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:
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:
- A current OHP member and Yamhill CCO A or B member
- Be one or more of the eligible groups below:
- Adult or youth discharged from an IMD, residential mental health and substance use disorder facility, or inpatient psychiatric unit 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).
- 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.
- 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.
- 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.
- Examples of housing-related needs:
- Require services to navigate, obtain, and sustain housing tenancy or create an accessible and health home environment
- Examples of nutrition-related needs:
- Experience marginal food security, including having anxiety over food sufficiency or shortage of food in the house.
- Examples of climate-related needs:
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:
- Be accessible to HRSN participants in your region, which may include having operating hours and staff necessary to meet member need.
- Demonstrate the ability and/or experience to effectively serve at least one of OHA’s Priority Populations.
- Demonstrate qualified service delivery and administrative staff
- Provide culturally and linguistically appropriate, responsive and trauma-informed services
- Demonstrate a history of responsible financial administration.
Domain Specific Qualifications for HRSN Providers:
HRSN Readiness Plan:
- Must meet provider qualification defined above
- Demonstrate readiness to participate in Closed Loop Referral process (explained below)
- Demonstrate readiness for invoicing for services as agreed upon between YCCO and HRSN Service Provider
- Comply with reporting and oversight requirements established by OHA and YCCO
- Comply with applicable laws relating to privacy and security
- 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
Click the image below:
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:
- Fax: 503.850.9398
- Email: utilizationmanagement@yamhillcco.org
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.
