MedicaidCoverageMedium impact
5160-59-03 - OhioRISE: covered services. (New/Final File)
Ohio Medicaid·OH · Pediatrics, Psychiatry, Family Medicine·Managed Care
Effective date
Jul 1, 2022
We identified it
Jun 20, 2026
Summary
Ohio has established Rule 5160-59-03 defining covered services under the OhioRISE program, which is Ohio's specialized Medicaid managed care program for children and youth with complex behavioral health and multi-system needs. This creates a new framework for billing behavioral health services for eligible pediatric patients in Ohio.
Action Required
Billing teams serving Ohio patients should review the OhioRISE covered services rule to understand which behavioral health services are covered under this specialized Medicaid program. Contact the Ohio Department of Medicaid at 614-752-3877 for specific billing guidance and covered service details for pediatric patients with complex behavioral health needs.