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1115 Waiver Initiative

District of Columbia Section 1115 Medicaid Behavioral Health Transformation Demonstration

On November 6, 2019, the Centers for Medicare and Medicaid Services (CMS) approved the District’s Behavioral Health Transformation demonstration with an effective date of January 1, 2020. Most new services authorized under the waiver will be phased in beginning on the effective date. The demonstration allows the District’s Medicaid program to pay for services provided to adults with serious mental illness (SMI)/serious emotional disturbance (SED) or substance use disorder (SUD) residing in an institution for mental disease (IMD). Additionally, the demonstration will add new community-based services designed to improve behavioral health treatment capacity and strengthen transitions from emergency, inpatient and residential treatment.

The demonstration furthers the District’s goals of 1) ensuring that Medicaid provides a broader continuum of behavioral health services and supports for individuals with SMI/SED, SUD, or other behavioral health needs; 2) advancing the District’s goals in the Opioid Strategic Plan, Live.Long.DC., to improve outcomes for individuals with opioid use disorder and other SUDs; and 3) supporting movement towards a more person-centered system of physical and behavioral health care for Medicaid beneficiaries that facilitates coordinated treatment.

Approved services include:

  • Services for non-elderly individuals with SMI or SUD in an IMD setting;
  • Comprehensive Psychiatric Emergency Program Services
  • Mobile Crisis Intervention and Outreach Services
  • Psychiatric Residential Crisis Stabilization Services
  • Transition Planning Services for individuals leaving a hospital, IMD or other facility
  • Recovery Support Services for individuals with SUDs
  • Psychologist and Other Licensed Behavioral Health Provider Services
  • Psychosocial Rehabilitative Services (also known as “Clubhouse” services)
  • Trauma-Informed Behavioral Health Services
  • Supported Employment Services, and
  • Eliminating the $1 copayment for prescriptions for medication assisted treatment (MAT)

The demonstration tests whether the expenditure authority granted under this demonstration, in addition to other concurrent behavioral health delivery system enhancements and re-design efforts, results in increased access to health care services and improved health outcomes for individuals with SUD and SMI/SED.

The proposed demonstration application was submitted on April 12, 2019, and the final draft demonstration application was submitted June 3, 2019. The District held a public comment period from April 12th through and May 13th and the demonstration was available for federal public comment from June 10th through July 11th, 2019. CMS approved the demonstration on November 6, 2019.

To support implementation of the District’s approved Behavioral Health Transformation Demonstration program on January 1, 2020, DHCF published emergency proposed rulemaking in the November 29, 2019 issue of the DC Register. An electronic copy of the published notice is available on the Register website and linked below. DHCF accepted comments until December 30, 2019 and they are now being reviewed for response.

To support implementation of the District’s approved Behavioral Health Transformation Demonstration program, the Department of Behavioral Health (DBH) published two (2) emergency and proposed rulemakings in the February 7, 2020 issue of the DC Register. Comments have been received and they are now being reviewed for response. Electronic copies of the published notices are available at the Register here for Supported Employment Services and here for New Specialty Mental Health Rehabilitation Services. They are also linked below.

To support implementation of the District’s approved Behavioral Health Transformation Demonstration program, the Department of Behavioral Health (DBH) published an emergency and proposed rulemaking on Certification Standards for Substance Use Disorder Treatment and Recovery Providers in the February 28, 2020 issue of the DC Register. Comments have been received and are now being reviewed for response. An electronic copy of the published notice is available here and is linked below.

To further our efforts to work with stakeholders to ensure an easier transition, the Department of Health Care Finance (DHCF) and the Department of Behavioral Health (DBH) are hosting Friday calls to provide brief updates and serve as a listening session for questions and concerns related to the implementation of the 1115 Behavioral Health Transformation Demonstration waiver. The calls will be held every other Friday at 3 pm. We encourage participants to submit questions to [email protected] by 5 pm the Wednesday before the call or use the WebEx chat function during the call. To appropriate staff DHCF’s response to the COVID-19 health emergency, these calls are currently on hold.

Date: TBD
Time: 3-4 pm
Link: TBD
Dial-In: TBD

For further information, please contact DHCF at [email protected]

Waiver-Related Documents: 

Approval Materials
CMS Waiver Approval Special Terms and Conditions 11.6.19 - (pdf)
Press Release Waiver Approval 11.6.19 -  (pdf)

Application Materials
Summary of 1115 Waiver Demonstration Application 6-3-19 - (pdf)
District Letter from DM Turnage to Administrator Verma 6-3-19 -  (pdf)
1115 Draft Demonstration Waiver Application 4.12.19 -  (pdf)
Summary of Draft 1115 Waiver Demonstration Application - (pdf)
1115 Final Demonstration Application 6-3-19 -  (pdf)
Section 1115 Medicaid Waiver Demonstration Press Release 4.12.19 - (pdf)

Waiver-Related Transmittals

Behavioral Health Transformation Demonstration Rates for Crisis Services - (pdf)
Compiled Behavioral Health Transformation Demonstration Program Rates - (pdf)
Behavioral Health Transformation Demonstration Rates for TREM and TST- (pdf)
Transmittal 19-31- Services Provided in Institutions for Mental Disease for Medicaid Beneficiaries Aged 21-64 -  (pdf)
Transmittal 19-25 Enrollment of New Behavioral Health Provider Types -  (pdf)
Transmittal 19-26 Billing Guidance for Medicaid Section 1115 Behavioral Health Transformation Demonstration Service - (pdf)
Transmittal 19-27 Removal of MAT Co-Pay - (pdf)
Transmittal 19-28 Independent Practice for Psychologists and Other Licensed Behavioral Health Providers (pdf)
Behavioral Health Transformation Demonstration Program Rates 12-09-2019 - (pdf)
Behavioral Health Transformation Demonstration Rates for Supported Employment - (pdf)
Transmittal 20-12 – Behavioral Health Transformation Demonstration Program – HIE Participation Requirements for IMDs - (pdf)

Stakeholder and Meeting Materials
Behavioral Health Transformation Demonstration Program Services Grid - (pdf)
District Medicaid Section 1115 Behavioral Health Transformation Waiver Frequently Asked Questions (FAQ) -  (pdf)
Public Hearing #2 Agenda -  (pdf)
Flyer Waiver Kickoff Meeting 11.21.19 -  (pdf)
Agenda for Waiver Kickoff Meeting - (pdf)
Waiver Kickoff Meeting Presentation 112119 - (pdf)

Rulemakings and Other Documents
Second Chapter 86 Behavioral Health Transformation Rulemaking - (pdf)
SUD Certification Standards Rulemaking - (pdf)
Chpt-86-Behavioral Health Transformation Demo Program Rulemaking - (pdf)
New Mental Health Rehabilitation Services Rule - (pdf)
Supported Employment Services Rule - (pdf)