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Department of Health Care Finance - DHCF
 

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1115 Waiver Initiative

District of Columbia Section 1115 Medicaid Behavioral Health Transformation Demonstration Program

On June 3, 2019, the Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in the Department of Health Care Finance Establishment Act of 2007, and in collaboration with the Department of Behavioral Health (DBH), submitted a Section 1115 Medicaid demonstration application for the District Medicaid Program to the Centers for Medicare and Medicaid Services for review and approval.

The proposed demonstration targets all Medicaid State Plan eligible individuals diagnosed with a serious mental illness (SMI)/serious emotional disturbance (SED) or substance use disorder (SUD), or is at-risk for an SUD. The demonstration proposes Medicaid service and reimbursement changes with the goal of 1) ensuring that Medicaid provides a broader continuum of behavioral health services and supports for individuals with an SMI/SED, SUD, or other behavioral health needs; 2) advancing the District’s critical 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 integrated system of medical and behavioral health care for Medicaid beneficiaries that facilitates coordinated treatment.

Specifically, the District seeks approval to reimburse for the full continuum of care for individuals with SMI/SED, SUD, or identified as at-risk for an SUD, including treatment of Medicaid-eligible adults in residential and inpatient hospital settings that are considered institutions for mental disease (IMDs).

The District is seeking approval to incorporate the following services and service changes for individuals participating under the demonstration:

  • Treatment of adults (21-64 years old) with SMI or SUD in IMD inpatient or residential settings
  • Crisis Stabilization Services, including changes to Crisis Psychological Emergency Program and Mobile Crisis Services and the addition of Psychiatric Residential Crisis Stabilization
  • Recovery Support Services, including SUD services provided by certified peer counselors and Clubhouse Peer-Run rehabilitative supports
  • Trauma-Informed Services
  • Supported Employment Services
  • Psychologist and Other Licensed Behavioral Health Provider Services;
  • Removal of Beneficiary Cost-Sharing Requirement for Prescriptions Associated with Medication-Assisted Treatment (MAT); and
  • Transition Planning Services for individuals transitioning from inpatient, residential, or criminal justice settings.

The demonstration will test 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 draft and final demonstration application and corresponding summaries are attached below. The draft application was published on April 12, 2019.  The District’s thirty (30) day public comment period was open from April 12, 2019 through 6 pm on May 13, 2019. After the comment period, the District reviewed and responded to comments and included information regarding the response in the final draft.  The final demonstration application and supporting documentation was submitted to the federal Centers for Medicare and Medicaid Services at the U.S. Department of Health and Human Services on June 3, 2019. Under federal guidelines, CMS will provide another 30-day public comment period for national stakeholders, which will be noticed at the federal level by CMS.

An electronic copy of the proposed demonstration application is attached below. A printed copy of the proposed demonstration application is available for viewing upon request at Department of Health Care Finance Main Entrance, 441 4th Street NW, 9th Floor South, Washington DC 20001.

Public Hearings 

DHCF and DBH held three public hearings during the comment period, where written and oral comments on the proposed application were accepted. Sign language translation and Spanish language translation were available at the two in-person hearings. Physical accommodations and additional translation supports were available upon request to [email protected]. Recordings of these hearings will be made available on this website.

Public Hearing #1 
Date: Thursday April 18, 2019 
Time: 4 to 5:30 pm
Location: Room 284/285 at 64 New York Avenue NE, Washington, DC 20002.  
Agenda [PDF]

Please note that picture identification is required to enter the building. 

Individuals can join the first public hearing by phone by dialing 1-650-479-3208 and using the access code 734 846 373, or by web conference by going to https://dcnet.webex.com/dcnet/j.php?MTID=m16ac0a389f0d792dfac836a622217677  

Public Hearing #2 
Date: Thursday April 25, 2019 
Time: 5:30 to 7 pm
Location: Room 2023 at 2235 Shannon Place SE, Washington, DC 20020. 
Agenda [PDF]

Please note that picture identification is required to enter the building. 

Individuals can join the second public hearing by phone by dialing 1-650-479-3208 and using the access code 736 944 854, or by web conference by going to https://dcnet.webex.com/dcnet/j.php?MTID=mb9af60f9b60a97c01b4a95bf9876de04  

Public Hearing #3 
Date: Tuesday April 30, 2019  
Time: 1:30 to 3 pm
Location: Web conference and Teleconference only  
Agenda [PDF]

Individuals can join the third public hearing by phone by dialing 1-650-479-3208 and using the access code 738 423 593, or by web conference by going to https://dcnet.webex.com/dcnet/j.php?MTID=m8faafc40b618fb1ebbc7d6dbf60bbf08  

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