yamhillcco.org

Health-Related Social Needs (HRSN) Benefit

Health-Related Social Needs (HRSN): The social and economic needs that impact an individual’s ability to maintain their health and well-being.

Learn More About Oregon’s HRSN Services Benefits:

Clinically Appropriate Climate Related Devices Benefit: Available Now

Since March 2024, climate-related benefits launched to  include air conditioners for heat risks, air filters to protect against wildfire smoke, and home modifications to protect people from extreme weather.

Clinically Appropriate climate-related devices for Members residing in their home or non-institutional primary residence include:

  • Air conditioners for individuals at health risk due to significant heat,
  • Heaters for individuals at increased health risk due to significant cold,
  • Air filtration devices and, as needed, replacement air filters for individuals at health risk due to compromised air quality,
  • Mini refrigeration units as needed for individuals for medication storage, and
  • Portable power supplies (PPSs) for individuals who need access to electricity-dependent equipment (e.g., ventilators, dialysis machines, intravenous equipment, chair lifts, mobility devices, communication devices, etc.) or are at risk of public safety power shutoffs (PSPS) that may compromise their ability to use medically necessary devices.

Housing Benefits: Available November 2024

Housing benefits (available November 2024) include help with the cost of rent, utilities, and other bills, help finding a place to live, and help with changes to make peoples’ homes safer and more accessible.

Food Benefits: Available January 2025

Food Benefits (available in January 2025) include prescriptions for fruits and vegetables and covering the cost of meals, nutrition education, medically-tailored meals for 6 months, meals or pantry stocking for pregnant individuals, children and youth under 21, and young adults 19-26 years old with special health care needs (YSHCN) for 6 months

Outreach & Engagement Benefits

Outreach & engagement benefits include providing O & E Services for OHP enrolled individuals presumed eligible for HRSN services, and helping HRSN members who may have an unmet need for medical, peer, social, education, or other related services with support necessary to connect them with the appropriate resource and/or service.

To be eligible for climate support or to receive HRSN services, a member must be an OHP member and be at least one of the following:

  1. A current OHP member and Yamhill CCO A or B member
  2. Be one or more of the eligible groups below:
    • Adult or youth discharged from residential and acute care mental health and substance use programs within the past 12 months.
    • Adult or youth released from incarceration within the past 12 months.
    • Involved in Oregon’s child welfare system at some point in member’s life.
    • Transitioning from Medicaid-only to dual coverage (receiving both Medicaid and Medicare) within the next 3 months or past 9 months.
    • Members who are houseless or at risk of becoming houseless.
    • Young adult, aged 19-26, with Special Healthcare Needs (starting in 2025).
  3. Meet at least one clinical risk factor. Examples include: (See Table 1 for climate-specific factors)
    • Younger than 6 years old with a history of or current clinical risk factor.
    • 65 years old or older with a history of or current clinical risk factor.
    • Currently pregnant with a history of or current clinical risk factor.
    • Have a sensory, physical, intellectual, or developmental disability.
    • Need assistance with activities of daily living (ADLs), instrumental activities of daily living (iADLs), or am eligible for long-term services and supports (LTSS).
    • Receive in-home hospice care.
    • Have complex physical health needs, like a chronic heart or lung condition, kidney disease, diabetes, or a condition that makes me at risk for blood clots or a stroke.
    • Have multiple sclerosis.
    • Have Parkinson’s.
    • Have had a spinal cord injury.
    • Have schizophrenia.
    • Have bipolar disorder.
    • Have an alcohol or substance use disorder.
    • Have major depressive disorder and have needed crisis services, hospitalization, or residential treatment in the past 12 months.
  4. Social risk factor: A Member meets the HRSN Climate Device Social Risk Factor requirement if they reside in their own home or a non-institutional, non-congregate primary residence and has a need that will be aided by one of the following devices: air conditioner, heater, air filtration device, portable power supply (PPSs), and/or mini refrigeration units.
    1. Examples of climate-related needs:
      • Have a health condition that makes extreme heat, cold temperature, poor air quality, or power outage particularly challenging or dangerous
      • Individual is currently without a heater, air conditioner, air filter, mini-refrigerator for medications, or a portable power supply that works enough to meet my needs.
    2. Examples of housing-related needs:
      • Require services to navigate, obtain, and sustain housing tenancy or create an accessible and health home environment
    3. Examples of nutrition-related needs:
      • Experience marginal food security, including having anxiety over food sufficiency or shortage of food in the house.
Table 1: Climate Device Clinical Risk Factor Overview

(Condition must have been active in the past 12 months. Members must meet age or pregnancy criteria at the time of eligibility determination, as relevant.)
Climate DeviceClinical Risk Factor
Air Conditioner, Air Filtration Device, Heater
Schizophrenia spectrum and other psychotic disorders 
Bipolar and related disorders 
Major depressive disorder with an acute care need in the past 12 months including a suicide attempt, crisis services utilization (emergency department, mobile crisis team, etc.), acute psychiatric hospitalization, or residential treatment 
One or more of the following substance use disorders: alcohol use disorder, hallucinogen use disorders, inhalant use disorder, opioid use disorder, stimulant use disorder 
Major neurocognitive disorders 
Chronic lower respiratory condition including chronic obstructive pulmonary disease (COPD), asthma requiring regular use of asthma controlling medications, restrictive lung disease, fibrosis, chronic bronchitis, bronchiectasis 
Chronic cardiovascular disease, including cerebrovascular disease and heart disease 
Spinal cord injury 
In-home hospice 
Any sensory, physical, intellectual, or developmental disability that increases health risks during extreme climate events 
Child less than 6 years of age and currently has, has a history of, or is at risk for at least one of the following:• Heat stroke or heat exhaustion• Hypothermia, frostbite, or chilblains• Malnutrition• Dehydration or is currently breastfeeding• Child maltreatment as defined by the CDC (https://www.cdc.gov/violenceprevention/pdf/CM_Surveillance-a.pdf)Is a child with a special healthcare need (CYSHCN) as defined by HRSA (https://mchb.hrsa.gov/programs-impact/focus-areas/children-youth-special-health-care-needs-cyshcn#i)• An acute or chronic respiratory conditionA respiratory or gastrointestinal infectious disease, or becoming febrile with an infectious illness• Low birth weight of <2500 grams 
Air Conditioner, Air Filtration Device, HeaterPregnant and currently has, has a history of, or is at risk for at least one of the following:• Heat stroke or heat exhaustion• Hypothermia, frostbite, or chilblains• An acute or chronic respiratory condition• Infection• High-risk pregnancy as defined by the NIH (https://www.nichd.nih.gov/health/topics/high-risk/conditioninfo)• History of previous pregnancy, delivery, or birth complication including gestational diabetes, preeclampsia, preterm labor, preterm birth, placental abruption, newborn low birth weight, stillbirth• Abuse or interpersonal violence• Malnutrition• Hyperemesis gravidarum and other causes of dehydration
Air Conditioner, Air Filtration Device, HeaterAdult 65 years and older and currently has, has a history of, or is at risk for at least one of the following:• Heat stroke or heat exhaustion• Hypothermia, frostbite, or chilblains• Malnutrition• Dehydration• Currently taking medications that impact heat tolerance, including for upper respiratory infections, allergies, COPD, muscle spasms, blood pressure, diuresis, diarrhea, constipation, anti-inflammation, mental health conditions, and sleep• Abuse or neglect• A respiratory or gastrointestinal infectious disease, or becoming febrile with an infectious illness• Mental health condition• Two or more chronic health conditions
Air Conditioner, HeaterChronic Kidney disease, Diabetes mellitus, requiring any medication, oral or insulin Multiple Sclerosis Parkinson’s Disease Previous heat-related or cold-related illness requiring urgent or acute care, ex) emergency room and urgent care visits
Air Filtration DeviceIndividual requires home oxygen use: home oxygen, oxygen concentrators, home ventilator
Mini Refrigerator·         Individual uses medications requiring refrigeration. Examples include but are not limited to medications for diabetes mellitus, glaucoma, and asthma; TNF inhibitors
·         Enteral and parenteral nutrition
Portable Power SupplyIndividual needs durable medical equipment (DME) requiring electricity for use. Examples include but are not limited to:• Oxygen delivery systems, including concentrators, humidifiers, nebulizers, and ventilators• Intermittent positive pressure breathing machines• Cardiac devices• In home dialysis and automated peritoneal dialysis• Feeding Pumps• IV infusions• Suction pumps• Power wheelchair and scooter• Lift systems and electric beds• Breast pumps for first 6mo post-partum• Other DME medically required for sustaining life
Individual requires assistive technologies requiring electricity necessary for communication or ADLs.
Any DeviceOther conditions approved through an individual review for medical exception aligned with OHA’s

HRSN Service Providers can be a public or private social service organization or clinic, community organization, or other similar individual or entity that provides HRSN services and helps to connect members with the HRSN benefit.

HRSN Service Provider Qualifications: the service provider must:

      1. Be accessible to HRSN participants in your region, which may include having operating hours and staff necessary to meet member need.
      2. Demonstrate the ability and/or experience to effectively serve at least one of OHA’s Priority Populations.
      3. Demonstrate qualified service delivery and administrative staff
      4. Provide culturally and linguistically appropriate, responsive and trauma-informed services
      5. Demonstrate a history of responsible financial administration.

Domain Specific Qualifications for HRSN Providers:

Outreach and Engagement Providers:

      1. Have the competency and experience to perform activities for the purpose of identifying OHP enrolled individuals presumed eligible for HRSN Climate-Related Services.
      2. Have knowledge of cultural specificity and responsiveness approaches, community outreach and engagement best practices, eligibility and enrollment policies and practices for OHP members, and local community resources for supporting basic needs.
      3. Ability to maintain strict confidentiality and handle sensitive information appropriately.

Climate Device Providers and/or Vendors:

      1. YCCO Service Vendors of Climate-Related Supports must have the ability to appropriately deliver Climate-Related Supports. Installation may be requested for AC Units only.  YCCO will require that all contracted installers be licensed and bonded, complete a background check.

HRSN Housing Providers:

      1. Have knowledge of principles, methods, and procedures of housing services covered under HRSN, or comparable services meant to support individuals in obtaining and maintaining stable housing.
      2. Be trained, if necessary, to provide the specific service.
      3. Have the ability to directly meet the member’s needs for the activities listed in the housing service descriptions or the ability to connect members to the appropriate service provider or vendor.

HRSN Nutrition Providers:

      1. Comply with all applicable federal, state, and local laws governing food safety standards.
      2. Be trained and accredited on industry standards to provide the specific service. For example) webinar courses offered by SNAP-Ed, CDC-approved training for the National Diabetes Prevention Program Lifestyle Coach, and other trainings from accredited nutrition programs, Certified Nutrition & Wellness Educator, Registered dietician Nutritionist Licensure.
      3. Have the ability to meet the needs of member’s personal and cultural dietary preferences.
      4. Have the capacity to provide services on one-time, daily, weekly, or monthly basis.
      5. If a nutrition service is administered by a gift card/debit card, the HRSN Service Provider must have the ability to administer and coordinate the service, including engaging with members to explain the service, having relationships with food retailers that will accept payment, and monitoring and overseeing use of the cards.

HRSN Readiness Plan: 

      1. Must meet provider qualification defined above
      2. Demonstrate readiness to participate in Closed Loop Referral process (explained below)
      3. Demonstrate readiness for invoicing for services as agreed upon between YCCO and HRSN Service Provider
      4. Comply with reporting and oversight requirements established by OHA and YCCO
      5. Comply with applicable laws relating to privacy and security
      6. Ability to enroll as “encounter only” providers in MMIS, if not an already enrolled provider

*YCCO recognizes that some providers may need additional assistance to participate as a HRSN Provider. YCCO may contract with service providers who do not meet all HRSN Provider Qualifications. 
Contact providerrelations@yamhillcco.org to inquire about becoming an HRSN provider. 

To begin the process of enrolling as an HRSN service provider: 

1. Complete this application.

2. Once you’ve completed the applications, email the OHA Provider Enrollment Team at Provider.Enrollment@odhsoha.oregon.gov to let them know you’ve submitted an application. 

Find more information here: https://www.oregon.gov/oha/HSD/OHP/Tools/HRSN-Provider-Journey.pdf

Learn more by viewing the YCCO Service Provider Webinar!

HRSN Invoicing and Fee Schedule:

YCCO will follow OHA’s HRSN fee schedule to reimburse and/or directly pay through an automated payment system, which is slated to be in effect beginning August 2024.  OHA has determined that MMIS will be ready to accept CCO Encounter Data for HRSN Services beginning August 1, 2024.

To receive payment, YCCO will collect the following information from HRSN Service Providers:

    • Member identifying information (name, date of birth, Medicaid ID)
    • Rendering provider organization
    • Qualifying member information
    • Date(s) of service
    • Location of service
    • Description of service provided
    • Applicable service code
Climate Devices Fee Schedule

Click the image below:

Housing Fee Schedule

Tentatively available starting in November 2024

More details coming soon!

Nutrition Fee Schedule

Tentatively available starting in January 2025

More details coming soon!

Closed-Loop Referrals:

Closed-Loop referrals refers to the process of exchanging information between and among YCCO, OHA, a member, and/or HRSN Service Provider, Primary Care Provider, and referent to communicate about the status of referrals for a member.  The structures currently in place at YCCO for Closed-Loop Referrals include secure email, Community Information Exchange (CIE), direct mail, and/or phone.

Members can opt out of their data being shared through CIE. If a member opts out of their data being shared through technology, it will be documented in YCCO’s Member Service Documentation System and YCCO will notify the HRSN Service Provider.

The Closed-Loop Referral Process will continued to be developed and expanded according to HRSN processes and requirements, which will continue to be created in the next two years.

 

The SDOH Metric requires all YCCO contracted providers to train staff who conduct SDoH screening with members. 

SDOH Training addresses the following:

1. Trauma Informed Care,

2. Motivational Interviewing,

3. Empathic Inquiry, and

4. Empathic Inquiry, Social Needs Screening Data & Clinical Workflows.

Complete the Social Determinants of Health (SDOH) Screening and Referral Metric Form Today

As YCCO contracted providers, you are responsible for ensuring that your staff, who conduct SDOH screenings, complete training in each category mentioned above. Once the training is completed, please submit the SDOH Training Attestation Form to providerrelations@yamhillcco.org as proof of completion.

The link below provides SDOH Screening Training Modules and Social Needs Training Resources Developed by the Oregon Rural Practice-based Research Network (ORPRN) and the Oregon Health Authority Transformation Center to support and meet the SDOH Screening and Referral Incentive Metric implementation.

Learn more and download today!

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

A request form needs to be filled out and submitted to YCCO 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 855-722-8205 (TTY 711).
  • The member themselves, an organization or clinic supporting the member, a member’s parent, a caregiver, a guardian/support/trusted friend, case manager or an HRSN Service Provider can fill this form out.
  • The form can be returned to YCCO by:

DOWNLOAD HRSN PA Form

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

If a member does not meet eligibility criteria for the HRSN benefit, they may qualify support through the health-related services flex funding program.