Medicaid
Article

OhioRISE

April 29, 2021
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Why OhioRISE?

A new managed-care approach, OhioRISE (Ohio Resilience through Integrated Systems and Excellence),[1] will focus on a population of children and youth with serious behavioral health needs, who are often involved in multiple public youth-serving systems, and their families. Many of these children and young people are often referred to as “multisystem” youth or MSY.

OhioRISE is designed to address the behavioral health treatment and support needs of ‘intersection’ of young people who need a greater array and intensity of services…

What will OhioRISE accomplish?

OhioRISE will support the development of a single managed-care plan for the OhioRISE youth population and their families. The plan will ensure the following:

  • Appropriate assessments as to intensity of need
  • Individualized plans of care that draw on an array of in-home and community services and coordination of these services across various community providers, agencies, and systems.OhioRISE is designed to address the behavioral health treatment and support needs of ‘intersection’ of young people who need a greater array and intensity of services and care coordination than the current Medicaid plan provides.

The ultimate goal of OhioRISE is to keep youth in their homes, communities and schools by assessing for and delivering the appropriate intensity of services needed, thus reducing unnecessary out-of-home placement and potential custody relinquishment. State and local level partnering across the juvenile justice, behavioral health, developmental disabilities, child welfare and education systems, will further this goal.

Since the children, youth, and families eligible for OhioRISE will typically be involved in multiple public systems, it is important to have a single assessment tool that supports communication across those systems, therefore the Child and Adolescent Needs and Strengths (CANS)[2] has been selected as the system-wide assessment tool.

The proposed structure asks the following of each participating system: What do these youth need and what do we bring to the table to build a Medicaid system that works for this population?

Who is eligible for OhioRISE?

Under the proposed OhioRISE plan, eligible youth are (but not limited to):[3]

  • Enrolled in Medicaid (managed care and fee for service)
  • Up to age 21
  • In need of significant behavioral health services
  • Meet functional needs criteria as assessed by the Child and Adolescent Needs and Strengths (CANS)ODM estimates up to 50,000-60,000 children, youth, and their families may be enrolled by the end of year one.

What are the OhioRISE services and supports?

In addition to the current behavioral health services under Medicaid,[4] there are several key services to be added or expanded with OhioRISE:

  • Intensive care coordination using High Fidelity Wraparound (HFWA)
  • Moderate care coordination using a wraparound-informed approach
  • Mobile Response and Stabilization Services (MRSS)
  • Intensive Home-Based Treatment (IHBT) Services
  • Psychiatric residential treatment facilities (PRTFs)imp

How is OhioRISE collaborative?

The Governor’s Office of Children’s Initiatives, Ohio Family and Children First, and the respective state and local agencies, will continue partnering in further planning, implementation, and evaluation of OhioRISE. OhioRISE will partner with ODJFS on the implementation of the Family First Prevention Services Act (FFPSA)[5] which allows the child protection system to use Title IV-E funds for an array of evidence-based community interventions designed to preserve and support families and limit out-of-home placement.

Another key collaborative effort across the systems, will be the implementation of a Child and Adolescent Behavioral Health Center of Excellence (COE)[6] through a contract with the Ohio Department of Mental Health and Addiction Services (OMHAS). The role of the COE will support the further advancement of the child, youth and family behavioral health field and will be a resource to the efforts of OhioRISE and FFPSA.

How will OhioRISE be implemented?

OhioRISE will employ a “shared governance” approach to management comprised of the Office of Children’s Initiatives, OFCF, and all state departments which serve youth and families. The proposed structure asks the following of each participating system: What do these youth need and what do we bring to the table to build a Medicaid system that works for this population?

What are the next steps?

ODM selected Aetna Better Health Inc. dba Aetna Better Health of Ohio, as the single MCO for the implementation of OhioRISE. The next six months will be in preparation for ‘going live’ in January 2022.

[1] https://managedcare.medicaid.ohio.gov/wps/portal/gov/manc/managed-care/ohiorise/ohiorise

[2] https://praedfoundation.org/tools/the-child-and-adolescent-needs-and-strengths-cans/

[3] https://managedcare.medicaid.ohio.gov/wps/portal/gov/manc/managed-care/ohiorise/ohiorise

[4] https://managedcare.medicaid.ohio.gov/wps/portal/gov/manc/managed-care/ohiorise/ohiorise

[5] https://jfs.ohio.gov/ocf/Family-First.stm

[6] https://mha.ohio.gov/Portals/0/assets/ResearchersAndMedia/News%20and%20Events/NewsNowBlog/COE.pdf

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