1115 SUD Demonstrations

As part of the Department-wide effort to combat the ongoing opioid crisis, on October 26, 2017 the Centers for Medicare & Medicaid Services issued guidance to states how they plan to provide additional flexibilities on section 1115 demonstrations to improve access to and quality of treatment for enrollees impacted by the Opioid crisis. This revised policy will take the place of the initiative announced in the State Medicaid Directors’ letter issued on July 27, 2015.”

In August 2015, CMS approved a section 1115 demonstration project for California that includes an evidence-based benefit design covering the full continuum of care, requiring providers to meet industry standards of care, a strategy to coordinate and integrate across systems of care, reporting specific quality measures, and ensuring there are the necessary program integrity safeguards and a benefit management strategy in place. Learn more about the California 1115 SUD demonstration, called the Drug Medi-Cal Organized Delivery System.

In November 2016, CMS approved a section 1115 demonstration project for Massachusetts that will strengthen the state’s system of recovery-oriented SUD treatments and supports by covering a more comprehensive array of outpatient, residential inpatient and community SUD services to promote treatment and recovery as part of a statewide opioid action plan.

In December 2016, CMS approved a section 1115 demonstration project for Virginia that authorizes the state to strengthen its SUD delivery system to improve the care and health outcomes for Virginia Medicaid beneficiaries. Virginia’s new SUD benefit and delivery system, called the Addiction and Recovery Treatment Services (ARTS) Delivery System Transformation, contributes to a comprehensive statewide strategy to combat opioid use disorders by expanding the SUD benefits package to cover the full continuum of care, integrating SUD services into comprehensive managed care and introducing new program, provider and managed care requirements to improve the quality of care consistent with national treatment guidelines established in the American Society of Addiction Medicine (ASAM) Criteria.

In December 2016, CMS approved a section 1115 demonstration project that will support Maryland to serve individuals with SUD, including an evidence-based benefit design covering the full continuum of care, implementing key benchmarks from industry standards of care, reporting specific quality measures, and embarking on a strategy to integrate physical and behavioral health services to improve health outcomes for beneficiaries with SUD.

In October 2017, CMS approved a section 1115 demonstration project for West Virginia that strengthens the state’s SUD delivery system through expanded service coverage, including for methadone treatment, peer recovery supports, withdrawal management and residential treatment, introduces new programs to improve the quality of care, including requiring providers to deliver care consistent with national treatment guidelines, and establishes new care coordination features. West Virginia is implementing an extensive quality and performance measurement plan to monitor and report on the impact of the demonstration.