Substance Use Disorder Demonstration Project

Section 1115 Demonstration Waiver for Substance Use Disorder (SUD) Treatment

Overview

Questions and comments about the Demonstration may be sent to ct-sud-demo@ct.gov.

***Click this link to subscribe to updates regarding this project.***

Section 1115 Demonstration Waiver for Substance Use Disorder Treatment

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 for states to demonstrate and test flexibilities to improve the continuum of care for beneficiaries with substance use disorders (SUD) including Opioid Use Disorder (OUD).

The Connecticut Department of Social Services (DSS) requested an 1115 Demonstration Waiver for SUD inpatient and residential treatment for adults and children under fee‑for‑service (FFS). Connecticut also requested this Demonstration to ensure a complete American Society of Addiction Medicine (ASAM) levels of care (LOCs) service array is available as part of an essential continuum of care for Medicaid‑enrolled individuals with OUD and other SUDs. Connecticut requested the Demonstration amendment be effective immediately upon approval to use Institutions for Mental Diseases (IMDs) as a Medicaid‑covered setting.

Connecticut Medicaid covers all ambulatory ASAM Level of Care (LOCs) 0.5 through 2.5, as well as inpatient withdrawal management (ASAM level 4-WM). Connecticut will be submitted a Medicaid State Plan Amendment (SPA) in conjunction with this Demonstration to cover residential and inpatient treatment, as well as all levels of withdrawal management (ASAM levels 1-WM, 2-WM, 3.1, 3.2-WM, 3.3, 3.5, 3.7, 3.7-WM, 4). The Demonstration will permit DSS to provide critical access to medically necessary SUD treatment services in the most appropriate setting for the member as part of a comprehensive continuum of SUD treatment services.

Additional information about SUD 1115 demonstrations, including a list of all states that have already established a SUD 1115 demonstration, can be found on the CMS website at this link: https://www.medicaid.gov/medicaid/section-1115-demonstrations/1115-substance-use-disorder-demonstrations/section-1115-demonstrations-substance-use-disorders-serious-mental-illness-and-serious-emotional-disturbance/index.html. Connecticut’s SUD 1115 application, approval letter and Special Terms and Conditions of the waiver as well as all required reporting and evaluation deliverables are accessible at this webpage: https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/index.html (select the appropriate filters within the webpage to find the relevant waiver application).

Submission to the Centers for Medicare & Medicaid Services (CMS) - Substance Use Disorder (SUD) Section 1115 Demonstration Waiver

On August 9, 2021, the Department of Social Services (DSS) formally submitted to CMS the following documents for review:

The State’s SUD 1115 Waiver application, implementation plan and SUD Health Information Technology (HIT) plan were approved by CMS on April 14, 2022 and is effective from the approval date through March 31, 2027. The approval document contains the CMS approval letter as well as the special terms and conditions (STCs) for the demonstration. The State’s Acceptance of Award and STCs was sent to CMS on April 28, 2022.

Responses to Public Comments – Substance Use Disorder (SUD) Section 1115 Demonstration Waiver

After completion of the public comment period and public hearings described below, DSS issued formal responses to comments and revised the draft waiver application. These documents are posted here:

Public Comment & Public Hearings – Substance Use Disorder (SUD) Section 1115 Demonstration Waiver

The Department of Social Services (DSS), in collaboration with the Department of Children and Families (DCF) and the Department of Mental Health and Addiction Services (DMHAS), proposes a SUD demonstration waiver under section 1115 of the Social Security Act (Demonstration), described below. For public review and comment, please see the following documents:

Public Comments: Written comments are accepted from February 2, 2021 through March 4, 2021. Please send comments to: Public.Comment.DSS@ct.gov

Public Hearings: There will be two electronic public hearings (accessible by electronic device and telephone). Links and call-in information are contained within the public notice. Please check this webpage regularly for updates before logging onto the public hearing.