OAR 410-120-2005: Temporary rule language in effect until 10/27/2026. 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 1 through 10 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 4 through 10 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 7 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 10 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 7 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. [ED. NOTE: To view attachments referenced in rule text, click here to view rule.]