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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 Request for Applications (RFA)

On October 28, 2020, ODM released a request for applications (RFA) to solicit responses from managed care organizations (MCOs) interested in serving as our OhioRISE specialized managed care organization for eligible Medicaid youth with complex behavioral health and multi-system needs. ODM seeks to contract for comprehensive and highly coordinated behavioral health services provided by a specialized MCO experienced in and dedicated to serving the unique needs of this population.

View a recording of the OhioRISE RFA release virtual event or watch the video below for more details about the OhioRISE program and the request for applicants to serve as the OhioRISE specialized managed care plan.

The presentation from the Pre-Application Conference is also available.

The OhioRISE plan will partner with the state, providers, and community organizations to expand access to in-home and community-based services. The OhioRISE plan 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.

Additional details and a link to the OhioRISE RFA can be found on the RFPs page of medicaid.ohio.gov

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. Once selected, the OhioRISE plan 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).

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 and recorded it for your viewing here. That video presentation is available here. To access the recording, please register here.

Along with the OhioRISE MCO procurement process, in the coming months, ODM will begin engaging stakeholders in the process of designing the OhioRISE services package. Additional details about the process and timing of sessions will be made available on this webpage as they become available.

Check this page periodically for updates related to the OhioRISE program and procurement process.