Attention! You May Be Contacted by Aetna About a Medicaid Child/Youth’s OhioRISE Eligibility
Announcement from the Ohio Department of Medicaid
The Ohio Department of Medicaid (ODM) is working with sister state agencies and community partners to identify Medicaid children and youth eligible for specialized behavioral healthcare services through the OhioRISE Plan, Aetna Better Health of Ohio (Aetna), beginning July 1. Children and youth who meet the following criteria may qualify for the program:
- Are eligible for Ohio Medicaid (either managed care or fee-for-service).
- Are age 0-20.
- Require significant behavioral health treatment needs, measured using the Child and Adolescent Needs and Strengths (CANS) assessment.
Children and youth also may be eligible for OhioRISE following specific and urgent situations such as a recent hospitalization for behavioral health reasons. The Ohio Administrative Code rule 5160-59-02.1 defines eligibility as children and youth who have recently received one of the following types of care:
- On or after Jan. 1, 2022: Inpatient psychiatric and/or substance use disorder services or out-of-state psychiatric residential treatment facility services.
- On or after April 1, 2022: Intensive home-based treatment (including multisystemic therapy and functional family therapy), care at an intermediate care facility/intellectual developmental disability with an intensive behavioral support rate add-on, care in a developmental center while under age 18, or a CANS assessment entered in the CANS IT system indicating OhioRISE eligibility.
- On or after May 1, 2022: Substance use disorder residential treatment or services from a children’s residential center or residential parenting facility while in Title IV-E agency custody.
ODM is pulling data weekly to identify the youth who meet the above criteria who are expected to be enrolled in OhioRISE on July 1. The names of pre-identified Medicaid children/youth are shared with Aetna and Ohio’s Medicaid managed care organizations (MCOs). Meanwhile, the MCOs are sharing relevant information with the OhioRISE plan. As a Medicaid provider, Aetna may contact you prior to July 1, and ask you to:
- Contract with them to ensure continuity of care.
- Provide them with additional medical information about Medicaid children/youth who have been identified for OhioRISE eligibility.
- Arrange for a CANS assessment if the child or youth has not already received one.
- Provide insight into the child or youth’s care coordination needs.
Medicaid children and youth who are identified as candidates for OhioRISE will receive information about the OhioRISE program beginning in June. If you have any questions, please reach out to Aetna Better Health of Ohio at 1-833-711-0773 (TTY: 711), Monday through Friday from 7 a.m. to 8 p.m. ODM’s Integrated Help Desk (IHD) is another provider resource and can be reached at 1-800-686-1516 Monday to Friday from 8 a.m. to 4:30 p.m. The Integrated Voice Response System (IVR) provides 24/7/365 access to information regarding client eligibility, claim and payment status, and provider information.
If a Medicaid member reaches out to you with questions about OhioRISE, please direct them to the Medicaid Consumer Hotline at 800-324-8680 (TTY 711) Monday through Friday from 7 a.m. to 8 p.m. and Saturday from 8 a.m. to 5 p.m.