DeWine Administration Releases Revised Gender Transition Services Rules

On February 7^th, the DeWine Administration released updated rules for Gender Transition Services that were proposed by OhioMHAS and the Ohio Department of Health.  

As a result of the previous public comment period, OhioMHAS has made substantive changes to the proposed Gender Transition Services Rules, which we are pleased to see address many of the concerned raised by the Ohio Council and many others.  Highlights of the proposed new rules are the following:

• The comments revealed a significant interest in the original drafts’ impact on adult patients. The revised rules are now applicable only to minors.
• Recognizing concerns regarding limited availability of certain medical specialties, options for professionals included in the required multi-disciplinary care team were expanded and modified.
• A point of confusion existed surrounding the review of care plans by a medical ethicist. The requirement for review by a medical ethicist was never applicable to individual patient care plans but rather provider operations. However, to alleviate confusion and because of assurances from healthcare leaders that providers already appropriately engage medical ethics professionals in this type of care, the proposed rules do not contain this requirement.

The OhioMHAS rules have been submitted to the Common Sense Initiative (CSI) Office for review. Links to the rules and Business Impact Analysis (BIA) are included below.  Comments regarding the rules can be submitted through the link on the OhioMHAS web site. Alternatively, comments may be sent separately to OhioMHAS at [email protected] and to the CSI Office at [email protected].  Comments are due by 5:00PM on Wednesday, February 14, 2024. 

5122-14-12.1 | Gender Transition Care (IP Hospitals)

5122-26-19 | Gender Transition Care.

Business Impact Analysis

Similarly, the Ohio Department of Health (ODH) issued a revised rule package with updates that partially address concerns raised for reporting on gender-related conditions and more narrowly define requirements for hospital and healthcare settings to those serving minors. Highlights of the ODH rule revision include:

• In response to privacy concerns, the rules are now even more clear that the data collected will not identify individual patients.
• The comments revealed a significant interest in the original draft’s impact on adult patients. The revised quality standard rules are now applicable only to care for minors.
• Recognizing concerns about the limited availability of certain medical specialties, options for the mental health professionals included in the required multi-disciplinary care team were expanded and modified.
• A point of confusion existed surrounding the review of care plans by a medical ethicist. The requirement for review by a medical ethicist was never applicable to individual patient care plans but rather to institutional operations. However, to alleviate confusion and because of assurances from healthcare leaders that institutions already appropriately engage medical ethics professionals in this type of care, the proposed rule’s requirement has been removed.

The updated ODH rules are available here.  ODH will now proceed with the rule adoption process, which includes review by the Ohio Common Sense Initiative (CSI) Office and subsequent filing with the Joint Committee on Agency Rule Review (JCARR).

OhioMHAS Releases MRSS RFI – Responses Due March 8^th

The Ohio Department of Mental Health & Addiction Services (OhioMHAS) is seeking requests for interest from current MRSS providers or other providers interested in rendering MRSS. MRSS providers are certified by OhioMHAS and render services in Ohio. Click here to download the RFI.

In October 2023, OhioMHAS and the Ohio Department of Medicaid (ODM) shared a proposed regional MRSS model concept with stakeholders. Based on feedback received, OhioMHAS is issuing this RFI to gather more information prior to moving forward with a new MRSS model for Ohio. The information obtained through this RFI will assist OhioMHAS and its partners with future MRSS model development. The goal of this RFI is to understand the current service delivery areas and opportunities to fill in gaps in access to services.

Governor DeWine has spent his career focused on the health and well-being of children. In his role as governor, with support from the Ohio General Assembly, he has prioritized programs and services, such as MRSS, that provide interventions for children and youth in crisis. MRSS is delivered to any person under the age of 21 who is experiencing a behavioral health crisis that has impacted their ability to function within their family, living situation, school, or community. Something unique to MRSS is that the caller and family define the crisis.

OhioMHAS and its partners are working to develop a supported, system of care and quality crisis response system to serve as a timely and appropriate alternative to unnecessary hospitalization, arrest/incarceration, or displacement from home. We aim to create statewide capacity and access to youth-focused high quality behavioral health crisis response that addresses the family or caregiver’s sense of urgency while preserving their dignity. MRSS is one part of the whole crisis response system and a critical tool in supporting child protection systems across Ohio.

While expansion of MRSS has happened across the state, there have been significant obstacles to developing complete statewide access to MRSS. Stakeholder feedback, especially from MRSS providers, strongly highlight the need for increased efficiencies in service delivery and indicate that statewide expansion can be attained through creating model flexibility and additional funding support, including:

This approach is aimed at supporting statewide service coverage, addressing workforce and operational challenges, providing a clear pathway for quality improvement, and encouraging integration and efficiency.

• Updating the OhioMHAS’ MRSS rule to address staffing and hours of operation (See
• below)
• Expanding funding support for an accountable provider-led firehouse model, includes gathering additional data about service area and development of fee schedule. Proposed future funding will be based on Medicaid billing and cross department collaboration from General Revenue Funds, accounting for staffing and infrastructure costs in the allocation.

A provider led accountable model is intended to promote efficiency and ensure access to MRSS. Providers will leverage strong community partnerships, specifically with ADAMH boards, child- serving agencies, organizations (public children services agencies, schools, law enforcement, juvenile courts), and other health care providers (emergency departments, residential treatment providers, providers of other behavioral health services, primary care physicians) to spread access to and use of MRSS.

The following key updates to the OhioMHAS MRSS rule are expected to be released in early 2024:

• MRSS service providers will be operational, at a minimum, between the hours of 8:00 am and 8:00 pm Monday through Friday and will respond to all calls that come during operational hours on those days. Any call received outside of operational hours will be responded to at the beginning of the next operational day.
• New minimum standards for staffing requirements to provide initial MRSS response. The initial response will be conducted by at least a clinician; a clinician and either a Qualified Behavioral Health Specialist (QBHS), a family peer supporter, or a youth peer supporter; or a combination of at least one QBHS and either another QBHS or a peer supporter. If a clinician is not part of the initial MRSS response, there will be immediate access to one virtually.

Questions may be sent to: [email protected] no later than February 23, 2024, at 5 pm. A Q&A will be posted on the grants page of the OhioMHAS website.  Letters or e-mails of must be submitted to [email protected] by March 8, 2024 at 5:00 p.m.

US Outpatient Care for Serious Mental Health Issues Declined During COVID-19

A study today in the Annals of Internal Medicine shows that while telemedicine helped some groups seeking mental health care during the COVID-19 pandemic, Americans with serious mental health symptoms suffered from a decline in in-person outpatient mental health visits that has persisted. Moreover, this lack of outpatient care for those with significant mental illness was seen mostly in patients with lower incomes and education levels. The study was based on trends seen in participants in the Medical Expenditure Panel Survey Household Component, given from 2018 to 2021 to 86,658 adults. Respondents were asked how frequently in the previous 30 days they had felt so sad that nothing could cheer them up, nervous, restless or fidgety, hopeless, that everything was an effort, or worthless (all, most, some, a little, or none of the time). Responses were scored from 0 to 4, with a score of 13 or higher defining serious psychological distress, the authors said.

CMS’ New Behavioral Health Model Illustrates Ongoing Effort To Push Value-Based Care, Integration Forward

The new IBH model is an effort by CMS to marshal public resources into a coordinated whole for those with severe behavioral health issues. Specifically, the model will connect adults with mental health conditions or substance use disorders (SUDs) to physical, behavioral and social supports, prioritizing a collaborative care model between behavioral health and physical health providers. The model also goes in the opposite direction of most integration programs. Instead of integrating behavioral health in physical care settings, the IBH Model calls for physical health and social support to be integrated into behavioral health, an idea becoming increasingly common in the mainstream of health care. Announced Jan. 18, the to-be-enacted program seeks to fill this void in the health care system using behavioral health as the entry point rather than vice versa. The finer details of the IBH Model are presently unknown and may only be filled in once states start working on the model. CMS will release more information later this spring in a notice of funding opportunity (NOFO). In the fall, CMS will select eight states to participate in the program. It will run for eight years, five of which will encompass the implementation period. The three-year wind-up of pre-implementation features several moving parts.