Since 1989, PEP Connections has been delivering a care coordination service using a high-fidelity wraparound approach. Beginning July 1, services like those that have been provided by PEP Connections will be available across the state through a new specialized managed care program known as OhioRISE. This is great news for families across Ohio!
What is OhioRISE?
OhioRISE is a specialized Medicaid managed care program for children and youth with complex behavioral health needs (mental health/substance use disorder) and multisystem needs. Aetna Better Health of Ohio (Aetna) is the managed care partner for the program.
OhioRISE aims to shift the system of care and keep more kids and families together by creating new access to in-home and community-based services for children with the most complex behavioral health challenges. The OhioRISE program’s child and family-centric delivery system recognizes the need to specialize services and support for this unique group of children and families.
Aetna Better Health of Ohio (the OhioRISE plan) has partnered with the Ohio Department of Medicaid, sister state agencies, providers, families, and other stakeholders to develop and implement new and enhanced services.
What is an OhioRISE Care Management Entity (CME)?
CMEs serve as the go-to providers delivering wraparound care coordination for children and youth enrolled in OhioRISE who have the most complex behavioral health needs. CMEs will also help ground and grow their communities’ system of care so overall resources expand to help kids with behavioral health needs and their families in the coming months and years.
Positive Education Program, through PEP Connections, will serve as CME for OhioRISE in central Cuyahoga County and will provide Intensive Care Coordination (ICC) and Moderate Care Coordination (MCC) services. PEP Connections will continue to provide Intensive Home Based Treatment (IHBT) services, now a part of the OhioRISE menu of services.
Who Qualifies for OhioRISE?
Children and youth who may be eligible for OhioRISE:
- Are eligible for Ohio Medicaid (either managed care or fee-for-service),
- Are age 0-20,
- Are not enrolled in a MyCare Ohio plan; and
- Require significant behavioral health treatment, measured using the Ohio Child and Adolescent Needs and Strengths (CANS) assessment.
Children and youth may also be eligible for OhioRISE because of certain urgent conditions, as for example, if a child or youth is in a hospital for behavioral health reasons or is admitted into a Psychiatric Residential Treatment Facility.
Initiating a Referral to OhioRISE
There are multiple avenues for referrals to be made:
- Contact OhioRISE Member Services at -833-711-0773 (TTY: 711) from 7 a.m. to 8 p.m. Monday through Friday and Aetna Better Health of Ohio will work with the youth, their MCO, to coordinate a referral for a CANS Assessment to determine eligibility for the OhioRISE program.
- Contact the youth’s MCO, or if they are in fee-for-service Medicaid, the Medicaid Consumer hotline 1-800-324-8680 (TTY: 1-800-292-3572) to initiate a referral for a CANS assessment within one business day as a means to determine eligibility for the OhioRISE program.
You can also call PEP Connections at 216-361-2441 to learn more about how to access OhioRISE services.
PEP is hiring for many positions to support its work as an OhioRISE CME. Those opportunities can be found here.