Health Related Services – Flex Spending
Health-Related services are non-covered services that are offered as a supplement to covered benefits to improve care delivery and overall member and community health and well-being.
Who can request a service
To receive a flexible service, you must be a UHA member. You must also meet the rules for approval. These requests require documentation (proof) to support your request. Please see the criteria (rules) and documentation (proof) requirements below.
Both clinical and non-clinical may ask for flexible services request for a member at any time.
- Providers
- Primary care teams
- Specialists
- Health care providers
- Care coordinators
- Traditional Health Workers (i.e. patient navigators, community health workers, peer support specialists, doulas, etc.)
- Community partners
- Members
- Family members or representatives
How to request a service
To request a service or item to be covered, you can send us your request. To do this, complete the electronic Assistance Request Form. You can also complete a printable or fillable form and send it to us by mail, email, or fax. You can also deliver it in-person. You can call us if you need help.
| Fax | Phone | |
|---|---|---|
|
3031 NE Stephens St., Roseburg, OR 97470 |
541-677-5881 | 541-229-4842 |
| Assistance Request Form | CBO Unite Us Portal | |
|---|---|---|
| HRS – Flexible Spending Request Form | https://uniteus.com/networks/oregon/ (CBOs only) |
Timelines
All requests will be reviewed within 30 days. This is only if the form is completely filled out and the supporting documentation has been sent to UHA. Please review the supporting documentation requirements below.
Urgent requests will only be allowed for inpatient discharges. Care coordination will determine if the need meets the criteria for urgent review.
Supporting Documentation Requirements
All services require documentation to support the request. These include, but are not limited to:
- A recent W9 for the vendor or landlord receiving payment
- A bill, invoice and/or ledger indicating how much is due and/or past due
- Proof of income (most recent 60 days for all adults living in the household)
- Three (3) bids or estimated cost of the repair (as applicable)
- Lease agreement or proof of ownership (as applicable)
- Medical records or notes to support your qualifying health condition.
- A care or treatment plan from your provider or case manager.
- Evidence-based criteria, medical justification, or any additional documentation that the service or item will help your health outcomes.
- Health Risk Assessment
- Additional documentation or supporting information may be needed to determine the appropriateness of the service.
- All requests must have a signed attestation by the member, or submitter signature if attestation was received verbally, to share your personal health information for referrals and payment of services.
For questions or for more information, please reach out to flexspending@umpquahealth.com.
Helpful resources
General Criteria
All Flex requests must meet one of the following criteria:
- Improve health outcomes compared to a baseline and reduce health disparities among specified populations.
- Prevent avoidable hospital readmissions through a comprehensive program for hospital discharge.
- Improve patient safety, reduce medical errors, and lower infection and mortality rates.
- Implement, promote, and increase wellness and health activities.
- Support expenditures related to health information technology and meaningful use requirements necessary to accomplish the activities above that are set for the in 45 CFR 158.151 that promote clinic, community linkage and referral processes or support other activities as defined in 45 CFR 158.150.
- Social Determinates of Health and Equity (SDOH-E)
They must also meet all of the following:
- Likely improve health outcomes.
- Lack billing and encounter codes.
- Be health related.
- Be consistent with a care/treatment plan.
- Likely to be a cost-effective alternative.
- Have no other community resources are available.
Request Specific Criteria
- Please be sure to complete the gym membership section of the request form
- If the request is for a facility other than the YMCA, please provide rationale explaining the need for the alternative facility
- Initial request must be sent in by the provider/community partner and have medical notes to support the request
- Initial requests will only be approved in 3 month increments to ensure member is utilizing services
- For members to be approved for ongoing membership, they must utilize services at least 8 times/month
- Please be sure to complete the specific AC/Heating unit section of the request form
- These requests are primarily for members who are:
- 55 or older, or age 4 or younger, AND
- Living alone or socially isolated and has a condition that increases risk of a heat related illness (age 65 or older, morbid obesity, heart disease, diabetes, alcohol use disorder, Parkinson’s, disease, multiple sclerosis, history of certain brain injuries/tumors or spinal cord injuries, hyperthyroidism, asthma or COPD, use of a medication that cause temperature regulation interruption), OR
- Has a history of heat-related illness requiring treatment or hospitalization that home cooling/heating could have prevented
- Please be sure to complete the specific Temporary Housing section of the request form
- Submission must include a signed Temporary Housing Member Agreement by the member for hotel/motel requests
- The member must be engaged/speak with our Care Coordination team with before a request will be considered (this is to ensure that care plans are offered to ensure long-term support beyond the temporary placement is made)
- Stays will be approved for the shortest time necessary and will not exceed 3 months
- These services are prioritized for member who:
- Experiencing homelessness or a disruption in their housing
- Short-term housing needed for recovery after hospital discharge or a medical procedure
- Enrolled in the New Day or New Beginning programs
- Receiving a Direct Acting Antiviral (DAA) medication for the treatment of Hepatitis C
- The member must have already received their medication
- Has a valid ID (hotel requirement)
- Not previously broken rules outlined in the temporary housing agreement
60 day financial proof of income. Qualifying examples:
-
- DHS printout with current TANF benefits
- Pay stubs
- SSA/SSI award letters
- Child support print out
- Unemployment benefits print out
- Bank statements checking/savings
- A copy of the rental agreement (as applicable)
- Eviction notice/72 Hour Notice (as applicable)
- Property management/Landlord information (as applicable)
- W9
- Name
- Address
- Email address
- Phone number
