Home » Blog Articles » Behavioral health billing » OhioRISE: Reformed Medicaid Managed Care & Regional Providers

Over the past few months, the Ohio Department of Medicaid (ODM) has released new information regarding the OhioRISE program. This includes information about the program’s 20 ODM approved regional providers.

The start date for the program is pushed back to July 1, 2022. The original start date for the program was scheduled for January 1, 2022.

Delayed Starts:

The waves of infections from COVID-19, especially the Omicron variant, are the main reason for the delay. The initial planning for the OhioRISE program occurred during 2019. The program’s name is abbreviated from Resilience through Integrated Systems and Excellence.

But like many things in 2020 and 2021, resilience was required. The outbreak and lingering effects of the Coronavirus delayed implementation of this new Medicaid managed care program. However, with COVID-19 case and death rates falling, the July startup date is now a reality.

The reorganization of Ohio’s Medicaid program is financially the largest contract in state history. In total, six healthcare insurance companies will split $20 billion the state contract. The OhioRISE, unlike the previous Medicaid program, provides expanded assistance for children with severe behavioral and mental health problems.

In addition, there is now a single pharmacy benefit manager system or SPBM. This should control the cost for the state of Ohio and provide another level of transparency.

Overall, in the state of Ohio, over 3 million individuals are part of the program.

Programs & Regional Providers:

In order to answer questions and provide a smooth transition for Ohioans, the OhioRISE program is offering community and provider training series. These programs will run over the next few months with a scheduled start date of July 1, 2022.

The trainings will be jointly conducted by the ODM, Aetna Better Health of Ohio, the Child and Adolescent Behavioral Health Center of Excellence (CABH COE) as well as other state agencies.

The sessions in each program will cover topics related to the operations, implementation and systems that underpin the OhioRISE program.

In addition, there are 20 community-oriented Care Management Entities or CMEs. These regional mental health providers will serve the needs of adolescents and children with intense behavioral health needs. These organizations will provide a single point of contact for families.

The Ohio CMEs will provide community mental health and substance use, specialty care coordination, hospital as well as educational services. Each CME will receive state grants ranging from $900,000 to $1.2 million in order to help with start-up expenses.

Here is a list of the 20 OhioRISE CMEs:

  1. Unison Health
  2. The Buckeye Ranch
  3. Harbor 
  4. Cincinnati Children’s Healthvine
  5. I Am Boundless, Inc.
  6. National Youth Advocate Program
  7. Wingspan Care Group
  8. Choices Coordinated Care Solutions
  9. OhioGuidestone
  10. CareStar
  11. Positive Education Program
  12. Lighthouse Youth and Family Services
  13. Ravenwood Health
  14. Cincinnati Children’s Hospital Healthvine
  15. Coleman Health Services
  16. Integrated Services for Behavioral Health (Southeast Ohio)
  17. Integrated Services for Behavioral Health (Southern Ohio)
  18. Cadence Care Network
  19. The Village Network
  20. Jefferson County Educational Service Center

The eligibility for individuals to participate in the OhioRISE program are:

  • The individual is under the age of 21 years of age.
  • The individual meets a functional needs threshold for behavioral health care, as identified by the Child and Adolescent Needs and Strengths (CANS) tool.
  • The individual is enrolled in Ohio Medicaid – either managed care or fee for service

For additional information on the OhioRISE program, please directly contact Ohio Medicaid Managed Care.

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