Rights & Responsibilities

As a member of YCCO you have rights. There are also responsibilities or things you have to do when you get OHP. If you have any questions about the rights and responsibilities listed here, call Customer Service at 855-722-8205.

You have the right to exercise your member rights without a bad response or discrimination. You can make a complaint if you feel like your rights have not been respected. Learn more about making complaints in the Member handbook (page 93). You can also call an Oregon Health Authority Ombudsperson at 877-642-0450 (TTY 711). You can send them a secure email at Oregon Health Authority.

There are times when people under age 18 (minors) may want or need to get health care services on their own. Minors 15 years and older can get medical and dental care without parental consent. To learn more, read “Minor Rights: Access and Consent to Health Care.” This booklet tells you the types of services minors of any gender can get on their own and how their health records may be shared. Visit the Oregon Health Authority website, and click on “Minor rights and access to care.” Or go to: Understanding Minor Consent and Confidentiality in Oregon Healthcare (PDF)

Your Rights as an OHP Member

You have the right to be treated like this:

• Be treated with dignity, respect, and consideration for your privacy.
• Be treated by providers the same as other people seeking health care.
• Have a stable relationship with a care team that is responsible for managing your overall care.
• Not be held down or kept away from people because it would be easier to care for you, punish you, or get you to do something you don’t want to do.

You have a right to get this information:

• Materials explained in a way and in a language you can understand. (See page 3 in the Member handbook)
• Materials, like the handbook, that tell you about CCOs and how to use the health care system.
• Written materials that tell you your rights, responsibilities, benefits, how to get services, and what to do in an emergency.
• Information about your condition, treatments and alternatives, what is covered, and what is not covered. This information will help you make good decisions about your care. Get this information in a language and a format that works for you.
• A health record that keeps track of your conditions, the services you get, and referrals. (See page 12 in the Member handbook) You can:
  • Have access to your health records
  • Share your health records with a provider.
• Written notice mailed to you of a denial or change in a benefit before it happens. You might not get a notice if it isn’t required by federal or state rules.
• Written notice mailed to you about providers who are no longer in-network. In-network means providers or specialists that work with YCCO. (See page 29 in the Member handbook)
• Be told in a timely manner if an appointment is cancelled.

You have a right to get this care:

• Care and services that put you at the center. Get care that gives you choice, independence, and dignity. This care will be based on your health needs and it will meet standards of practice.
• Services that consider your cultural and language needs and are close to where you live. If available, you can get services in non-traditional settings such as online. (See page 68 in the Member handbook).
• Care coordination, community-based care, and help with care transitions in a way that works with your culture and language. This will help keep you out of a hospital or facility.
• Services that are needed to know what health condition you have.
• Help to use the health care system. Get the cultural and language support you need. (See page 3 in the Member handbook). This could be:
  • Certified or qualified health care interpreters.
  • Certified traditional health workers.
  • Community health workers.
  • Peer wellness specialists.
  • Peer support specialists.
  • Doulas.
  • Personal health navigators.
• Help from CCO staff who are fully trained in CCO policies and procedures.
• Covered preventive services. (See page 31 in the Member handbook).
• Urgent and emergency services 24 hours a day, 7 days a week without approval or permission. (See page 75 in the Member handbook).
• Referrals to specialty providers for covered coordinated services that are needed based on your health. (See page 32 in the Member handbook).
• Extra support from an OHP Ombudsperson (see page 64 in the Member handbook).

You have a right to do these things:

• Choose your providers and change those choices. (See page 27 in the Member handbook)
• Get a second opinion. (See page 29 in the Member handbook)
• Have a friend, family member, or helper come to your appointments.
• Be actively involved in making your treatment plan.
• Agree to or refuse services. Know what might happen based on your decision. (A court-ordered service cannot be refused.)
• Refer yourself to behavioral health or family planning services without permission from a provider.
• Make a statement of wishes for treatment. This means your wishes to accept or refuse medical, surgical, or behavioral health treatment. It also means the right to make directives and give powers of attorney for health care, listed in ORS 127. (See page 88 in the Member handbook)
• Make a complaint or ask for an appeal. Get a response from YCCO when you do this. (See page 93 in the Member handbook).
  • Ask the state to review if you don’t agree with YCCO’s decision. This is called a hearing.
• Get free certified or qualified health care interpreters for all non-English languages and sign language. (See page 3 in the Member handbook)

Your Responsibilities as an OHP Member

You must treat others this way:

• Treat YCCO staff, providers, and others with respect.
• Be honest with your providers so they can give you the best care.

You must report this information to OHP:

If you get OHP, you must report certain changes about you and your household. Your OHP approval letter rells you what you must report and when.

You can report changes in one of these ways:

• Use your ONE Online Account to report changes online.
• Visit any Oregon Department of Human Service Office in Oregon. You can find a list of offices at Oregon Department of Human Services
• Contact a local OHP-certified community partner. You can find a community partner at: Oregon Healthcare
• Call OHP Customer Service weekdays at 800-699-9075 (TTY 711)
• Fax to 503-378-5628
• Mail to ONE customer Service Center, PO Box 14015, Salem, OR 97309

There are other rights and responsibilities you have as an OHP member. OHP shared these when you applied. You can find a copy at Medical, Food, Cash and Child Care Benefits, under the “Rights and Responsibilities” link.

You must help with your care in these ways:

• Choose or help choose your primary care provider or clinic.
• Get yearly checkups, wellness visits, and preventive care to keep you healthy.
• Be on time for appointments. If you will be late, call ahead or cancel your appointment if you can’t make it.
• Bring your medical ID cards to appointments. Tell the office that you have OHP and any other health insurance. Let them know if you were hurt in an accident.
• Help your provider make your treatment plan. Follow the treatment plan and actively take part in your care.
• Follow directions from your providers’ or ask for another option.
• If you don’t understand, ask questions about conditions, treatments, and other issues related to care.
• Use information you get from providers and care teams to help you make informed decisions about your treatment.
• Use your primary care provider for tests and other care needs, unless it’s an emergency.
• Use in-network specialists or work with your provider for approval if you want or need to see someone who doesn’t work with YCCO.
• Use urgent or emergency services appropriately. Tell your primary care provider within 72 hours if you do use these services.
• Help providers get your health record. You may have to sign a form for this.
• Tell YCCO if you have any issues, complaints, or need help.
• Pay for services that are not covered by OHP.
• If you get money because of an injury, help YCCO get paid for the services we gave you because of that injury.

YCCO OHP Benefit List

See below for a list of medical benefits that are available to you at no cost.

Health-Related Social Needs (HRSN)

Health-Related Social Needs (HRSN) are social and economic needs that affect your ability to be healthy and feel well. These services help members who are facing major life changes.

YCCO HRSN

Oregon Health Authority HRSN

You can also talk to your doctor, call Customer Service at 855-722-8205 (TTY 711), or in the YCCO 2025 Member Handbook.

Care Coordination

YCCO staff are committed to supporting members with their care needs and can assist you with finding physical, dental, behavioral, developmental, and social health care where and when you need it.

Care Coordination Assistance

Intensive In-Home Behavioral Health Treatment (IIBHT)

Intensive In-Home Behavioral Health Treatment (IIBHT) is intensive community-based care for youth ages 0-20 years old with complex mental health/behavioral health needs who are at risk for an out of home placement or who are being discharged home from residential or inpatient care. In home mean services delivered in the home, school or other community setting as specified by the member and family.

IIBHT includes access based on individual needs to many services including individual and family therapy, case management, psychiatric services, skills training, peer-delivered services, and proactive 24 hours 7 days a week crisis response.

Members are not required to participate in other behavioral health treatment services or other services or supports, including Wraparound, to receive IIBHT.

Eligibility

• Youth age 0-20 years old who are YCCO OHP members; and
• Member must meet medical necessity for treatment, this is determined by a mental health assessment.

Contact

YCCO members can contact Yamhill County Family and Youth for more info about these services and/or assessment these ways:

• Phone: 503-434-7462
• Address: 420 NE 5^th St., McMinnville OR 97128

Learn more about IIBHT at Yamhill County Family & Youth.

Youth are considered for IIBHT without regard to race, ethnicity, gender, gender identity, gender presentation, sexual orientation, religion, creed, national origin, age, intellectual and/or developmental disability, IQ score, or physical disability. Members can ask for an interpreters for all non-English languages and sign language, this help is free.

Extra Services

Flexible Services (Formerly Health Related Services)

Flexible services help improve overall member and community health and well-being.

Flex funds 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:

More About 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 93 in the Member handbook.

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 Funding Request

You can work with your provider to request for Flexible services or you or your representative can submit a request. You can 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 (page 93) and on Appeals & Complaints page.

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.

Transition of Care (TOC)

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 (TOC).”

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 this website on the documents and forms page in the member policies section. Please call Customer Service if you have questions.

If you want more info or a copy of the YCCO Care Coordination Policy you can call Customer Service at 855-722-8205. You can also view a PDF of the care coordination policy here. The information above is not currently in the Care Coordination Policy and is available in 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.

More About Your Rights

Click on the tabs below to learn more about some of your rights as a member of Yamhill Community Care (YCCO) on the Oregon Health Plan.