C3CAP - Service Guide

c3cap@

503-345-6732



C3CAP - Service Guide

__________________________________________________________________________________________

Directions: This guide outlines the available vendors, services and the appropriate workflow for submitting a Service Request.

-Order Online indicates that the service must be ordered online through the designated Website and recorded in Clara.

-Website indicates the appropriate website that should be used in addition to tracking your request in Clara.

-Pend indicates that the service or vendor will automatically pend once submitted in Clara. C3CAP will need to approve and/or take action to complete this Service Request.

-Print indicates that the voucher generated by Clara should be printed and presented at the time of scheduling or using the service.

-Special Instructions highlight any additional information you may need.

If you ever have any questions, please feel free to call the C3CAP team. We are happy to help.

Medicaid Flex Spending

Categories

Services

Vendors

Order

Online

Website

Pend

Print

Voucher

Special Instructions

1. Training/education for health

improvement or management (e.g. class

on healthy meal preparation or diabetes

self-management curriculum)

Chronic Disease

Management &

Prevention

Project Access NOW

No

-

Yes

No

-

2. Self-help or support group activities

(e.g. post-partum depression programs,

Weight Watchers groups)

Self Help/Support

Project Access NOW

No

-

Yes

No

-

Linguava

No

-

No

No

-

3. Care coordination, navigation, or case

management activities (not covered under

Interpretation

State Plan benefits, e.g. high utilizer

intervention program)

Clothing/Shoes

Durable Medical

Equipment

Home Equipment &

Supplies

4. Home/living environment items or

Oral Hygiene

improvements (non-DME items to improve

mobility, access, hygiene, or other

improvements to address a particular

health condition, e.g. air conditioner,

athletic shoes or other special clothing)

Target

Yes



Yes

No

You will be creating a wishlist of

items that will be used by C3CAP to

purchase. Detailed instructions are

in Clara.

Beaverton Pharmacy DME

No

-

No

Yes

Please fax this voucher to the

vendor when requesting service.

Lincare Holdings

Norco Medical Portland

No

No

-

No

No

Yes

Yes

-

Home Depot

Yes



No

No

You will be purchasing items on

behalf of your client. Purchasing

instructions are in Clara.

Lowes

Yes



No

No

You will be purchasing items on

behalf of your client. Purchasing

instructions are in Clara.

Amazon

Yes

smile.

Yes

No

Target

Yes



Yes

No

Amazon

Yes

smile.

Yes

No

You will be creating a wishlist of

items that will be used by C3CAP to

purchase. Detailed instructions are

in Clara.

No

You will be creating a wishlist of

items that will be used by C3CAP to

purchase. Detailed instructions are

in Clara.

No

You will be creating a wishlist of

items that will be used by C3CAP to

purchase. Detailed instructions are

in Clara.

No

You will be creating a wishlist of

items that will be used by C3CAP to

purchase. Detailed instructions are

in Clara.

Sensory Items

Target

Yes

Amazon

Yes



smile.

Yes

Yes

Supplies

Target

5/10/2016

Yes

1/4



Yes

You will be creating a wishlist of

items that will be used by C3CAP to

purchase. Detailed instructions are

in Clara.

You will be creating a wishlist of

items that will be used by C3CAP to

purchase. Detailed instructions are

in Clara.

v.0.0.5

c3cap@

503-345-6732



C3CAP - Service Guide

__________________________________________________________________________________________

Medicaid Flex Spending

Categories

Services

Ambulance

Wheelchair/Gurney

Vendors

Order

Online

Website

Pend

Print

Voucher

Special Instructions

American Medical Response

Northwest

No

-

No

Yes

-

B&R Medical Transport

No

-

No

Yes

-

Community Ambulance

No

-

No

Yes

-

Metro West

No

-

No

Yes

-

B&R Medical Transport

No

-

No

Yes

-

Mobile Care, WC and Gurney

No

-

No

Yes

-

Net Care

No

-

No

Yes

-

No

Super Users can order passes for

their department at . All

users should record distribution to

clients in Clara.

Canby Area Transit

Local bus ride

Yes



No

Columbia Area Transit

Yes



No

No

Columbia County Rider

Yes



No

No

The Wave/Tillamook Bus

No

-

No

Yes

-

Trimet

Yes



No

No

Super Users can order passes for

their department at . All

users should record distribution to

clients in Clara.

Green Shuttle for Wheelchairs

No

-

No

Yes

Wheelchair must be between 26"

(standard size) and 32" wide.

Paratransit

5. Transportation not covered under State

Plan benefits (such as transportation to a

medical appointment)

Secure

Transportation

Taxi Cab Services

Air Fare

Gas cards

Greyhound Bus

Long Distance Bus

Ride

Train Ride

5/10/2016

Super Users can order passes for

their department at . All

users should record distribution to

clients in Clara.

Super Users can order passes for

their department at . All

users should record distribution to

clients in Clara.

Trimet Lift

Yes



No

No

Clients must apply and be approved

by Trimet to use this service.

Following approval, Trimet passes

can be used for fare.

Mountain Retreat

No

-

No

Yes

-

NW Regional Secure Transport

No

-

No

Yes

-

Secure Transport

No

-

No

Yes

-

Advance Taxi

No

-

No

Yes

-

Broadway Cab

No

-

No

Yes

-

Care More Cab

No

-

No

Yes

-

Diamond Cab Company

No

-

No

Yes

-

Gorge Yellow Cab

No

-

No

Yes

-

Green Transportation

No

-

No

Yes

-

Metro Medical Taxi

No

-

No

Yes

-

Radio Cab

No

-

No

Yes

-

Willamette Valley Transport

No

-

No

Yes

-

Project Access NOW

No

-

Yes

No

C3CAP will purchase ticket and

email to you.

Yes

Record car's model, make, year, and

milage in Clara. C3CAP will mail the

card to the designated mailing

address.

Yes

Use website to plan trip. Record

details in Clara. C3CAP will

purchase ticket and provide you with

a confirmation number and if the

client does not have valid id - a

password. Please record this

information on the voucher and give

to client.

Shell

No

Greyhound

Yes

-



Yes

Yes

The Point

Yes



Yes

No

Use website to plan trip. Record

details in Clara. C3CAP will

purchase ticket and email to you.

Amtrak

Yes

home

Yes

No

Use website to plan trip. Record

details in Clara. C3CAP will

purchase ticket and email to you.

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v.0.0.5

c3cap@

503-345-6732



C3CAP - Service Guide

__________________________________________________________________________________________

Medicaid Flex Spending

Categories

Services

Cleaning

Vendors

Order

Online

Website

Pend

Print

Voucher

Special Instructions

Helping Hand Cleaners

No

-

No

Yes

Please fax this voucher to the

vendor when requesting service.

Home Depot

Yes



No

No

You will be purchasing items on

behalf of your client. Purchasing

instructions are in Clara.

Lowes

Yes



No

No

You will be purchasing items on

behalf of your client. Purchasing

instructions are in Clara.

Helping Hands Home Care

No

-

No

Yes

Please fax this voucher to the

vendor when requesting service.

6th Avenue Motel

No

-

No

Yes

-

Beaverton Budget Inn

No

-

No

Yes

-

Best Western Newberg Inn

No

-

No

Yes

-

Best Western Sandy Inn

No

-

No

Yes

-

Budget Lodge/Milwaukie Inn

No

-

No

Yes

-

Cascade Inn

No

-

No

Yes

-

Days Inn Clackamas

No

-

No

Yes

-

Days Inn Portland

No

-

No

Yes

-

Eastside Lodge Portland

No

-

No

Yes

-

Econo Lodge - Hillsboro

No

-

No

Yes

-

No

-

No

Yes

-

No

-

No

Yes

-

No

-

No

Yes

-

No

-

No

Yes

-

No

-

No

Yes

-

Extended Stay America - Tigard

No

-

No

Yes

-

Golden Knight

No

-

No

Yes

-

Holiday Motel

No

-

No

Yes

-

Lone Pine Motel

No

-

No

Yes

-

Motel 6 - Clackamas

No

-

No

Yes

-

Prater's Motel

No

-

No

Yes

-

Ranch Inn

No

-

No

Yes

-

Shilo Inn - Beaverton

No

-

No

Yes

-

Shilo Inn - Newberg

No

-

No

Yes

-

Shilo Inn Eastside

No

-

No

Yes

-

Sunset Motel

No

-

No

Yes

-

Travelodge

No

-

No

Yes

-

Vagabond Lodge Hood River

No

-

No

Yes

-

Viking Motel

No

-

No

Yes

-

Helping Hand Cleaners

No

-

No

Yes

Please fax this voucher to the

vendor when requesting service.

Fairhaven House 4 - Men's

Home Beaverton

No

-

No

Yes

-

Home Repairs

Home

Support/Services

7. Housing supports related to social

determinates of health (e.g. shelter,

utilities, critical repairs)

Hotel/Motel

Muck out

5/10/2016

Econo Lodge Southeast Milwaukie

Extended Stay America Beaverton

Extended Stay America Beaverton Eider Ct.

Extended Stay America Gresham

Extended Stay America Hillsboro

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v.0.0.5

c3cap@

503-345-6732



C3CAP - Service Guide

__________________________________________________________________________________________

Medicaid Flex Spending

Categories

Services

Vendors

Order

Online

Website

Pend

Print

Voucher

Special Instructions

Fairhaven House 5-Women and

Children's Home

No

-

No

Yes

-

Fairhaven House 6-Men's Home

Portland SE 150th

No

-

No

Yes

-

Fairhaven House 7 Scappoose

No

-

No

Yes

-

No

-

No

Yes

-

No

-

No

Yes

-

Fresh Start Recovery Homes

No

-

No

Yes

-

House of Hope

No

-

No

Yes

-

Just Us Recovery Homes

No

-

No

Yes

-

Transitions for Women

No

-

No

Yes

-

Fairhaven House 8-Men's Home

Beaverton

Fairhaven House 9-Men's Home

Tigard

Recovery Housing

Program (Clean

and Sober)

7. Housing supports related to social

determinates of health (e.g. shelter,

utilities, critical repairs)

-

No

Yes

-

No

-

No

Yes

-

Fairhaven House 11-Men's

Home-Portland SW Delmont

No

-

No

Yes

-

Fairhaven House 1-Men's Home

Portland

No

-

No

Yes

-

Fairhaven House 2-Mens Home

Beaverton

No

-

No

Yes

-

Fairhaven House 3-Women's

Home Beaverton

No

-

No

Yes

-

Shelter

City Team Ministries

Yes



No

No

Supportive Moving

and Hauling

Services

All-American Moving

No

-

No

Yes

-

Supportive Services Moving of

Oregon

No

-

No

Yes

-

Project Access NOW

No

-

Yes

No

Be prepared to provide detailed

payment information when

submitting this request.

No

Vendor will perform an intake

interview prior to acceptance into the

program. Please complete this

request once the client has been

accepted.

No

Please provide copies of bills,

invoices or notices with the

appropriate account information to

facilitate payment.

No

Vendor will perform an intake

interview prior to acceptance into the

program. Please complete this

request once the client has been

accepted.

Respite

Utility Assistance

Recuperative Care

Program

8. Assistance with food, or social

resources (e.g. supplemental food, referral Food Delivery

to job training or social services)

5/10/2016

No

Super Users can order passes for

their department at . All

users should record distribution to

clients in Clara.

Rental Assistance

9. Other (describe)

Fairhaven for Women

Fairhaven House 10-Men's

Home Vancouver

HARP

No

Project Access NOW

No

Central City Concern

No

-

-

-

Yes

Yes

Yes

Amazon

Yes

smile.

Yes

No

Cell Phone

Project Access NOW

No

-

Yes

Yes

Other Assistance

Project Access NOW

No

-

Yes

No

Visa Gift Cards

Project Access NOW

No

-

Yes

Yes

4/4

You will be creating a wishlist of

items that will be used by C3CAP to

purchase. Detailed instructions are

in Clara.

C3CAP will purchase a cell phone or

minutes and send to the designated

address.

Select Other Assistance when

another vendor does not meet your

needs. Contact C3CAP to make

payment arrangements.

C3CAP will mail the card to the

designated mailing address.

v.0.0.5

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