OhioRISE Implementation Checklist and OAC Rules – Released by Ohio Council

As you know, the new OhioRISE Medicaid managed care plan goes live this Friday 7/1/22. In order to assist members with this implementation and the necessary changes we created an OhioRISE operations implementation checklist. This resource outlines the operational and billing changes organizations should consider, links to OhioRISE resources, and contact information for the CMEs and Aetna teams.

Additionally, last Thursday, the Ohio Department of Medicaid (ODM) announced the full package of proposed OhioRISE Ohio Administrative Code (OAC) rules were reviewed by the Joint Committee on Agency Rule Review (JCARR) and final filed to become effective on July 1 for the launch of OhioRISE. ODM held 49 advisory councils and workgroup meetings and worked with stakeholders to develop this final package of rules and expressed appreciation for the work and support through this process.

You can visit the Register of Ohio website at https://www.registerofohio.state.oh.us/rules/search or click on the below links to view the final filed OhioRISE rules:

• 5160-59-01 OhioRISE: definitions   

• 5160-59-01.1 OhioRISE: application of general managed care rules   

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• 5160-59-02 OhioRISE: eligibility and enrollment  

• 5160-59-02.1 OhioRISE:  first day eligibility and enrollment   

• 5160-59-03 OhioRISE: covered services  

• 5160-59-03.1 OhioRISE: utilization management  

• 5160-59-03.2 OhioRISE: care coordination   

• 5160-59-03.3 OhioRISE: intensive home-based treatment service (IHBT)  

• 5160-59-03.4 OhioRISE: behavioral health respite service  

• 5160-59-03.5 OhioRISE: primary flex funds  

• 5160-59-04 OhioRISE HCBS waiver: eligibility and enrollment  

• 5160-59-05 OhioRISE HCBS waiver: covered services and providers  

• 5160-59-05.1 OhioRISE HCBS waiver: out-of-home respite  

• 5160-59-05.2 OhioRISE HCBS waiver: transitional services and supports  

• 5160-59-05.3 OhioRISE HCBS waiver: secondary flex funds  

All final files OhioRISE rules will be available on the Ohio Administrative Code rule webpage at https://codes.ohio.gov/ohio-administrative-code/chapter-5160-59 on July 1, 2022.  

If you have any questions about implementation or the rules, please reach out to me.