ODM has added several new provider specialties associated with the implementation of the OhioRISE program. ODM requires that providers add a provider specialty to their provider enrollment type in order to bill for some new and enhanced services under this program and part of the next generation of Ohio Medicaid, which begins July 1, 2022. For additional information about the new specialties and their requirements, click here to view the New OhioRISE Provider Specialties Guide.

New OhioRISE services that will require provider enrollment in order to seek reimbursement include:

• Child and Adolescent Needs and Strengths (CANS) Assessments (individual practitioner level enrollment)
• Mobile Response and Stabilization Services (MRSS) 
• Intensive Home-Based Treatment (IHBT), which includes IHBT, Multi-Systemic Therapy (MST), and Functional Family Therapy (FFT)
• Intensive and Moderate Care Coordination (for CMEs only)
• Behavioral Health Respite
• OhioRISE HCBS Waiver Transitional Services and Supports
• OhioRISE HCBS Waiver Out of Home Respite

Special notes to consider:  CANS Assessments and MRSS will be covered under both Next Generation Medicaid MCOs and Aetna’s OhioRISE program. OhioMHAS anticipates LACTS will be able to accept MRSS applications in early April and hopes to provide interim certificates shortly thereafter. Depending on when MITS enrollment is suspended for the transition to the PNM, providers may be able to enroll prior to July 1st for MRSS and ODM will accept interim certificates. With IHBT, if your organization is currently OhioMHAS certified, you may submit your current IHBT certificate for purposes of Medicaid enrollment. You should update your IHBT certificate in LACTS to indicate the types of programing you will offer, but do NOT need to wait for the new certificate to update Medicaid enrollment.

Medicaid Enrolled Providers: If you are currently enrolled as an ODM provider, plan to offer any of the new and enhanced services, and have the appropriate certification/documentation, please email ODM at [email protected] as soon as possible. Request that the applicable specialty for the new service be added to your existing provider type and attach required documentation.

New Providers: If you are a provider who is not currently enrolled in the Ohio Medicaid Program, and wish to enroll to provide any services under the next generation of Medicaid, please visit the following link to the Ohio Medicaid online application: https://portal.ohmits.com/Public/Providers/Enrollment/tabId/49/Default.aspx. If your enrollment requests the addition of more than one specialty, after your enrollment is complete, please email ODM at [email protected] to submit the required documentation for the new specialties.

The managed care entities (MCEs) are building their provider networks for the Next Generation program’s July 1 go-live date. When you enroll and add the appropriate specialties to your provider enrollment information, you will help members make an informed decision while selecting a managed care organization (MCO) during open enrollment. This will allow for prompt billing and claims payment after go-live. In late spring, ODM’s provider enrollment systems will be unavailable while the state converts to its new provider network management (PNM) modular system. During the conversion, new provider enrollments will stop, and specialties cannot be added until the new system is operational on July 1.