Health Related Services:
Flexible Funding "Flex Fund" Services Request

Flexible Services:

These services are provided instead of, or in addition to, CCO covered Oregon Health Plan benefits and are intended to:

• - Improve health quality and member health outcome (physical, oral, or behavioral health conditions)
• - Reduce health disparities among specific populations
• - Prevent avoidable hospital readmissions, improve patient safety, lower infection, and mortality rates
• - Be consistent with member’s treatment / care plan
• - Be used as a “payor of last resort“ - all available resources must be exhausted prior to request of CCO funds

Eligibility:

To be considered for Flex Funds:

• - The member must be enrolled in Advanced Health.
• - The request must NOT be for an item that is a billable service or item (exceptions may be considered such as replacement dentures prior to eligibility for new ones, certain DME supplies or products after denial and appeal process)

Who Can Request Flex Funds:

All requests must come from the member’s care team, which includes:

• - Primary Care Providers and Clinics
• - Specialists
• - Surgeons
• - Behavioral Health Providers
• - Dental Providers
• - Hospital Discharge Planners or Case Managers
• - Community Case Managers
• - Ancillary providers (PT/OT/Speech)
• - Advanced Health designated staff (ICC, CS Manager)
• - Members

**Members without a care team can reach out to customer service for assistance.

Timeline and Process:

Urgent Requests: CCO Flex Fund Services are NOT available as emergency or crisis funding. Urgent requests will be reviewed within 3 days. The CCO will decide if a request is urgent. Please try to send requests at least two business days before the funding is needed. Requests sent later may not be approved in time.

Requests: All requests under $1,000 will be reviewed for a decision within 10 business days of submission. This timeframe will not begin until the flex fund department has received all required paperwork. An extension may be necessary in certain cases where additional information or subject matter experts are needed.

Requests over $1,000: Items over $1,000 will require executive committee review and may require an extended review time and/or additional documentation requests.
**This committee meets weekly to review requests.

To check the status of a request, requestor can reach out to Advanced Health Flex Fund Coordinator at flexfund@advancedhealth.com. Please allow up to 10 business days for your request to be reviewed before asking for a status update.

Process:

• - Requestor submits a completed* request for flex funds through the flex fund portal located on the Advanced Health website. A care plan, recent chart notes (within 3 months) and all required supporting documentation need to be attached; if required documents are not attached, the request will be rejected.
• - Requestor may suggest a vendor or item for use to fulfill the request, however please note that the vendor or item is not guaranteed. We reserve the right to select a different vendor or item. *Please provide a link to any suggested items.
• - Requestor is responsible for arranging all delivery arrangements with the member.
• - Advanced Health teams will review request for eligibility and determination
• - You will be notified via the Advanced Health Flex Fund Coordinator on the decision for your item
• - If an item is not approved, the member will be mailed a notice informing them.

*It is the requestor's responsibility to coordinate with the member to ensure all supporting required documentation is turned in with the request. Incomplete requests will be rejected and not be reviewed for funding.

Incomplete Forms:

Any incomplete form will not be reviewed for funding. Some examples of incomplete forms are, but not limited to:

• - A Care Plan or chart notes are not attached to the request
• - Required values/fields in form are left blank
• - Alternative and/or community resources have not been pursued first
• - Item/service requested was not adequately relevant to member’s diagnosis and treatment plan
• - There was not enough information provided about sustainability for member’s immediate need
• - The item/service has an approved OHP or CMS billing procedure code (some exception, see above)
• - The member was not enrolled in Advanced Health

List of Examples and Category of Items That Have Been Covered:

If you have questions, call Member Services at 541-269-7400