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Idaho 1115 Waiver Summary – Institutions for Mental Diseases

January 14, 2020

McDermott+Consulting

On January 3, 2020, Idaho submitted a new section 1115 waiver application to the Centers for Medicare and Medicaid Services (CMS).  Specifically, Idaho is requesting a 5-year section 1115 demonstration that authorizes the state to receive federal financial participation for medically necessary acute short-term stays services provided in institutions for mental diseases (IMD) for diagnoses of substance use disorder (SUD), serious mental illness (SMI) or serious emotional disturbance (SED).  These services were previously not covered for Medicaid beneficiaries residing in an IMD. CMS is accepting comments on the application from January 9, 2020 through February 8, 2020.

Please find our summary of key points of the waiver below.

Expanding Coverage of Reimbursable Services

Through the 1115 Waiver, Idaho is seeking approval to receive federal Medicaid funds to reimburse medically necessary acute short-term stays in an IMD for Medicaid beneficiaries with SMI, SED or SUD.  Idaho will create a certification process for all newly enrolled providers and conduct ongoing assessment of existing providers to verify that beneficiaries are receiving high-quality care. The state will require that all participating providers have received licensing and accreditation from a nationally recognized accreditation entity.

Idaho intends to add ‘recovery coaching’ to the list of Medicaid covered benefits, while also expanding access to and utilization of peer and family support services.  Furthermore, the state plans on adding Assertive Community Treatment (ACT) to the Medicaid fee schedule.  ACT is a community-based form of mental health care designed to be delivered in a community setting as opposed to a more restrictive in-patient setting.

Beginning in 2020, the Idaho Department of Health and Welfare (IDHW) will provide methadone maintenance as a covered behavioral health service.  Furthermore, the IDHW will require all IMD’s receiving Medicaid payments to provide at least two forms for Medication Assisted Treatment (MAT).  Idaho Medicaid will reassess its reimbursements for MAT to ensure that providing MAT to Medicaid families remains financially viable.

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