Ohio Department of Medicaid

Ohio Administrative Code
Rule 5160-59-03.3 OhioRISE: intensive home-based treatment service.
Effective: July 1, 2022

(A) Scope. This rule sets forth provisions governing medicaid coverage of intensive home-based treatment (IHBT) services.

(B) Definition. IHBT is the service and activities as set forth by the Ohio department of mental health and addiction services (OhioMHAS) in rule 5122-29-28 of the Administrative Code.

(C) Eligible providers of IHBT services.

(1) Providers eligible for medicaid payment for IHBT will:

(a) Meet the criteria in paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code;
and

(b) Provide the service in accordance with rule 5122-29-28 of the Administrative Code.

(D) Coverage.

(1) Payment may be made for IHBT services rendered face-to-face in person or via telehealth in
accordance with rule 5122-29-31.

(2) Payment may be made for services rendered by IHBT staff described in rule 5122-29-28 of the
Administrative Code that are eligible as a provider of behavioral health services in accordance with
rule 5160-27-01 of the Administrative Code.

(3) Medicaid rates for services described in this rule are listed in the appendix A of this rule.

(E) Limitations

(1) The following activities are not reimbursable as part of IHBT:

(a) Time spent doing, attending, or participating in recreational activities.

(b) Child care services or services provided as a substitute for the parent or other individual
responsible for providing care or supervision.

(c) Respite care.

(d) Transportation for the beneficiary or family.

(e) Any art, movement, dance, drama, or animal therapies, unless incorporated into the IHBT
treatment modality.

(f) Services provided to teach academic subjects or as a substitute for educational personnel
including, but not limited to a teacher, teacher’s aide, or an academic tutor.

(2) A separate medicaid payment will not be made for any of the following services or treatments
while the youth is enrolled in IHBT services, unless the service is prior authorized by the OhioRISE
plan:

(a) Behavioral health assessments, screenings, and diagnostic evaluations, except of an Ohio
children’s initiative “child and adolescent needs and strengths” (CANS) assessment completed in
accordance with rule 5160-59-03.2 of the Administrative Code that is separately reimbursable.

(b) Individual, group, or family psychotherapy and counseling.

(c) Therapeutic behavioral services, except for therapeutic behavioral group service – hourly and per
diem as defined in rule 5160-27-06 of the Administrative Code.

(d) Community psychiatric supportive treatment as described in rule 5122-29-17 of the
Administrative Code

IHBTOhio.org is presented by The Center for Innovative Practices (CIP)
and the Child and Adolescent Behavioral Health Center of Excellence (CABH COE)
Part of the Begun Center for Violence Prevention
at Case Western Reserve University’s Mandel School of Applied Social Services
Mailing Address: 10900 Euclid Avenue | Cleveland, OH 44106-7164
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