless you tell us it is okay to do so.

If you need help to file a complaint you can call Customer Service, a peer wellness specialist, or a personal health navigator.

You can also complain to the Oregon Health Authority. Call Client Services at 800-273-0557 (TTY 711), or sent your complaint to:

Oregon Health Plan Client Services

P.O. Box 14520
Salem, Oregon 97309
You may also find a complaint form here: https://apps.state.or.us/Forms/Served/he3001.pdf