Community Health 360
Oregon HRSN Billing Requirements for CBOs: A Complete Guide for 2026
If your organization is delivering housing, nutrition, or outreach services to Oregon Health Plan (OHP) members in 2026, you are likely operating inside Oregon's Health-Related Social Needs (HRSN) framework, whether you know it fully or not. Getting reimbursed for that work requires understanding a billing system that most CBOs were never trained on. This guide walks through eligibility, documentation, billing codes, and closed-loop referral requirements so your team gets every dollar it has earned.
What Is HRSN in Oregon Medicaid?
HRSN stands for Health-Related Social Needs. In Oregon, HRSN services are covered benefits under the Oregon Health Plan that address housing, nutrition, and outreach needs for eligible members during times of instability or transition. Oregon received federal CMS approval in September 2022 to implement HRSN services as part of the OHP 2022–2027 1115 Medicaid Demonstration Waiver. Coordinated Care Organizations (CCOs) are required to provide these services to eligible members enrolled in CCO-A or CCO-B plans.
Why Oregon HRSN Billing Matters More in 2026
Oregon's HRSN program expanded significantly, with clinical risk factor criteria updated as of January 1, 2026. That means eligibility criteria your team relied on last year may have changed, and claims submitted without updated documentation could be denied.
Beyond the rule changes, CMS is pushing all Medicaid states toward standardized Z-code reporting and mandatory social screening. Oregon is ahead of that curve, which means CBOs operating here are navigating a billing environment that is more demanding but also more reimbursable than anywhere else in the country. If your team is not billing correctly today, you are leaving money on the table that your community has already earned.
Who Qualifies for HRSN Services in Oregon?
Not every OHP member is eligible. A member must meet all five of the following criteria:
- Be enrolled in OHP (excluding Temporary Medicaid Expansion, OHP Bridge Basic Health Program, or OHP Bridge Basic Medicaid)
- Belong to a qualifying HRSN Covered Population
- Have a qualifying clinical risk factor
- Have a qualifying social risk factor
- Meet any service-specific eligibility criteria
HRSN Covered Populations include adults and youth discharged from a behavioral health facility in the past 12 months, individuals released from incarceration, people currently or previously in the Oregon child welfare system, individuals transitioning to dual-eligible status, people who are homeless or at risk of homelessness, and young adults with special health care needs (YSHCN).
Each HRSN service has its own specific eligibility criteria. Not all covered populations qualify for all services. For example, only individuals at risk of homelessness qualify for rent and utility financial assistance. Always confirm service-specific criteria before delivering and documenting services.
How Does Oregon HRSN Billing Actually Work?
How do HRSN service providers submit claims in Oregon?
HRSN service providers do not submit claims directly to OHA. They submit invoices to the CCO, and the CCO creates and submits encounters to OHA for payment. If the member is on Open Card (not enrolled in a CCO), the provider is paid directly by OHA.
This distinction matters: your documentation and invoicing needs to satisfy the CCO's requirements first. If your documentation does not match what the CCO needs to submit a clean encounter to OHA, your invoice will sit unpaid with no clear indication of why.
What HCPCS codes apply to Oregon HRSN services?
Oregon uses procedure codes with modifier stacking for HRSN billing. The core modifier to know is U1, the HRSN program modifier that must be included on every HRSN service claim.
Additional modifiers are stacked based on service type:
- CCO Variable Admin for Housing Services: U9 as the primary modifier and U1 as the secondary modifier
- Home Modifications: UB as the primary modifier and U1 as the secondary modifier
- Monthly rent assistance: procedure code H0044 (Supported housing, per month) with the appropriate modifier
The full HRSN fee schedule is maintained on the OHA HRSN Provider web page and updated as the program evolves. Always pull the current version before submitting claims.
How are units and time billed for HRSN services?
Services are billed in 15-minute increments following industry standard timed-code practices. At least 8 minutes must be spent with the member to bill one unit. Two units require at least 23 minutes. This 8-minute rule applies across outreach and engagement services, tenancy services, and device installation.
Documentation Requirements
For each HRSN service delivered, your record must capture:
- Date the service was provided
- Description: which specific activity was performed, mapped to OAR 410-120-2005 tables
- Outcome: what happened as a result (HRSN request sent, member connected to housing resource, paperwork completed)
Incomplete documentation is the single most common reason HRSN claims are denied or go unbilled. The service may have happened. If the record does not show it to the CCO's standard, it did not happen as far as the billing system is concerned.
The Closed-Loop Referral Requirement
Oregon's guidance explicitly requires closed-loop referrals for HRSN services. A referral is not complete when you send it. It is complete when you confirm the member received or connected to the service.
CCOs are required to use technology to support closed-loop referrals, and members have the right to opt out of technology-based tracking. The phased approach means some CCOs are further along than others, but the documentation expectation is consistent: your system needs to show the loop was closed, not just opened.
This is where most CBOs lose reimbursable claims, not because the service was not delivered, but because the referral was never confirmed and the documentation trail ends at the send.
How CH360 Helps
CH360 is built for exactly this kind of documentation and billing challenge. Our platform maps your service delivery to the correct HRSN codes and modifiers, tracks closed-loop referral status in real time, and generates the documentation your CCO needs to submit a clean encounter to OHA — so your team spends time serving members, not chasing paperwork.
Learn how CH360 supports HRSN providers at communityhealth360.com/advantage and see which funders recognize CH360's reporting standards at communityhealth360.com/funder-coverage.
Sources: OHA HRSN CCO Guidance Document, December 2025 (oregon.gov) · OHA HRSN CCO Billing Guide, November 2025 (oregon.gov)