PEP Connections: OhioRISE

Positive Education Program, through PEP Connections, provides care coordination services for OhioRISE in central Cuyahoga County.

Overview

As the agency that administers Medicaid's OhioRISE program in central Cuyahoga County, PEP Connections provides care coordination for young people who are on track for deeper system involvement, often including residential treatment, psychiatric hospitalization, juvenile court placement. This role means that PEP is what is known as a Care Management Entity (CME) for Ohio Medicaid's OhioRISE program. As a CME, PEP Connections uses a strengths-based and trauma-informed approach to help young people and their families reach the highest quality of life possible.

PEP has provided care coordination services for young people in Northeast Ohio for more than 30 years.

OhioRISE: Resilience through Integrated Systems and Excellence

OhioRISE is a Medicaid program in Ohio designed to help young people with significant behavioral health issues succeed in their schools, homes, and communities.

“RISE” stands for “Resilience through Integrated Systems and Excellence,” highlighting the program’s mission to provide comprehensive care that meets the needs of each unique individual. PEP is proud to partner with OhioRISE as one of 18 care management entities (CME). We help connect OhioRISE members in our service area with the care they need. We serve most of Cleveland and its inner-ring eastside suburbs.

Who may benefit from OhioRISE?

OhioRISE serves young people who are dealing with behavioral health challenges. These children/youth may need extra support and could be at risk for out-of-home placement or deeper system involvement due to:

Mental health needs.
Substance use challenges.
Autism or other developmental disabilities.
Juvenile court involvement.
Situations that lead to child protective services involvement.
Difficulty with peer and/or family relationships.
Problems at school.

How does OhioRISE help youth with behavioral health needs?

OhioRISE provides support for behavioral health concerns through “care coordination.” An OhioRISE enrollee and their caregiver/family are paired with a care coordinator who assists them by:

Designing a care plan that builds on the young person and their caregiver/family’s strengths, needs, culture, and vision.
Building a care team that collaborates to prioritize child/youth and caregiver/family voice and choice.
Connecting a child/youth to treatment services and resources.
Ensuring all needed services are received and barriers to care are removed.

What does OhioRISE cover?

The program provides new and improved behavioral health services including:

Intensive in-home and crisis services.
Outpatient services, such as individual and group counseling.
Inpatient mental health and substance use care at hospitals.
Behavioral health respite, which is temporary relief for a child/youth’s caregiver(s).
Primary flex funds, which is funding for services or items to help address a need in a young person’s care plan.

More information about OhioRISE services can be found on PEP’s OhioRISE Services flyer.

Who qualifies for OhioRISE?

Young people can be eligible for OhioRISE if they are:

Between the ages of 0-20,
Eligible for Medicaid, and
Need significant behavioral health treatment, as measured by the Child and Adolescent Needs and Strengths Assessment (CANS).

Children/youth may also be eligible because of certain urgent conditions. For example, if a child/youth is in a hospital for behavioral health reasons.

Two women having a meeting

What is a CANS assessment?

The Ohio Child and Adolescent Needs and Strengths (CANS) assessment is a tool used to determine eligibility for OhioRISE. The CANS assessment also:

Gathers the young person and their caregiver/family’s story.
Helps understand the young person and their caregiver/family’s needs and strengths.
Guides the best ways to provide support.
Assists with ongoing care planning.

The CANS assessment is updated regularly to make sure the child/youth’s needs are being met.

What is a CME?

A CME is an organization that is contracted by the OhioRISE plan (Aetna). In addition to completing CANS assessments, CMEs:

Provide care coordination for many of the young people enrolled in OhioRISE.
Have regular communication with OhioRISE enrollees and their caregivers/families.
Work with community organizations to see what other services and supports are available for the enrollee and their family/caregiver.
Offer 24/7 crisis support to OhioRISE enrollees and their caregivers/families so they are never alone.
Advocate for enrollees and their caregivers/families with schools, juvenile courts, behavioral health providers, and others, to ensure their voices are heard and their needs are being met.

Where can a child or youth get a CANS assessment?

PEP completes CANS assessments. To request a CANS assessment, you can:

Call 216-361-2441, or
Email pepohiorise@pepcleve.org.

What happens after the CANS assessment?

Following a CANS assessment, eligible children and youth are enrolled in OhioRISE effective the date their assessment is submitted.

If a child or youth is determined to not be eligible, they will be sent a denial notice with hearing rights.

What is the OhioRISE Waiver?

As part of the OhioRISE program, the OhioRISE 1915(c) waiver was created. The OhioRISE Waiver helps young people who are at risk of custody relinquishment or placement in a facility. This waiver has specific eligibility criteria and includes additional services. To learn more about the OhioRISE Waiver, click here.

Learn More about Care Coordination Services

To make a referral call 216-361-2441 or via email at pepohiorise@pepcleve.org