OhioRISE care coordination overview What is OhioRISE?
OhioRISE (Resilience through Integrated Systems and Excellence) is a specialized Medicaid managed care program that focuses on children and youth who have complex behavioral health and multisystem needs. The OhioRISE program covers behavioral healthcare services and supports, one of which is care coordination. Young people with multisystem needs often require educational, developmental disability, child protection, juvenile justice, and/or mental health and addiction supports. OhioRISE helps to bring all of these systems together to support the needs of OhioRISE enrollees through care coordination.

Why was I/my child referred to OhioRISE?

A child or youth may be referred to OhioRISE by a number of individuals, including a therapist, school counselor, child protection or developmental disability system staff member, court, pediatrician, or the child’s parent or caregiver. These individuals may identify that a child or youth could benefit from the program because they:

» Have multiple needs that result from behavioral health challenges, » Are at risk for deeper system involvement, and/or
» Are at risk of out-of-home placement or are returning to their families from out-of-home placement.

After a child or youth is referred to the program, they or their caregiver will be contacted by a certified Child and Adolescent Needs and Strengths (CANS) assessor to schedule a CANS assessment. The CANS assessment is a tool that gathers the child or youth and caregiver’s story to better understand their situation and determine the best ways to provide help. The CANS assessment is used to determine eligibility for OhioRISE and assists with coordination of care.

What is OhioRISE care coordination?

Care coordination is an important benefit offered to all children, youth, and families enrolled in OhioRISE. Care coordinators work closely with you, providers, and community partners you already meet with to:

» Reduce the number of meetings you participate in. » Develop one plan of care.
» Organize everyone involved in a coordinated way to support your needs.

Care coordinators are experienced in working with children, youth, and their families to improve member health. You will be assigned a professional who knows what services are available through the OhioRISE program and your Medicaid managed care plan or fee-for-service Medicaid. Your care coordinator will:

» Know about the services and programs offered in your local community. » Support your and your family’s access to services.
» Work with your MCO, providers, and community organizations. What are care coordination tiers?
OhioRISE offers care coordination at three levels called tiers. You will be assigned an initial tier for care coordination based on your results from the Ohio Children’s Initiative CANS assessment.

» Tier 1: Limited care coordination for children and youth who have less intensive behavioral health needs.

Last updated: January 23, 2023	1

» Tier 2: Moderate care coordination for children and youth with moderately intensive behavioral health needs.

» Tier 3: Intensive care coordination for children and youth with highly intensive behavioral health needs.

If you are placed in Tier 2 (moderate) or Tier 3 (intensive), a care management entity (CME), regional providers contracted with Aetna Better Health of Ohio, will provide your care coordination services. CMEs and their care coordinators are in the area you live and know what services are available in your community. They have experience working with child-serving agencies and will be your partner in care decisions to improve your overall health outcomes. If you are assigned to Tier 1 (limited), your care coordination will be provided directly by an Aetna Better Health of Ohio care coordinator.

What happens during my first meeting with a care coordinator?

A lot happens during the first visit with your care coordinator. First, you and your care coordinator will review information provided from the CANS assessment to learn more about your needs and goals. Your care coordinator will get information about past healthcare you have received and what services you use now. They will also:

» Review and talk about current behavioral health concerns. » Help you better understand the conditions that affect you.
» Talk about what level (tier) of care coordination you may need and whether you agree or disagree with that level.

» Find out who is, or should be, on your child and family team (CFT) so we can connect with them.

» Start to work together on a child- and family-centered care plan that ensures your behavioral health needs are met.

» Explain how to get services for crisis situations and start to create a crisis plan. » Set up times for regular contacts through visits and calls.
» Determine what services you need help setting up and how we can help. » Help you with referrals to services.
» Connect you with healthcare providers, state child-serving agencies, and other groups. » Share how to contact your care coordinator.
» Explain what to do if you want to change your care coordinator or CME.

I already have a team of people working with me/my child. What is the role of a care 

coordinator?

OhioRISE care coordinators invest in you and your family to support your voice and choices. They facilitate the collaboration and communication of everyone on your team to develop and provide one comprehensive care plan. An OhioRISE care coordinator:

» Helps your family to identify your unique strengths and natural support systems.

» Serves as a support when communicating with other providers or organizations you interact with. » Helps your family in determining appropriate services.
» Serves as a central point of contact for all providers.

» Helps your family with understanding the services that you qualify for through OhioRISE.

Ohio Department of Medicaid (ODM) follows state and federal civil rights laws that protect you from discrimination or unfair treatment. To help you understand this brochure, language assistance, interpretation services, auxiliary aids, and services are available upon request at no cost to you. You can request these services by calling ODM’s Civil Rights/ADA Coordinator at 614-995-9981/TTY 711, fax 1-614-644-1434, or email: ODM_EEO_EmployeeRelations@medicaid.ohio.gov.

Last updated: January 23, 2023	2