Oregon Health Plan. February Client handbook OHP 9035 LP (02/15)

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1 Oregon Health Plan Client handbook February 2015 OHP 9035 LP (02/15)

2 This document can be provided upon request in an alternate format for individuals with disabilities or in a language other than English for people with limited English skills. To request this publication in another format or language, contact Oregon Health Plan (OHP) Client Services at or 711 for TTY. De solicitarse, este documento se facilitará en otros formatos a personas con discapacidades o en otros idiomas aparte del inglés para las personas con un nivel limitado de inglés. Para solicitar este documento en otro formato o idioma, comuníquese con el Departamento de Atención a los Clientes del Plan de Salud de Oregon (OHP) al o al 711 (TTY, personas con problemas auditivos). Spanish По запросу, этот документ может быть предоставлен в альтернативном формате лицам с нарушениями функций или на другом (не английском) языке лицам с ограниченными навыками владения английским языком. Для того, чтобы запросить этот документ в другом формате или на другом языке, обращайтесь в отдел обслуживания клиентов программы Oregon Health Plan (OHP) по тел (телетайп: 711). Russian Tài liệu này khi được yêu cầu có thể được cung cấp trên một hình thức thay thế khác dành cho những người khuyết tật hoặc ngôn ngữ khác với Anh ngữ dành cho những người không thông thạo tiếng Anh. Để yêu cầu ấn bản này trên một hình thức hoặc ngôn ngữ khác, hãy liên lạc với Dịch Vụ Thân Chủ Chương Trình Y Tế Oregon (OHP) tại số điện thoại hoặc 711 dành cho TTY (điện thoại dành cho người điếc hoặc khuyết tật về phát âm). Vietnamese Haddii la codsado waxaa la helayaa dukumeentigan oo ah noocyo kale oo loogu talagalay dadka naafada ah ama ku qoran luqad aan ahayn af Ingiriiska iyadoo loogu talagalay dadka aan ku hadlin luqadda af Ingiriiska. Si aad u codsato daabacaadan oo qaab ama luqad kale ah, la xiriir Adeega Macmiilka Qorshaha Caafimaadka Oregon (OHP) ama 711 ee TTY. Somali يمكن تزويد ھذا المستند عند الطلب بتنسيق بديل لألفراد ذوي إعاقات أو بلغة أخرى غير اللغة اإلنجليزية لألشخاص ذوي مھارات محدودة في اللغة اإلنجليزية. لكي تطلب ھذا النموذج بتنسيق آخر أو لغة أخرى يجب عليك االتصال بقسم خدمات الزبائن لدى خطة أوريغون الصحية OHP) (Oregon Health Plan: على رقم الھاتف أو 711 لالتصال عبر المبرقة الكاتبة.(TTY) Arabic ဒ စ ရၾက စ တမ က မသန စၾမ သ တၾက တ ခ ပ စ တစ မ န ဖစ စ အဂ လ ပ စက က႗မ က င မႁ နည သ တၾက အဂ လ ပ မဟ တ တ တ ခ ဘ သ စက န ဖစ စ တ င ရင ရႎ င ပၝတယ ဒ ထ တ ဝခ က က တ ခ ပ စ တစ မ န ဖစ စ တ ခ ဘ သ စက န ဖစ စ တ င ဆ ဖ အတၾက အ ရ ဂၾန က န မ ရ အစ အစဥ (OHP) ဝန ဆ င မႁရယ သ မ အတၾက ဝန ဆ င မႁဌ နက မႀ ဒၝမႀမဟ တ TTY အတၾက 711 မႀ ဆက သၾယ ႎ င ပၝတယ Burmese 根 据 残 障 人 士 的 要 求, 我 们 可 以 提 供 本 文 件 的 其 他 格 式 版 本 ; 根 据 英 语 能 力 有 限 的 人 士 的 要 求, 我 们 可 以 提 供 本 文 件 的 非 英 文 版 本 如 需 本 刊 物 其 他 格 式 或 语 言 的 版 本, 请 致 电 或 711( 聋 哑 人 士 专 线 ), 联 系 俄 勒 冈 州 健 康 计 划 (OHP) 客 户 服 务 部 Simplified Chinese Ovaj dokument se na zahtjev može osigurati u alternativnim formatima za osobe s onesposobljenjem ili na jeziku koji nije engleski za osobe s ograničenom znanjem engleskog jezika. Da ovu publikaciju tražite u nekom drugom formatu ili na nekom drugom jeziku, obratite se na Potrošačke usluge Oregon Health Plana (OHP) na ili 711 za TTY. Bosnian ÉksarenHGacRtUv)aneKpþl;CUneTAtamsMeNIkñúgTMrg;epSgeTotsMrab;buKÁlEdlmanBikarPaB b CaPasaepSgeTot erkabipasagg;ekøs smrab;mnussnaedlminechganpasagg;ekøs. edim,iesñismukare)ahbum<enhcatmrg; b CaPasaepSg/ curtak;tgetaesvabmerismacik KeRmagsuxPaBrdæGUrihÁin (Oregon Health Plan - OHP) tamry³elx b 711 smrab; TTY. Cambodian ເອກະສານນ ສາມາດຈ ດຫາໃຫ ໄດ ຕາມການຮ ອງຂ ໂດຍຈ ດຫາໃຫ ໃນຮ ບແບບອ ນສ າລ ບບ ກຄ ນທ ພ ການ ຫ ໃນພາສາອ ນທ ບ ແມ ນພາສາອ ງກ ດສ າລ ບ ບ ກຄ ນທ ມ ຄວາມຊ ານານພາສາອ ງກ ດຈ າກ ດ. ຖ າຫາກຕ ອງການຮ ອງຂ ສ ງຕ ພ ມນ ໃນຮ ບແບບອ ນ ຫ ພາສາອ ນ, ຂ ໃຫ ຕ ດຕ ພະແນກບ ລ ການລ ກຄ າຂອງ Oregon Health Plan (OHP) ທ ເບ ໂທຣະສ ບ ຫ 711 ສ າລ ບສາຍໂທຣ TTY. Acest document poate fi oferit la cerere într-un format diferit pentru persoanele cu dizabilități, sau în altă limbă decât engleza pentru persoanele cu cunoștiințe limitate de engleză. Pentru a solicita această publicație în alt format sau limbă, vă rugăm contactați Serviciul pentru clienți al Planului Medical Oregon (OHP) la sau 711 pentru TTY. Romanian 按 殘 障 人 士 的 需 要, 我 們 可 以 向 其 提 供 本 文 件 的 其 他 格 式 版 本 ; 按 英 語 能 力 有 限 人 士 的 請 求, 我 們 亦 可 以 向 其 提 供 本 文 件 英 語 以 外 的 語 言 版 本 如 需 索 取 以 另 一 種 格 式 或 語 言 制 定 的 本 刊 物, 請 致 電 或 711( 聾 啞 人 士 專 線 ), 聯 絡 奧 勒 岡 州 健 康 計 劃 (OHP) 客 戶 服 務 部 Traditional Chinese Lao

3 Accessible services Do you have a disability that makes it hard for you to read printed material? Do you speak a language other than English? We can give you information in one of several ways: Large print Audio tape Braille Electronic format Oral presentation (face-to-face or on the phone) Sign language interpreter Translations in other languages Let us know what you need. Call OHP Customer Service at , TTY 711. Is access a problem? Do barriers in buildings or transportation make it hard for you to attend meetings? To get state services? We can move our services to a more accessible place. We can provide the type of transportation that works for you. You have a right to complain if: You keep getting DHS printed forms and notices, but you need them some other way, or Our programs are not accessible. The Governor s Advocacy Office 500 Summer St NE, E17 Salem, OR TTY Fax or send to US Dept of Health & Human Services Office for Civil Rights TTY 2201 Sixth Avenue, Mail Stop RX Fax Seattle, WA

4 Contents Welcome to the Oregon Health Plan... 1 What is the Oregon Health Plan?... 1 Benefit packages OHP Plus benefit package OHP Plus Supplemental benefit package OHP with Limited Drug benefit package Qualified Medicare Beneficiary (QMB) benefit package Citizen Alien-Waived Emergency Medical Assistance (CAWEM) benefit package CAWEM Plus benefit package... 6 Health care services... 7 Preventive services... 8 Medical services... 8 Second opinions... 9 Not covered and limited services Dental services include the following:...11 Mental health services include the following:...11 Chemical dependency or substance use disorder treatment...11 Outpatient treatment and medication treatment services...12 Residential treatment services...13 Stop smoking programs...13 i

5 Pregnancy care coverage Pregnant clients Newborn care coverage Family planning and related services Patient-Centered Primary Care Homes (PCPCHs) Medical transportation services...17 Transportation brokerages Oregon Health ID card Coverage Letter How to read the sample Coverage Letter Service delivery Fee-for-service Native rights hour health care advice Emergency medical care Urgent care Dental emergency and urgent care Oregon Health Plan Care Coordination services (OHPCC) Care away from home Travel outside of the United States Pharmacy Management Program OHP home-delivery pharmacy services Problems with health care services OHP client rights ii

6 OHP client responsibilities Managed care member rights and responsibilities Managed care member rights Managed care member responsibilities Managed care What are the benefits of managed care?...41 Types of managed care enrollment...41 Coordinated care organizations (CCOs) Primary care provider in a CCO, medical or dental plan Interpreter services Identification cards Special services Intensive Care Coordination Services (ICCS) and Exceptional Needs Care Coordinators (ENCC) Urgent care Emergencies and crises If you need care out-of-town Labor and delivery Newborn enrollment Getting a ride Child care Physician incentives Mental health services Mental health prescriptions ISA services for children s mental health treatment iii

7 Services on this page are offered only by CCOs Care helpers Involvement in CCO activities AMHI services for mental health treatment Culturally-sensitive health education...51 Problems with your health care services...51 How to change CCOs Disenrollment If you want to receive services as a fee-for-service client When to call your CCO or plan Requesting a copy of your records Your records are private Billing information If you get a bill If you were in the hospital and get bills from other providers Paying for medical services on OHP Co-payments More information Grievance, appeal and hearing rights How to make a complaint or grievance Notice of action How to appeal a decision If you need a fast appeal Provider appeals iv

8 How to get an administrative hearing Fast (expedited) hearings End-of-life decisions and advance directives (living wills) Declaration for Mental Health Treatment Health care professionals Who to call for help and other resources When to call Who to call OHP Client Services OHA Ombudsperson Division of Child Support Assignment of rights...71 Personal injury or accident liens...71 Personal Injury Liens Unit Domestic violence Notice of Privacy Practices Estate recovery How the program works...74 For care provided before October 1, Medicare Part D prescription drug coverage My OHP phone list Managed care enrollment My healthcare providers v

9 Welcome to the Oregon Health Plan The Oregon Health Plan (OHP) is a state program that provides health care coverage to low-income Oregonians. This booklet will help you understand: The different ways people receive care under OHP managed care and fee-for-service. How to read your Oregon Health Identification Card and Coverage Letter. Health care coverage under OHP. The benefit packages under OHP. How to use the health services that are covered under OHP. What you need to know about managed care, including coordinated care organizations (CCOs), under OHP. Keep this booklet, and the information you received from your CCO or managed care plan for answers to your questions about your health care coverage. What is the Oregon Health Plan? In Oregon, the Medicaid program is called the Oregon Health Plan (OHP). Medicaid is a health care program for low-income families that is paid for by both federal and state dollars. OHP covers doctor visits, prescriptions, hospital stays, dental care, mental health services, and help with addiction to tobacco, alcohol and drugs. OHP can provide hearing aids, medical equipment, home health care, and transportation to health care appointments. Helpful phone numbers: Page 1 Info for ALL OHP Clients

10 Info for ALL OHP Clients OHP does not cover all health care services. Oregon Health Plan clients receive services based on where health care conditions and treatments are placed on the Prioritized List of Health Services. The Prioritized List of Health Services is a list of health care conditions and their treatments, which are ranked in order of effectiveness. Diseases and conditions that are below the current line of coverage are usually not covered by OHP. However, something that is below the line may be covered if the patient also has an above the line condition that could get better if their below-the-line condition is also treated. The Prioritized List of Health Services is online at OHP covers reasonable services for finding out what s wrong. That includes diagnosing a condition that is below the coverage line. However, in most cases, once it s determined that a diagnosis or treatment is below the coverage line, OHP will not pay for any more services for that condition. Page 2 Helpful phone numbers:

11 Benefit packages The medical, dental or mental health services OHP covers for each client is called a benefit package. Each client receives a benefit package based on certain things, such as age or healthcare condition. Members of your household may receive different benefit packages. Benefit package information for each household member is found on page 2 of the Coverage Letter (see example on page 15). An explanation of each benefit package appears below. A quick reference chart on page 5 lists the benefits for each benefit package at a glance. Info for ALL OHP Clients 1. OHP Plus benefit package This is a comprehensive package of medical, dental, mental health and chemical dependency services. Services covered by OHP Plus are listed on the Benefit Packages chart on page 5. Co-payments Some OHP Plus adult clients are required to make copayments for outpatient services and prescription drugs. If you are enrolled in a CCO or managed care plan, you may not have to pay a co-payment. Amounts of OHP Plus co-payments are: $0 - $3 for prescription drugs (for each filled prescription). $3 for outpatient services (such as office visits to see a doctor, dentist or other health care provider). You do not have to make co-payments for treatments such as shots, lab tests or x-rays. You do not have to pay for emergency services. The co-payment is only for the visit to the provider. Helpful phone numbers: Page 3

12 Info for ALL OHP Clients You do not have to pay a co-payment for: Family planning services and supplies, such as birth control pills. Prescription drugs ordered through the OHP Home- Delivery Pharmacy Program. See page 20 for more information about this program. Emergency services. Lab tests, shots, durable medical equipment or x-rays. Services received from most CCOs or managed care plans. If you cannot pay If you cannot make a required co-payment, you will still receive the drug product or health care service; however, you will still owe a debt to the pharmacy or health care provider for the co-payment. 2. OHP Plus Supplemental benefit package This benefit package provides additional coverage to pregnant women. It expands vision and dental coverage to the same level that children and adults under the age of 21 receive. If you become pregnant, call OHP Customer Service at , TTY OHP with Limited Drug benefit package OHP Plus with Limited Drug is a comprehensive package of services that focuses on preventive care (page 6). Only the prescription drug coverage is limited. You receive this benefit package if you are eligible for both Medicaid and Medicare Part D. Page 4 Helpful phone numbers:

13 The OHP with Limited Drug package covers all the same medical, dental and mental health benefits as the OHP Plus package. However, this package does not cover prescription drugs that Medicare Part D pays for. OHP does pay for some other drugs that Medicare does not cover. Note: OHP will not pay for types of drugs that Medicare Part D would cover, even if you choose not to enroll in a Medicare drug plan. You will have to pay for them yourself. Co-payments You may have to make a co-payment for the outpatient services and prescription drugs. Co-payments are: $3 for outpatient services, such as office visits to see a doctor or other health care provider. You do not have to make co-payments for treatments such as shots, lab tests or x-rays. You do not have to pay for emergency services. The co-payment is only for the visit to the provider. $0 -- $3 prescription drugs, for each filled OHP prescription. Info for ALL OHP Clients If you are enrolled in a CCO or medical plan, you may not have to pay a co-payment. Different, mandatory co-payments of $1 to $6.50 apply to your Medicare Part D drugs. OHP does not pay Medicare premiums, deductibles or co-payments for Medicare Part D drug plans or services. Helpful phone numbers: Page 5

14 Info for ALL OHP Clients 4. Qualified Medicare Beneficiary (QMB) benefit package This program helps you if you are eligible to receive hospital benefits through Medicare. QMB clients have limited income but are not eligible for Medicaid. The state helps by paying for QMB clients Medicare premiums, deductibles and coinsurance. However, OHP does not pay for premiums or co-payments for Medicare Part D drug plans or services. If you have only QMB, your health care costs are paid for by Medicare, not by OHP. Clients may be eligible for more than one benefit package at once. For example, a person with QMB benefits may also be eligible for OHP with Limited Drug benefits. 5. Citizen Alien-Waived Emergency Medical Assistance (CAWEM) benefit package These clients are not citizens of the United States and do not have an immigration status that meets Medicaid requirements. Coverage is limited to emergency services. 6. CAWEM Plus benefit package This program helps pregnant women receiving CAWEM benefits by providing all OHP Plus benefits except sterilizations, therapeutic abortions, hospice services, and Death with Dignity services. Page 6 Helpful phone numbers:

15 Health care services The health services you may receive are based on your assigned benefit package. See page 2 on your Coverage Letter to find out what type of coverage you have. Benefit packages are defined on pages 2 through 4. The following chart shows what services are covered by benefit package. Your Oregon Health Plan benefits The chart below shows what benefits are available under your OHP coverage. Check with your provider or CCO to see if a specific service is covered. Info for ALL OHP Clients Benefits covered under: OHP Plus, OHP with Limited Drug and CAWEM Plus Chemical dependency Dental Basic services including cleaning, fluoride varnish, fillings and extractions Urgent or immediate treatment Crowns for pregnant women and children under age 21. Sealants, root canals on back teeth for children under age 21. Hearing aids and hearing aid exams Home health; private duty nursing Hospice care not covered for CAWEM Plus clients Hospital care Emergency treatment Inpatient and outpatient care Immunizations Labor and delivery Laboratory and X-rays Medical care from a physician, nurse practitioner or physician assistant Medical equipment and supplies Medical transportation Mental health Physical, occupational and speech therapy Prescription drugs OHP with Limited Drug only includes drugs that are not covered by Medicare Part D Vision Medical services Services to correct vision for pregnant women and children under age 21 Glasses are covered for pregnant adults and adults who have a qualifying medical condition such as aphakia or keratoconus, or after cataract surgery. Other benefit packages: CAWEM Covers emergency medical, emergency dental and emergency transport services. Qualified Medicare Beneficiary (QMB) Only covers Medicare premiums and copayments (except for Medicare Part D) and deductibles. DMAP 1418 (Rev 03/14) Helpful phone numbers: Page 7

16 Info for ALL OHP Clients Preventive services Preventing health problems before they happen is an important part of your care. Under OHP, you can get preventive services to help you stay healthy. Preventive services include check-ups and tests to find out what is wrong. You should talk with your provider about how often you should get check-ups. Other preventive services include the following: Immunizations (shots) for children and adults (not for foreign travel or employment purposes) Dental check-ups, exams and preventive dental care for children and adults Mammograms (breast x-rays) for women Maternity and newborn care Maternity management (special services to help you have a safe pregnancy) Pap smears Prostate screenings for men Routine physicals Well-child exams Medical services Services covered by OHP Plus, CAWEM Plus, and OHP with Limited Drug all include the following: 24-hour emergency care, x-ray, and lab services Page 8 Helpful phone numbers:

17 An exam or test (laboratory or x-ray) to find out what is wrong, whether the treatment for the condition is covered or not Chemical dependency (alcohol and drug) treatment Diabetic supplies and education Emergency ambulance Eye health care Family planning Hospice Labor, delivery and newborn care Medical equipment and supplies Mental health services Most prescription drugs Preventive services Treatment for most major diseases Some surgeries Specialist care and referrals Stop-smoking programs If you are in a CCO or managed care plan, you will need to get a referral from your provider to see a specialist. Second opinions Second opinions are a covered service. If you want a second opinion about your treatment options, ask your PCP to refer you for another opinion. If you are enrolled in managed care and want to see a provider outside of your CCO or plan s network, you or your provider will need to get your CCO s or plan s approval first. Info for ALL OHP Clients Helpful phone numbers: Page 9

18 Info for ALL OHP Clients Not covered and limited services OHP covers reasonable services for diagnosing conditions, including the office visit to find out what is wrong. However, once they know what is wrong, OHP may not cover followup visits if the condition or treatment is not funded on the Prioritized List of Health Services (see page 1). There are some services that are not covered even if treatment may be important. If you get a health care service that is not covered, you may have to pay the bill. Your provider will tell you if a service is not covered and what choices you have. For example, OHP does not pay for the following services: Treatment for conditions that get better on their own (such as colds or flu) Treatment for conditions for which home treatment works (such as sprains, allergies, corns, calluses or some skin conditions) Cosmetic surgeries or treatments Treatments that are not generally effective Services to help you get pregnant Weight loss programs Buy-ups. To buy up means you get an item that is not covered by OHP by paying the difference between the item OHP covers and a more expensive, non-covered item. For example, OHP may cover a basic pair of eyeglasses but the client may want a more expensive pair that is not covered by OHP. The client cannot buy up by paying the difference between the two. Page 10 Helpful phone numbers:

19 Some services have limits. Your provider can help answer your questions about limited services. Dental services include the following: Preventive services (cleanings, fluoride treatments, sealants for children) Routine services (fillings, x-rays) Dental check-ups Tooth removal Dentures 24-hour emergency care Specialist care and referrals Info for ALL OHP Clients Mental health services include the following: Evaluations and consultations Therapy Case management Medication management Hospitalization Emergency services Programs to help with daily and community living Chemical dependency or substance use disorder treatment The services you may receive are based on the benefit package you have been assigned to. Problems with alcohol or other drugs affect the whole family. You may need treatment if drinking alcohol or using other drugs causes Helpful phone numbers: Page 11

20 Info for ALL OHP Clients problems such as these in your life: Fighting with your loved ones Missing work Getting sick Having trouble with the law Identifying problems before they become worse will increase your chance of recovery. You do not need a referral to get help for problems with alcohol or drugs. You can go to: Any provider who will take your Oregon Health ID Your primary care provider. Outpatient treatment and medication treatment services OHP covers outpatient treatment and medication treatment, such as: Methadone Suboxone Buprenorphine Vivitrol Other medication services that help a person reduce the use of or abstain from alcohol or other drugs Some of the outpatient and residential treatment services are: Screening and assessment Acupuncture Detoxification Individual and group counseling Medication Page 12 Helpful phone numbers:

21 Family/couple counseling Physical examination Urine Analysis (UAs) Residential treatment services OHP covers residential treatment services including treatments provided in a 24-hour care facility, for both adults and youth. There are residential treatment facilities that allow parents to bring their young children to treatment with them. For more information on residential services, call the Oregon Partnership Alcohol and Drug HelpLine at: HELP (4357) or TEEN (8336) youth line for Spanish-speaking clients The Addictions and Mental Health Medicaid Policy Unit can also answer your questions about these types of services. Stop smoking programs OHP pays for services to help you stop smoking. Talk to your primary care provider for more information. Oregon Quit Line: English QUIT NOW ( ) Español: DEJELO-YA TTY Online Info for ALL OHP Clients Helpful phone numbers: Page 13

22 Info for ALL OHP Clients Pregnancy care coverage Pregnancy care is covered by OHP. If you become pregnant, call OHP Customer Service at , TTY 711, right away. They will make sure you do not lose medical coverage before your baby is born. You also need to call OHP Customer Service if a pregnancy ends. Pregnant clients: Receive services under OHP Plus or OHP with Limited Drug and the OHP Plus Supplemental benefit package. Are not charged co-payments. If you are pregnant, or think you might be, it is important that you see a health care provider right away. Remember! Regular check-ups are important to have a healthy baby. Keep your appointments and follow your provider s advice. Alcohol and drugs taken before or during pregnancy can harm your unborn baby. If you need help for alcohol and drug use, talk to your provider. Now is a good time to stop smoking cigarettes. Smoking during pregnancy can harm your baby. Talk to your provider to find out ways he or she can help you quit. If you need a specialist for your pregnancy care, your provider can refer you to one. Your provider can give you vitamins that will keep your baby healthy during your pregnancy and help prevent birth defects. Page 14 Helpful phone numbers:

23 Newborn care coverage Call OHP Customer Service at , TTY 711 as soon as you can after your baby is born within two weeks is good. Your baby has medical coverage until his or her first birthday, even if you are no longer eligible for OHP. You will receive a new OHP Coverage Letter listing your baby and an OHP Health ID card for your baby. Call OHP Customer Service if you do not receive these. When you call OHP Customer Service, give the following information about your baby, and your baby s parents: Date of birth Name Sex Social Security number (or call again as soon as your baby gets one) Your primary care provider Family planning and related services The following family planning and related services are available to women, men and teens: Family planning visits (physical exam and contraceptive education) Contraceptive supplies, such as oral contraceptives and condoms Sterilization services (tubal ligations and vasectomies) Info for ALL OHP Clients Helpful phone numbers: Page 15

24 Info for ALL OHP Clients Related services include the following: Pap smear Pregnancy test Screenings for sexually transmitted diseases (STDs) Abortions Testing and counseling for AIDS and HIV Even if you re in a CCO or managed care plan, you can go to any one of the following places to receive family planning services: A county health department; A family planning clinic; Any provider who will take your Oregon Health ID. There is no co-payment for any of the family planning and related services or supplies. Patient-Centered Primary Care Homes (PCPCHs) We want you to get the best care possible. One way we try to do that is ask our providers to be recognized by OHA as a patient-centered primary care home (PCPCH). PCPCHs receive extra funds to follow their patients closely and make sure all their medical and mental health needs are met. You can ask at your clinic or provider s office if it is a PCPCH. Page 16 Helpful phone numbers:

25 Medical transportation services Keeping your health care appointments is important. If you do not have your own transportation, you might: Take the bus Ask a friend or relative to drive you Find a volunteer from a community service agency Call the transportation brokerage call center that serves OHP clients free of charge in your county. Transportation brokerages are listed on page 18. In some cases, you may be reimbursed for medical transportation expenses including gas, meals and lodging. You need to get approval for transportation reimbursement before you go to your health care appointment. To get approval: Contact your DHS/AAA branch office or OHP Customer Service if you live in one of the following counties and are not enrolled in Willamette Valley Community Health: Marion Polk Yamhill For all other counties, and Willamette Valley Community Health members, contact the transportation brokerage listed on the chart on the following page. Info for ALL OHP Clients Helpful phone numbers: Page 17

26 Info for ALL OHP Clients Transportation brokerages Call a brokerage in your county to ask for rides to appointments for OHP-approved services. In most areas, you can also ask them to approve and reimburse your medical transportation costs. For TTY/Relay Service, dial 711. If you live in a county marked with an asterisk (*), you will need to contact the following about reimbursement: Yamhill County, and non-willamette Valley Community Health (WVCH) members in Marion and Polk counties: Contact your local DHS/AAA office or OHP Customer Service ( ). Counties served Crook Deschutes Jefferson Benton Linn Lincoln Clackamas Multnomah Washington Curry Jackson Douglas Josephine Brokerage Cascades West Ride Line Central Oregon Intergovernmental Council Phone: Toll-free: Cascades West Ride Line Cascades West Council of Governments Phone: Toll-free: Ride to Care (for Family Care and Health Share of Oregon members only): Access2Care Toll-free: Tri-County MedLink (for all other members) Toll-free: Ready Ride (for AllCare members only) Toll-free: Page 18 Helpful phone numbers:

Let us know what you need. Call OHP Customer Service at 1-800-699-9075, TTY 711.

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