Flexible services (flex requests)
What are flexible services?
Flexible services are cost-effective items and/or services delivered to an individual OHP member to supplement covered benefits and improve their health and well-being. Flexible services are intended to meet immediate social needs, stabilize crisis situations and support a sustainable plan for ongoing needs. These are commonly referred to as flex requests.
Limitations of flexible services:
The Oregon Administrative Rules restrict health-related services to items not paid for with grant money, funding separate from CCO contract revenue, normal clinical service billing, and payor of last resort. In other words, health-related services may be used only if other funding is not available.
How members access flexible services:
Any primary care or behavioral health provider or care team, care coordination staff member working directly with members, or other subcontractors of CareOregon’s network, may make a flex request for a member. Members
are not able to submit flex requests on their own. CareOregon encourages our community-based organization (CBO) partners to help our shared members access flexible services. CBOs can work with members and their treatment providers to identify
the need, and the provider can submit a request.
If you are a CBO and need help connecting a member to a provider, please complete the Care Coordination referral form.
What flexible services covers
These funds can be used for items or services that aren’t covered under Oregon’s Medicaid plan but will improve a person’s health.
Flexible services funds cover services like:
- Housing support: Furniture, application fees for housing or a state-issued ID, moving costs, etc.
- Living environment: Air conditioners, athletic shoes, items to improve mobility, etc.
- Food supports: Meal delivery, food vouchers, farmers market funds, etc.
- Phone/video appointments: A cell phone, tablet, an internet connection for better access to health care providers
This is not an exhaustive list. Any requests will be evaluated for consistency with a member’s health needs and treatment plan.
What flexible services do not cover
Flexible services do not cover anything that can be billed with a CPT or HCPCS code that is a covered benefit. Some specific examples include:
- Provider visits
- Pharmacy benefits
- Non-emergent medical transportation (we can help with transportation to non-medical appointments). Below are links to the NEMT websites for our CCOs:
- Health Share of Oregon (Ride to Care)
- Columbia Pacific CCO (NW Rides)
- Jackson Care Connect (TransLink)
- 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.
CareOregon evaluates all completed request forms based on:
- The member’s eligibility
- How the request matches their treatment plan.
- Because CCOs are not able to support long term needs, a sustainability plan describing how the member’s needs will be met long-term must be outlined.
- Which other community resources or safety net funds (besides HRS) were pursued before the request was made.
- Often evaluating requests 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 are indicated, this form can be used to provide that information.
We will provide members with a written outcome (mailed to the address on file with the CCO) and copy the requesting provider (and the member’s representatives, if applicable).
Requesting flexible services funds
Standard individual flex request
For non-hotel requests, for individual members:
- Please include:
- Standard health-related flexible services request
- Medical documentation (care plan, progress notes, chart notes, etc.) and information about the member’s diagnosis.
- Items that are needed on a repeating basis — like gym memberships, phone minutes, etc. — require the submission of a new Standard health-related services funding request Form form each month.
- Urgent requests will be processed in two to five business days. Requests may be reclassified to standard if, upon review, the standard timeline would not seriously jeopardize the health and safety of the member.
- Standard requests will be processed in 10-14 business days. Processing time does not include shipping and delivery timelines.
Hotel flex requests
For stays in hotels for individual members:
- The maximum number of days we will consider funding in a single request is 30, but be aware that many hotels do have shorter limits of time a member can stay without checking out and checking back in. Please have a conversation with the member and potentially the hotel to make sure the requested hotel is a good fit. Some reasons it may not be a good fit:
- No rooms are available that meet accessibility requirements
- No smoking rooms are available or there is no easy access to an outside smoking area
- No pets are allowed
- The member does not have ID and the hotel requires it
- There will be transportation challenges (if the only challenge is getting to the hotel, you can also request help with transportation in the request)
To submit a request for a hotel:
There are two different options for submitting hotel requests. Please note, both options do still require medical documentation (care plan, progress notes, chart notes, etc)
- Submit multiple documents:
- Submit a Hotel Flex Request (which combines all of the forms listed above into one document)
If a member needs an extension, please note:
- Extensions of hotel stays require a new submission of a Funding Request form but do not require a new code of conduct or checklist.
- To avoid disruption of services, please submit extension requests at least three to five business days prior to checkout.
State of Emergency requests
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.
We recognize that providers frequently feel there is a small window of opportunity to provide some services for members, so we’ve made some of these items that are commonly needed and have a clear benefit available via our bulk reimbursement process. This allows providers to have them on hand and give them to members as needed.
There is one option for procuring bulk items:
- CareOregon reimburses: Provider purchases items and submits request and receipts for CareOregon to reimburse.
- Bulk reimbursement requests are limited to items on our list
- Providers can substitute like items (i.e., buying a different type of phone or tent)
Below are some examples of items available via bulk reimbursement.
- Cell phones and phone minutes
- Transit passes
- Sleeping bags
- Shelter materials (tents and tarps)
- City Team shelter vouchers
- Personal hygiene products