Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-59 - OhioRISE › Section 5160-59-02 - OhioRISE: eligibility and enrollment

Current through all regulations passed and filed through July 1, 2024
(A) To be eligible for enrollment in the Ohio
			 resilience through integrated systems and excellence (OhioRISE) program, an
			 individual has to meet the criteria for first day eligibility and enrollment in
			 rule 5160-59-02.1 of the
			 Administrative Code or the criteria in paragraphs (A)(1) to (A)(3) and either
			 paragraph (A)(4), (A)(5), (A)(6) or (B) of this rule.
(1) Be twenty years of age or younger at the
			 time of enrollment;
(2) Be
			 determined eligible for Ohio medicaid in accordance with Chapters 5160:1-1 to
			 5160:1-6 of the Administrative Code;
(3) Not be enrolled in a MyCare Ohio plan as
			 described in Chapter 5160-58 of the Administrative Code;
(4) For youth age six through twenty years of
			 age, have an Ohio children's initiative brief or comprehensive "child and
			 adolescent needs and strengths" (CANS) assessment, using the tool available on
https://www.medicaid.ohio.gov
(September 20, 2021), and completed by a certified Ohio CANS assessor within
			 ninety days prior to eligibility determination that indicates paragraph
			 (A)(4)(a) and either paragraph (A)(4)(b) or (A)(4)(c) of this rule have been
			 met:
(a) For behavioral/emotional needs domain
			 items, at least one of the following items is dangerous or disabling and needs
			 immediate action or at least one of the following items is interfering with
			 functioning and needs action to ensure that the identified need is addressed:
(i) Psychosis;
(ii) Impulsivity/hyperactivity;
(iii) Depression;
(iv) Anxiety;
(v) Oppositional behavior;
(vi) Conduct;
(vii) Adjustment to trauma;
(viii) Anger control;
(ix) Substance use;
(x) Eating disturbance;
(xi) Attachment difficulties;
(xii) For youth age fourteen or older,
			 interpersonal problems.
(b) For risk behavior domain items, at least
			 one of the following items is dangerous or disabling and needs immediate action
			 or at least one of the following items is interfering with functioning and
			 needs action to ensure that the identified need is addressed:
(i) Suicide risk;
(ii) Non-suicidal self-injury
			 behavior;
(iii) Other
			 self-harm;
(iv) Danger to
			 others;
(v) Delinquent
			 behavior;
(vi) Runaway;
(vii) Intentional misbehavior;
(viii) Fire setting;
(ix) Victimization/exploitation;
(x) Sexually problematic behavior.
(c) For life functioning domain
			 items, at least one of the following items is dangerous or disabling and needs
			 immediate action or at least one of the following items is interfering with
			 functioning and needs action to ensure that the identified need is addressed:
(i) Family functioning;
(ii) Living situation;
(iii) Social functioning;
(iv) Sleep;
(v) For Ohio children's initiative brief CANS
			 school or for Ohio children's initiative comprehensive CANS school attendance
			 or school behavior.
(5) For youth age birth through five years of
			 age, have an Ohio children's initiative brief or comprehensive CANS assessment,
			 using the tool available on
https://www.medicaid.ohio.gov
(September 20, 2021), and completed by a certified Ohio children's initiative
			 CANS assessor within ninety days prior to eligibility determination that
			 indicates paragraph (A)(5)(a) and either paragraph (A)(5)(b), (A)(5)(c), or
			 (A)(5)(d) of this rule have been met:
(a) For
			 early childhood challenge domain items, at least one of the following items is
			 dangerous or disabling and needs immediate action or at least one of the
			 following items is interfering with functioning and needs action to ensure that
			 the identified need is addressed:
(i)
			 Impulsivity/hyperactivity;
(ii)
			 Depression;
(iii)
			 Anxiety;
(iv) Oppositional
			 behavior;
(v) Attachment
			 difficulties;
(vi) Adjustment to
			 trauma;
(vii) Regulatory.
(b) Meeting at least one of the
			 following:
(i) For caregiver resources and
			 needs domain items, at least one of the following items prevents the provision
			 of care and needs immediate action or at least one of the following items is at
			 least interfering with the provision of care and needs action to ensure that
			 the identified need is addressed:
(a)
			 Supervision;
(b) Residential
			 stability;
(c)
			 Medical/physical;
(d) Mental
			 health;
(e) Substance
			 use;
(f) Developmental;
(g) Family stress;
(h) Caregiver post-traumatic stress
			 reaction;
(i) Marital/partner
			 violence;
(j) Family relationship
			 with the system;
(k) Legal
			 involvement.
(ii) For
			 early childhood domain item developmental or intellectual, the need is
			 dangerous or disabling and needs immediate action or is interfering with
			 functioning and needs action to ensure that the need is addressed.
(c) The caregiver resources and
			 needs domain item "safety" is identified as a need that at least needs
			 monitoring, watchful waiting, or preventive action based on history, suspicion,
			 or disagreement.
(d) For early
			 childhood domain items, at least one of the following items is dangerous or
			 disabling and needs immediate action or at least one of the following items is
			 interfering with functioning and needs action to ensure that the identified
			 need is addressed:
(i) Sleep;
(ii) Family functioning;
(iii) Early education;
(iv) Social and emotional
			 functioning;
(v)
			 Medical/physical;
(vi) Failure to
			 thrive.
(6)
			 For youth who meet one of the following but do not meet the criteria in
			 paragraph (A)(4) or (A)(5) of this rule;
(a)
			 Meets the criteria for moderate care coordination as described in paragraph
			 (A)(1) or (A)(3) of rule
			 5160-59-03.2 of the
			 Administrative Code; or
(b) Meets
			 the criteria to receive intensive home-based treatment (IHBT) service as
			 described in rule
			 5122-29-28 of the Administrative
			 Code.