Substance Use Disorder Section 1115 Demonstration Opportunity
Description of the Demonstration Opportunity
As part of the U.S. Department of Health and Human Services’ effort to combat the ongoing opioid crisis, the Centers for Medicare & Medicaid Services (CMS) created an opportunity under the authority of section 1115(a) of the Social Security Act (Act) for states to demonstrate and test flexibilities to improve the continuum of care for beneficiaries with substance use disorders (SUDs) including Opioid Use Disorder. This demonstration opportunity aims to give states flexibility to design demonstrations that improve access to high quality, clinically appropriate treatment for opioid use disorder (OUD) and other substance use disorders (SUDs) while incorporating metrics for demonstrating that outcomes for Medicaid beneficiaries are in fact improving under these demonstrations. Further, through this initiative, CMS offers states the opportunity to demonstrate how to implement best practices for improving OUD and other SUD treatment in ways that take into account the particular challenges raised by the opioid epidemic in each state.
Monitoring and Evaluation Materials
State monitoring and evaluation guidance materials: CMS developed resources to support state approaches to monitoring and evaluation of their section 1115 SUD demonstrations opportunity. To learn more about these resources, please review the 1115 Demonstration State Monitoring & Evaluation Resources webpage.
Federal monitoring and evaluation: CMS conducts federal monitoring and evaluation of section 1115 SUD Demonstrations. Federal monitoring includes periodic Cross State Analyses which summarize trends over time from state demonstration monitoring reports.
Additionally, in September 2018, CMS also contracted with Research Triangle Institute (RTI) to design and conduct federal evaluations through a meta-analysis. The design for the federal meta evaluation of SUD demonstrations can be found here. A meta-analytic approach that draws on experiences across multiple states implementing the same type of demonstration will provide CMS and states with a deeper understanding of the variables that impact successful implementation and outcomes of demonstrations, and whether these initiatives should be replicated in other states.
In the meta-evaluation, state reported data is supplemented by other secondary and primary data sources, including Transformed Medicaid Statistical Information System (TMSIS) and national survey data. Additionally, RTI conducts limited key informant interviews and case studies to help illuminate best practices and understand particularly challenging policies to implementation.
To identify innovative approaches to address high-priority challenges, RTI will draw from the assembled analyses to create rapid-cycle reports and a summative evaluation reports.
For available Rapid Cycle Reports, please see Federal Evaluation Rapid-Cycle and Evaluation Reports.
Learning Collaboration and Other Resource Documents
Templates for a Section 1115 SUD Demonstration Initiative
- SUD Implementation Plan Template: The provides a framework for the state to document its approach to implementing the SUD demonstration.
Webinar Resources