CMS Announces Approval of Oklahoma & Maine’s Substance Use Disorder Demonstrations, the 30th and 31st to Expand Access to Combat the Opioid Crisis
The Centers for Medicare & Medicaid Services (CMS) announced today, the approval of both the Oklahoma and Maine section 1115 demonstrations to expand treatment for substance abuse disorder. CMS approved Oklahoma’s new demonstration, titled “Institutions for Mental Diseases Waiver for Serious Mental Illness/Substance Use Disorder,” and Maine’s new demonstration, entitled “Maine Substance Use Disorder (SUD) Care Initiative.” These Medicaid Substance Use Disorder (SUD) demonstration projects are the 30th and 31st approvals to broaden treatment services available to Medicaid beneficiaries diagnosed with SUD, capstoning a dramatic acceleration of participating states since the Trump Administration streamlined the pathway for states to receive approval for these demonstrations in 2017. The Oklahoma demonstration project also brings to seven the number of states that have both Serious Mental Illness (SMI)/ Serious Emotional Disturbance (SED), and SUD demonstration authority to increase access to high quality, evidence-based treatment options for Medicaid beneficiaries with SMI, SED, and/or SUD. The SMI/SED demonstration opportunity was first created in 2018. These demonstrations are expected to improve health outcomes and combat the opioid crisis for eligible Medicaid beneficiaries living in Oklahoma and Maine.
Nationwide opioid-related fatal overdoses have impacted 47,000 deaths in 2018 and more than two million individuals who have an opioid use disorder. Like many other states, the opioid crisis has impacted Oklahoma and Maine as they continue to see waitlists for inpatient and residential treatment for beneficiaries with acute SUD diagnoses. The expanded access to treatment services provided through these demonstrations are especially important in light of the COVID-19 public health emergency and the strain it is placing on everyday life.
“Today’s announcement represents a powerful reminder of what can be achieved when states are given the flexibility they need to develop innovative programs to address local needs. These demonstrations will have a massive impact on increasing access to vitally needed treatment services for Oklahomans and Mainers,” said CMS Administrator Seema Verma.
The approval of these demonstrations opens the door to critical treatment options including continuity of care in the community following episodes of acute care in hospitals and residential treatment facilities that qualify as Institutions of Mental Diseases (IMDs) as it allows the Oklahoma and Maine Medicaid programs to overcome longstanding payment exclusions. Oklahoma now has the authority to receive federal Medicaid payment for medically necessary residential SMI, SED and/or SUD treatment in IMDs, and Maine has the authority to receive federal Medicaid payment for SUD treatment in IMDs.
In addition, the Oklahoma demonstration provides facility-based stabilization of beneficiaries who are in a crisis due to mental health diseases and SUD. The demonstration will allow inpatient treatment services for short-term residents within settings that qualify as IMDs and includes services made available through call centers, mobile crisis units and intensive outpatient services.
CMS is already seeing results from other approved SUD demonstrations that improve access to opioid treatment in other states: In Virginia, the number of Medicaid beneficiaries with SUD receiving SUD services increased 104%, from 13,389 to 27,319.
For more information, please visit:
Oklahoma 1115 demonstration - https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ok-imd-waiver-smi-sud-ca.pdf
Maine 1115 demonstration - https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/me-sud-care-initiative-ca.pdf