Or. Admin. Code § 410-120-2005 - [Effective 6/29/2025] HRSN Service Eligibility; Identifying HRSN Eligible Members, HRSN Outreach and Engagement Services
(1) A Member is authorized to receive HRSN
Services so long as they meet the definition of HRSN Eligible in OAR
410-120-0000 and all other
eligibility requirements applicable to the specific HRSN Service requested by
the Member or Member Representative, all of which are identified in Tables 3
through 9 of this rule.
(2) A
Member is not eligible for a requested HRSN Service if any of the following
applies:
(a) The Member is not eligible for
the OHP Plus benefit package as described in
410-120-1210;
(b) The Member is already receiving the same
service from a different state, local, or federal agency, organization, or
entity, according to existing information held by the MCE or the Authority, or
by Member Self-Attestation. If a Member is receiving a similar service as the
requested HRSN, the requested HRSN Services may be provided to the Member so
long as they meet all eligibility criteria for the requested HRSN Service and
the amount and duration of the HRSN Services is in an amount that may fill the
gaps of or otherwise supplement the deficiencies in the similar service the
Member is receiving;
(c) The Member
does not meet all other eligibility criteria for the specific HRSN Service
requested, all of which are identified in Tables 3 through 9 of this rule, OAR
410-120-2005.
(3) Identifying Members
Potentially Eligible for HRSN Services: The MCE and the Authority shall ensure
multiple pathways for Members to be identified as potentially eligible for HRSN
Services. Pathways for identifying potentially eligible Members for HRSN
Services at a minimum must include the following:
(a) Proactively identifying Members who can
be Presumed HRSN Eligible through a review of the MCE or Authority's encounter
and claims data;
(b) Contracting
with HRSN Service Providers to conduct HRSN Outreach and Engagement (O&E)
to identify Members;
(c) Engaging
with and receiving HRSN Requests (outlined in OAR
410-120-2010) from HRSN
Connectors (defined in OAR
410-120-0000), including HRSN
Service Providers;
(d) Regardless
of whether a contractual relationship exists, conducting proactive outreach to
HRSN Service Providers, especially HRSN Housing Service Providers, for the
purpose of encouraging communication with Members who may be eligible for and
benefit from HRSN Services; and
(e)
Accepting Members' referrals or Self-Attestations, as applicable.
(f) MCEs and the Authority may scale up or
down the Member identification efforts described in subsections (a)-(d) of this
section (3) if the Member self-referral or Self-Attestations described in
subsection (e) of this section (3) results in sufficient numbers of HRSN
Eligible individuals requesting and being screened for HRSN Services.
(4) HRSN Outreach and Engagement
Services and Compensation.
(a) MCEs, the
Authority, and HRSN Service Providers shall provide the HRSN Outreach and
Engagement Services (HRSN O&E Services) described in Table 8 of this rule
to Members who are Presumed HRSN Eligible, HRSN Eligible, and HRSN Authorized
Members as described in OAR
410-120-0000 and Table 9 of this
rule.
(b) HRSN O&E Service
Providers must be compensated by the MCE, or, as applicable the Authority for
providing HRSN O&E Services described in Table 8 of this rule to:
(A) HRSN Eligible Members;
(B) Members who are confirmed to be enrolled
in OHP (FFS or an MCE) and are Presumed HRSN Eligible Members as defined in OAR
410-120-0000; or
(C) HRSN-Authorized Members.
Notes
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Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.572, 414.605, 414.665, 414.719 & 414.632
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