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OhioRISE Overview

On July 1, OhioRISE will begin to provide coordination and specialized services to help children and youth with behavioral health needs who receive care across multiple systems. This builds on the work already underway including the selection and launch of a statewide network of community-based care management entities, the design and build of a centralized technology for the Child and Adolescent Needs and Strengths assessment tool, transition grant funding to Care Management Entities (CMEs) and MRSS providers (Mobile Response and Stabilization Services) to launch new OhioRISE services and support provider and workforce development; and the completion of extensive community and provider training sessions for more than 1,650 participants. 

CANS Assessment

The Child and Adolescent Needs and Strengths (CANS) assessment is a support tool in the clinical decision-making process to determine eligibility into OhioRISE and level of care and service planning.

A description of the OhioRISE Plan and MCO responsibilities

As a part Ohio Department of Medicaid’s (ODM) effort to launch the next generation of Medicaid, 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.  Consistent with System of Care core principles, OhioRISE intends to provide individualized services informed by youth and family’s voice and choice.

Buckeye, in collaboration with the OhioRISE care team, will be providing physical health care services, including vision, dental and transportation, and will take an active role in the child and family centered care plan and child and family team as needed.

Children enrolled in OhioRISE will be eligible for new Behavioral Health Services including:Image that explains New & Enhanced Services

OhioRISE Eligibility Requirements

Chart that explains- Meet General Program Eligibility. Including twenty years of age or younger; determined eligible for Ohio Medicaid in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code; and not enrolled in a MyCare Ohio plan. Plus (symbol) next chart, showing 'and'. One or more rece3nt BH service(s) prior to program effective date, six months prior: admission into out of state PRTF, and inpatient admission into a hospital, with a primary diagnosis of mental illness or substance use disorder. Three months prior: intensive home-based treatment (IHBT) service. Two months prior: therapeutic behavioral group services - hourly or per diem service, and qualified residential treatment program (QRTP) services as defined in rule 5122-29-09.1.   

Process for referring children/families for a CANS assessment

Members that may benefit from OhioRISE enrollment may be identified through various means, including, but not limited to, health risk assessment information, provider referrals, member/ family referrals or following an emergency room/ inpatient hospitalization event due to a behavioral health diagnosis.  Upon identification, Buckeye’s Care Coordination (CC) team ensures the member and/ or family is connected with a local certified Child and Adolescent Needs and Strengths (CANS) assessor to complete the assessment and determine program eligibility.  The provider submits the CANS assessment into ODM’s CANS IT system and determination is made through the OhioRISE Decision Support Model.  In partnership with ODM, Buckeye’s CC team monitors and accesses CANS IT system to determine RISE enrollment status. 

CANS Providers

Coming Soon

General Timeframe for a CANS Assessment and OhioRISE Eligibility Determination

Flow chart that shows the eligibility process