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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.


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.

Today’s 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. 

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.

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 Click here to join the meeting - Registration not required
Advisory Council Meeting 08/10/2021 9:00 - 11:00 AM EST Click here to join the meeting - Registration not required
PRTF Workgroup 08/11/2021 9:00 - 11:00 AM EST Click here to join the meeting - Registration not required

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.

Procurement "Quiet Period"

Like any procurement of this size, there are significant guardrails placed in both federal and state law regarding communications during certain periods of contract procurements. ODM must adhere to federal and state procurement requirements to ensure a fair process. As a result, ODM cannot:

  • Share details related to RFA responses received and/or award prior to official public announcements.
  • Communicate design discussions and decisions related to OhioRISE beyond what is stated in the RFA.

At this point in time, ODM is in the “quiet period” for the OhioRISE Procurement, which dramatically limits the information available to share on an individual basis. All information ODM releases regarding the OhioRISE Procurement must be at equal opportunity.