Web Content Viewer
Actions

OhioRISE (Resilience through Integrated Systems and Excellence)

OhioRISE (Resilience through Integrated Systems and Excellence)

As a part Ohio Medicaid’s effort to launch the next generation of its managed care program, ODM will implement OhioRISE (Resilience through Integrated Systems and Excellence), a specialized managed care program for youth with complex behavioral health and multi-system needs.

OhioRISE Summary

OhioRISE MCO

On April 1, 2021, ODM selected Aetna Better Health of Ohio to serve as the new OhioRISE specialized managed care organization for the state’s children with the most complex behavioral health and multi-system needs. Click here to read the full press release.

OhioRISE services through Aetna Better Health of Ohio are projected to begin July 1, 2022. Additional updates about the OhioRISE implementation timeline will be communicated in the coming weeks.

On October 28, 2020, ODM released a request for applications (RFA) to solicit responses from managed care organizations (MCOs) interested in serving an estimated 60,000 Ohio children as the program’s MCO. After the close of the December 16, 2020 response period, Ohio Medicaid evaluated responses from four bidders and conducted oral presentation with each.

This announcement is the culmination of years of work to create a stronger, family-focused system of care for children dealing with intense behavioral health needs.

As the OhioRISE MCO, Aetna, will partner with the state, providers, and community organizations to expand access to in-home and community-based services. Aetna will contract with regional care management entities to ensure OhioRISE members and families have the resources they need navigate their interactions with multiple systems such as juvenile justice and corrections, child protection, developmental disabilities, mental health and addiction, education, and others.

A link to the OhioRISE RFA can be found on the Ohio e-Procurement website. More information about the new OhioRISE MCO, Aetna, is coming soon. 

November 2021 CANS Training Dates Announcement

ODM is pleased to announce November 2021 Child and Adolescent Needs and Strengths (CANS) training dates for CANS assessors. With leadership from Governor DeWine’s Children’s Initiative, the ODM in partnership with state child-serving agencies and the Praed Foundation created an Ohio-specific Child and Adolescent Needs and Strengths tool and Decision Support Model that all Ohio CANS assessors will be expected to utilize.

The CANS is a support tool in the clinical decision-making process to determine eligibility into OhioRISE and level of care and service planning. The Ohio CANS assessment tool has been developed for broad application across multiple systems, including youth involved in child protection, developmental disability, department of youth services, and mental health and addiction. This ensures youth only need to go through one assessment across multiple providers. The tool gathers all dimensions of the youth and family story to determine needs and strengths and integrates multiple storytellers capturing the voice of the youth and family to produce a full consensus-based assessment. The CANS is updated routinely over the course of treatment to continue ongoing care planning.

As a reminder, all assessors must maintain certification in the new Ohio CANS with the Praed Foundation, which requires completion of the TCOM (Transformational Collaborative Outcomes Management) and Ohio Children’s Initiative CANS Comprehensive training. Currently certified assessors who have completed certification on other versions of the CANS will meet Ohio CANS certification requirements if they also complete a 2.5-hour virtual Ohio CANS booster training. This “grandfathered” group must obtain the new Ohio CANS certification at their annual recertification date.  

Please refer to the CANS Training FAQCANS Training Registration Guide, and CANS Training Enrollment Guide for information on how to register and enroll for the CANS training. Additional training dates will be announced prior to each month before the start date of OhioRISE. For questions or concerns related to course registration or enrollment please contact support@tcomtraining.com. For any additional questions, please contact OhioRISE@Medicaid.Ohio.gov.

Thank you to all CANS assessors for your participation and dedication to Ohio’s youth and families.

October 2021 CANS Training Dates

Training Type
Date
Time
TCOM 10/11/2021 9:00  12:30 PM EST
CANS 10/13/2021 9:00  12:30 PM EST
CANS 10/14/2021 1:00  4:30 PM EST
Booster 10/15/2021 9:00  11:30 AM EST
TCOM 10/18/2021 9:00  12:30 PM EST
Booster 10/19/2021 1:00  3:30 PM EST
CANS 10/20/2021 9:00  12:30 PM EST
CANS 10/21/2021 1:00  4:30 PM EST
TCOM 10/25/2021 9:00  12:30 PM EST
Booster 10/26/2021 1:00  3:30 PM EST
CANS 10/27/2021 9:00  12:30 PM EST
CANS 10/28/2021 9:00  12:30 PM EST

November 2021 CANS Training Dates

Training Type Date Time
TCOM 11/1/2021 9:00  12:30 PM EST
CANS 11/2/2021 9:00  12:30 PM EST
CANS 11/3/2021 1:00  4:30 PM EST
Booster 11/4/2021 9:00  11:30 PM EST
TCOM 11/8/2021 9:00  12:30 PM EST
CANS 11/8/2021 1:00  4:30 PM EST
Booster 11/9/2021 1:00  3:30 PM EST
CANS 11/10/2021 9:00  12:30 PM EST
TCOM 11/15/2021 9:00  12:30 PM EST
CANS 11/16/2021 1:00  4:30 PM EST
Booster 11/17/2021 1:00  3:30 PM EST
CANS 11/18/2021 9:00  12:30 PM EST
TCOM 11/29/2021 9:00  12:30 PM EST
CANS 11/30/2021 9:00  12:30 PM EST

OhioRISE Advisory Council and Workgroups

The OhioRISE Advisory Council and Workgroup meetings commenced at the start of 2021. The purpose of these meetings is to engage with stakeholders to obtain critical feedback and expert advice for OhioRISE’s services and operations. You can find the members selected to be in the Advisory Council here and the presentation for the kickoff OhioRISE Stakeholder meeting on December 18, 2020 here.

Development of the OhioRISE services and major components of the program have been championed by four Workgroups – CANS and Care Coordination (CCC), Mobile Response and Stabilization Services (MRSS), Intensive Home-Based Treatment (IHBT), and Psychiatric Residential Treatment Facility (PRTF). In August 2021, OhioRISE commenced a new set of Workgroups focused on implementation and operational items for the program. The OhioRISE team in coordination with stakeholders, state agencies, Aetna Better Health of Ohio, and the Child and Adolescent Center of Excellence (CoE) identified the following new Workgroups:

Systems of Care & Care Management Entities (CMEs) Workgroup – This Workgroup will discuss cross-system initiatives, the roles, responsibilities, and relationships across state and local partners, and how the CMEs will deliver care coordination using a system of care approach through interactions with multiple entities.

Business Practices Workgroup – This Workgroup will focus on how providers will contract with Aetna (the OhioRISE plan), the requirements to contract as a CME, how the provider network will be built, and other areas of oversight.

Service Development Workgroup – This Workgroup will combine the four current services Workgroups (IHBT, MRSS, PRTF, and CCC) to understand how services interlink while addressing training and workforce issues.

Outreach & Engagement Workgroup – This Workgroup will develop strategies to engage with youth and families across the state and local cross-system partners while acting as a feedback loop to strengthen communication tools and strategies to shape the OhioRISE program. The Outreach & Engagement Workgroup will work closely with the other Implementation and Operations workgroups to disseminate information more broadly.

Please select the 'Advisory Council and Workgroup Meetings' dropdown tab below to view presentation materials and meeting registration links.

Advisory Council and Workgroup Meetings

Meeting Name
(Link to Materials)
Date
Time
Registration Link
01/11/2021
12:00 – 1:30 PM EST
Registration Has Closed
01/22/2021
12:00 – 1:30 PM EST
Registration Has Closed
01/28/2021
12:00 – 2:00 PM EST
Registration Has Closed
02/09/2021
9:00 – 11:00 AM EST
Registration Has Closed
MRSS Workgroup 02/09/2021 1:30 - 3:30 PM EST Registration Has Closed
CANS and Care Coordination Workgroup 02/11/2021 12:00 - 2:00 PM EST Registration Has Closed
IHBT Workgroup 02/19/2021 2:30 - 4:30 PM EST
Registration Has Closed
CANS and Care Coordination Workgroup 02/25/2021 12:00 - 2:00 PM EST
Registration Has Closed
03/09/2021
9:00 – 11:00 AM EST
Registration Has Closed
CANS and Care Coordination Workgroup 03/11/2021 10:00 - 12:00 PM EST Registration Has Closed
PRTF Workgroup 03/16/2021 3:00 - 5:00 PM EST Registration Has Closed
IHBT Workgroup 03/18/2021 11:00 - 1:00 PM EST Registration Has Closed
CANS and Care Coordination Workgroup 03/25/2021 12:00 - 2:00 PM EST Registration Has Closed
Advisory Council Meeting 04/13/2021 9:00 - 11:00 AM EST Registration Has Closed
Respite Rule Discussion 04/15/2021 10:00 - 11:30 AM EST Registration Has Closed
OhioRISE Rules Overview 04/22/2021 9:00 - 12:00 PM EST Registration Has Closed
PRTF Workgroup 05/06/2021 10:00 - 11:30 AM EST Registration Has Closed
Advisory Council Meeting 05/11/2021 9:00 - 11:00 AM EST Registration Has Closed
Rate Discussion 05/17/2021 11:00 - 1:00 PM EST Registration Has Closed
ICC/MCC Rate Discussion 05/25/2021 2:00 - 4:00 PM EST Registration Has Closed
MRSS/IHBT Rate Discussion 05/27/2021 2:00 - 4:00 PM EST Registration Has Closed
PRTF Workgroup 06/02/2021 9:00 - 11:00 AM EST Registration Has Closed
Advisory Council Meeting 06/08/2021 9:00 - 11:00 AM EST Registration Has Closed
CANS and Care Coordination Workgroup
Brief CANS: [Reference Guide] [Rating Sheet]
Comprehensive CANS: [Reference Guide] [Rating Sheet]
OH CANS: [Decision Support Model]
06/17/2021 2:00 - 4:00 PM EST Registration Has Closed
1915(c) Waiver Rules Overview 06/22/2021 10:00 - 12:00 PM EST Registration Has Closed
CANS and Care Coordination Workgroup 06/24/2021 2:00 - 4:00 PM EST Registration Has Closed
PRTF Workgroup 06/29/2021 9:00 - 11:00 AM EST Registration Has Closed
1915(b) and 1915(c) Waivers Office Hours 06/30/2021 10:00 - 11:00 AM EST Registration Has Closed
1915(b) and 1915(c) Waivers Office Hours 07/08/2021 1:00 - 2:00 PM EST Registration Has Closed
Advisory Council Meeting 07/13/2021 9:00 - 11:00 AM EST Registration Has Closed
PRTF Workgroup 07/14/2021 9:00 - 11:00 AM EST Registration Has Closed
Services Rates Update 08/05/2021 9:00 - 11:00 AM EST Registration Has Closed
Advisory Council Meeting
ODM [Amended First Package of Rules]
MHAS [Amended First Package of Rules]
08/10/2021 9:00 - 11:00 AM EST Registration Has Closed
PRTF Workgroup
ODM [PRTF Rule] [PRTF Cost Report Rule]
MHAS [PRTF Rule]
08/11/2021 9:00 - 11:00 AM EST Registration Has Closed
Advisory Council Meeting 09/14/2021 9:00 - 11:00 AM EST Registration Has Closed
Systems of Care / Care Management Entities 09/16/2021 1:30 - 3:00 PM EST Registration Has Closed
Advisory Council Meeting  10/12/2021 9:00 - 11:00 AM EST Registration Has Closed
PRTF Workgroup 10/27/2021 1:00 - 2:00 PM EST Click here to join the meeting

About OhioRISE

OhioRISE is governed by ODM, the Governor’s Office of Children’s Initiatives, and Ohio’s Family and Children First Cabinet Council. Council members include: Ohio Department of Mental Health and Addiction Services (MHAS), Ohio Department of Job and Family Services (ODJFS), Department of Youth Services (DYS), Ohio Department of Rehabilitation and Correction (DRC), Ohio Department of Health (ODH), Ohio Department of Developmental Disabilities (DODD), Ohio Department of Education (ODE), and the Office of Family & Children First. Ohio Medicaid will hold the contract with the OhioRISE plan.

OhioRISE aims to shift the system of care and keep more kids and families together by creating new access to in-home and community-based services for children with the most complex behavioral health challenges. The OhioRISE program’s child and family-centric delivery system recognizes the need to specialize services and support for this unique group of children and families. Aetna will partner with ODM, sister state agencies, providers, families, and other stakeholders to develop and implement new and enhanced services, including those listed below. OhioRISE will also feature a new 1915(c) Medicaid waiver that will drive toward improving cross-system outcomes for its enrollees. OhioRISE will feature intensive care coordination and both new and enhanced behavioral health services targeted toward this population and will offer a new Medicaid waiver program that will help families prevent custody relinquishment.

OhioRISE Eligibility

  • Enrolled in Ohio Medicaid – either managed care or fee for service
  • Under the age of 21
  • Meet a functional needs threshold for behavioral health care, as identified by the Child and Adolescent Needs and Strengths (CANS) tool

OhioRISE Services

New services available through OhioRISE include:

  • Intensive Care Coordination: Two levels of this service (intensive and moderate) will be consistent with principles of High-Fidelity Wraparound and be delivered by a Care Management Entity-qualified agency.
  • Intensive Home Based Treatment (IHBT): OhioRISE will make changes to existing IHBT services and align with the Family First Prevention Services Act (FFPSA).
  • Psychiatric Residential Treatment Facility (PRTF): This service is aimed at keeping youth with the most intensive behavioral health needs in-state and closer to their families and support systems.
  • Mobile Response and Stabilization Service (MRSS): Provide youth in crisis and their families with immediate behavioral health services to ensure they are safe and receive necessary supports and services (this new service will also be available to children who are not enrolled in OhioRISE).
  • Behavioral Health Respite: provide short-term, temporary relief to the primary caregiver(s) of an OhioRISE plan enrolled youth, in order to support and preserve the primary caregiving relationship.

These services will be provided through a collaborative delivery system, as illustrated in the image below.

OhioRISE Delivery System

For Ohio Medicaid managed care youth members who are not enrolled in the OhioRISE plan, Ohio Medicaid MCOs and the fee for service program will continue coverage for the Medicaid’s existing behavioral health services and MRSS. MCOs will manage also administrative care coordination, utilization management, and quality improvement efforts. The Ohio Medicaid MCOs also will be responsible for assuring access to the Child and Adolescent Needs and Strengths (CANS) assessment to determine when a child needs the enhanced services of the OhioRISE plan.

ODM presented highlights of OhioRISE to stakeholders via webinar. To access the recording, please register here. Click here to view the presentation.

Along with the OhioRISE MCO procurement process, ODM engaged stakeholders in the process of designing the OhioRISE services package.