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HRSN Providers

Health-Related Social Needs (HRSN) providers are organizations that will provide HRSN services in a way that is culturally and linguistically appropriate, responsive and trauma-informed. All contracted HRSN providers must meet certain provider qualifications.


HRSN providers must have the ability to participate in closed-loop referrals. "Closed-loop referral" means the process of exchanging information between and among CCO, FFS Program, OHA, a Member, HRSN Service Providers, and other similar organizations, to make referrals and communicate about the status of referrals for a Member.

In addition, HRSN providers must meet these minimum qualification requirements:

Demonstrate the capacity and experience to provide HRSN services as described below:

  1. Housing services providers must have knowledge of principles, methods, and procedures of housing services covered under the waiver, or comparable services meant to support individuals in obtaining and maintaining stable housing.
  2. Nutrition services providers must have knowledge of principles, methods, and procedures of the nutrition services covered under the waiver, or comparable services meant to support an individual in obtaining food security and meeting their nutritional needs. Nutrition service providers must follow best practice guidelines and industry standards for food safety.
  3. HRSN outreach and engagement and benefit linkages providers must have knowledge of principles, methods, and procedures of these services or comparable services meant to outreach to and engage the populations covered under the waiver and connect them to benefits and services to meet their needs.
  4. Providers of medically necessary home devices during significant weather events (e.g., ACs during heat waves) must have knowledge and experience in providing such devices during significant weather events, including the ability to store devices and distribute them prior to or during the event so that members have access to the devices when they need them most (i.e., while the event is taking place)
  5. Providers of medically necessary devices at times other than during significant weather events must have the ability to timely and appropriately deliver devices to members’ homes.
  6. HRSN Provider Experience and Expertise: All HRSN services providers are expected to meet certain qualifications that ensure they are capable of providing high-quality services to qualifying members as well as have culturally specific expertise to connect with members of priority populations. Qualifications may include, for example:

a. Maintain sufficient hours of operation and staffing to serve the needs of HRSN participants.

b. Demonstrate their capabilities and/or experience with effectively serving at least one “priority population,” as determined by the state. HRSN Providers may demonstrate these capabilities and/or experience through, for example:

1 Providing letter(s) of support from community members being served or other entities in the community, describing the HRSN Provider’s presence in the community and impact on individual community members and/or the community as a whole.

2 Submitting an annual report or similar document that describes the HRSN Provider’s relevant capabilities and activities.

3 Other methods deemed appropriate by the CCO or FFSTPC.

4 Demonstrate that it has qualified service delivery and administrative staff, as determined at CCO or FFS TPC discretion.

c. The ability to comply with applicable federal and state laws.

d. The capacity to provide culturally and linguistically appropriate, responsive and trauma-informed service delivery, including by ensuring their ability to:

1 Adhere to federal and state laws and requirements related to ensuring communication and delivery of services to Members with diverse cultural and ethnic backgrounds

2 Meet cultural needs of the community for whom it provides services

3 Provide documentation of how cultural responsiveness and trauma informed care trainings are impacting organizational policies and staff practices

4 Document efforts to recruit and employ staff who reflect the HRSN Provider’s region’s Medicaid population, including individuals with similar demographics, lived experience, background and language fluency to the greatest extent possible.

e. A history of responsible financial stewardship and integrity via a CCO-conducted audit and/or recent annual financial reports.

To receive HRSN services, members must meet the following criteria:

  • One Clinical Risk Factor 
    • Complex behavorial health neeed
    • Developmental disability need
    • Complex physical health need
    • Need for assistance for ADLs / IALDS or eligible for LTSS
    • Interpersonal violoence experience
    • Adults 65 years of age or older
    • Repeated emergency department use and crisis encounters
    • Pregnant/postpartum
    • Young adults with special healthcare needs
  • One Social Risk Factor
    • Housing-related needs
    • Nutrition-related needs
    • HRSN device needs

HRSN climate-related supports launched March 1, 2024. For more information, visit the Oregon Health Plan Climate Support webpage

Trillium has partnered with Unite Us, also called Connect Oregon, to help members access HRSN benefits through closed-loop referrals. Through this platform, providers can:

  • Send HRSN requests as closed-loop referrals to Trillium
  • Receive referrals from Trillium to fulfill HRSN contracted services
  • Submit invoices to Trillium for HRSN services provided to receive reimbursement
  • Support clients in submitting a self-referral to request HRSN services

Providers who do not use the Unite Us platform may submit closed-loop referrals via the following options:


Please submit your invoices to Trillium for HRSN services using one of the following methods:

  • Submit invoices and supporting documentation through the Unite Us Platform.
  • Submit invoices and supporting documentation via email  to Trillium's Finance team.  

Fee Schedules

HRSN climate-related supports launched March 1, 2024. View the HRSN Devices Fee Schedule (PDF)