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Department of Health Care Finance Applies for Medicaid Demonstration for Mental Health and Substance Use Disorders Under New CMS Guidance

Tuesday, June 4, 2019

(Washington, DC) – Today, the District announced its efforts to fight opioid use by seeking additional federal resources to expand treatment and recovery services for District residents enrolled in the Medicaid program. The District of Columbia Department of Health Care Finance (DHCF), in collaboration with the District of Columbia Department of Behavioral Health (DBH), has applied for an 1115 Medicaid Behavioral Health Transformation Demonstration from the federal Centers for Medicare and Medicaid Services (CMS) within the U.S. Department of Health and Human Services. The proposed demonstration expands coverage for behavioral health services and promotes links between levels of behavioral health care to improve outcomes for the nearly one-third of Medicaid beneficiaries with a behavioral health diagnosis.

The application, submitted on June 3, 2019, reflects stakeholder input received through a public comment process. The proposed demonstration application was initially shared with the public on April 12, 2019 and stakeholders were given the opportunity to comment during three public hearings and a 30-day comment period that ended on May 13, 2019.

The District’s 1115 Medicaid Behavioral Health Transformation Demonstration, if approved, will allow Medicaid to pay for services provided by an institution for mental disease (IMD) to adults with serious mental illness (SMI) or substance use disorder (SUD). It would also expand and add new community-based Medicaid services for individuals with SMI/serious emotional disturbance (SED), SUD, or at risk for an SUD or behavioral health crisis. These services are designed to improve treatment capacity and strengthen transitions from emergency, inpatient and residential treatment and correctional facilities to outpatient and community settings.

The District is the first state Medicaid program to submit a new application for a combined SMI and SUD demonstration under Section 1115 of the Social Security Act for federal approval since CMS announced the SMI/SED opportunity in November 2018.

“The District’s submission of the Behavioral Health Transformation waiver today offers new hope for District residents with behavioral health and substance abuse needs,” said Wayne Turnage, Deputy Mayor for DC Health and Human Services and Director of the DC Department of Health Care Finance. “If approved, this Medicaid waiver could help the District stem the rise in opioid-related fatalities and allow Medicaid to better align systems to provide more coordinated and effective care for behavioral health needs.”

Expanded and new services proposed include:

  • adding adult residential and inpatient services in behavioral health facilities for short-term, acute stays;
  • expanding crisis stabilization and mobile outreach services, including psychiatric residential crisis stabilization;
  • providing comprehensive recovery support services, including peer specialist services and community-based peer services;
  • providing expanded supported employment services;
  • creating new coverage for psychologists and other independent behavioral health providers;
  • eliminating the copayment for prescriptions for medication assisted treatment (MAT); and
  • adding transition planning services for beneficiaries leaving inpatient or residential settings or correctional sites.

“By providing greater access to treatment and increased supports to maintain recovery, this waiver will allow the Department of Behavioral Health to provide a more robust system of care for thousands of District residents living with mental or substance use disorders,” said Dr. Barbara J. Bazron, Acting Director of the DC Department of Behavioral Health. “This waiver will strengthen the District’s ability to reduce deaths from opioid and other substance use disorders and decrease the negative impact of mental illness and addiction on overall health which can lead to poor physical health and early deaths.”

“This waiver helps move Medicaid towards a more person-centered, coordinated way of delivering care and helps the District focus on what matters – connecting residents to care and maximizing opportunities for recovery,” said DHCF Senior Deputy Director/Medicaid Director Melisa Byrd. We look forward to building on the collaboration with stakeholders to ensure we continue to move in the right direction.”

To view the District's proposed 1115 Medicaid Behavioral Health Transformation Demonstration application, please go to: dhcf.dc.gov/1115-Waiver-Initiative.

The Department of Health Care Finance is the District’s State Medicaid Agency. The mission of the Department of Health Care Finance is to improve health outcomes by providing access to comprehensive, cost-effective and quality healthcare services for residents of the District of Columbia. For more on DHCF, please visit dhcf.dc.gov.