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 (OAR 410-141-3500, 410-141-3845, 45 CFR 158.150, 45 CFR 158.151).

  • These requests can be sent to UHA using Connect Oregon’s referral platform Unite Us. Connect Oregon is a coordinated care network of health and social service organizations. If you would like access to the Unite Us platform, please check out our Connect Oregon Flyer and/or visit
  • For users that do not yet have access to Unite Us, please fill out the Health-Related Services – Flexible Spending form (Click here for the Spanish version) as well as the Health Risk Assessment for this request to be reviewed. These have been combined for you. This form can be faxed to 541-677-5881, emailed to , mailed or hand delivered to 3031 SE Stephens St. Roseburg, OR 97470, ATTN: Utilization Management – Flexible Spending.
  • All requests will be processed in 5-10 business days. For urgent requests (requests in which the standard timeframe could seriously jeopardize the member’s life, health, or ability to attain, maintain, or regain maximum function will be completed and notice will be provided as expeditiously as the member’s health condition requires and no later than 72 hours). These requests will require intake from our Care Coordination team at 541-229-4842.
  • If the request is for services being provided by independent vendor/provider, they must include a W9 to make the payment (if one is not already on file).
  • Both clinical (providers, primary care teams, specialists, and other health care providers) and non-clinical (i.e. care coordinators, patient navigators, community health workers, community partners, members or representatives)  may initiate a flexible services request for a member at any time. Documentation and/or supporting notes (chart notes, treatment plans, etc.) may be required to determine appropriateness of need depending on the service/item being requested. If this is not submitted with the original request, UHA may work with the member and/or care team to obtain the needing information to make the request valid.

For questions, please reach out to For more information, see our Provider Newsletter and Member Newsletter.

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

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