Oregon Health Authority (OHA) expectations for Health-Related Social Needs (HRSN) service transitions for Healthier Oregon members

REQUIREMENTS: By November 19, 2026: Billing and authorization teams must establish internal tracking systems to identify and process all complete HRSN requests received on or before this date. These requests MUST receive authorization decisions and, if approved, at least one month of service delivery must begin before December 31, 2026. Do not issue Notices of Adverse Benefit Determinations (NOABDs) for approved services—instead, communicate to affected Healthier Oregon members that OHP Open Card will cover and coordinate HRSN services starting January 1, 2027. By December 4, 2026: Billing team must cease issuing service authorization extensions unless the member explicitly requests one. Update authorization protocols to reflect this cutoff date. By December 17, 2026: Complete all authorization decisions and referrals for requests received between November 20 and December 17. If an Open Card-enrolled HRSN provider cannot be identified, send authorization information to Acentra immediately and notify the member that OHP Open Card will complete the referral. By December 31, 2026: For requests received between December 18-31, make best-effort eligibility screening and authorization decisions. If unable to complete, refer incomplete requests to Acentra and inform members that OHP Open Card will make the authorization decision. For truly incomplete requests not resolved by this date, notify members and encourage them to submit requests directly to Acentra. After January 1, 2027: All HRSN service authorizations, referrals, and coordination transfer to Acentra (OHP Open Card). Billing team should coordinate with Acentra for any member service continuation questions. ONGOING: Monitor OHA's monthly list of HRSN service providers enrolled to serve Open Card members (provided by OHA). Participate in technical assistance calls if your CCO is identified as having HRSN backlogs.