Nevada's 1115 Demonstration Waiver Amendment- Proposed Program Design
Public comments on the Demonstration Waiver Amendment can be submitted through 5 p.m. Pacific on October 29, 2024
Nevada’s
Treatment of Substance Use Disorders (SUDs) and Severe Mental Illness
(SMI)/Serious Emotional Disturbance (SED) Transformation Project (see link to
waiver below)
The Nevada Department of Health and Human Services (DHHS) is requesting authority from the Centers for Medicare & Medicaid Services (CMS) for a five-year, Section 1115 Demonstration waiver to expand statewide access to comprehensive behavioral health services for the most vulnerable Nevadans, including those with opioid use disorders (OUDs) and other substance use disorders (SUDs). Specifically, DHHS seeks authority to provide a limited demonstration of the federal Medicaid Institutions for Mental Diseases (IMD) exclusion (hereinafter referred to as the "Demonstration"). Nevada DHHS is seeking to amend the Demonstration to provide a limited demonstration waiver of the IMD exclusion for adults with a serious mental illness (SMI) and children with a Serious Emotional Disturbance (SED) as well as provide housing and nutrition supports as health-related social needs (HRSN) to eligible members based on clinical and social risk factors.
This demonstration is part of the State's broader efforts to ensure access to a comprehensive continuum of BH and HRSN services, in addition to the services in the SUD component of the demonstration. This demonstration waiver amendment will ensure comparable access to IMDs for Medicaid and CHIP enrollees with SMI/SED as well as SUD, regardless of delivery system. Currently, managed care organizations can provide up to 15 days of coverage as an in lieu of service for individuals with SMI/SED residing in an IMD. However, individuals served via fee-for-service (FFS) do not have such access. This demonstration waiver will provide coverage in an IMD for up to 30 days and eliminate the inconsistency between managed care and FFS coverage, to ensure comparability among delivery systems.
This Demonstration will further the objectives of Title XIX and Title XXI of the Social Security Act by improving access to high-quality, person-centered services that produce positive health outcomes for individuals with SUD, OUD, and SMI/SED; and by advancing an innovative delivery system and payment models to strengthen provider network capacity and drive greater value for Medicaid. The Demonstration will not modify the State's current Medicaid program or Children's Health Insurance Program (CHIP) outside of the benefits and reimbursement methodologies described within the application.
Program Design Information for Beneficiaries and Providers
Program 1115 Demonstration Waiver Amendment Approved and Evaluation Design
Public Hearings and Public Workshops
The Department of Health and Human Services (DHHS) recognizes that it is crucial to listen to and learn from the people who live and work with Medicaid every day. To develop the strongest Medicaid program for Nevada, DHHS continues to talk with providers, beneficiaries, advocates, and health care experts across the state and country. DHHS is committed to continuing these partnerships.
April 20th, 2021 at 9:00 AM PST
October 26th, 2021 at 9:00 AM PST
May 25th, 2022 at 10:00 AM PST
May 31st, 2022 at 10:00 AM PST
October 9th, 2024 at 9:00 AM PST
October 11th, 2024 at 9:00 AM PST
October 29th, 2024 at 10:00 AM PST
Public Comments
Public comments regarding the 1115 Demonstration Waiver Amendment were able to be submitted until 5 p.m. Pacific on October 29, 2024.
All Public Comments and State responses can be found here.
Please email questions, comments, or concerns to: 1115waivers@dhcfp.nv.gov
Contact Information
Questions related to what is covered by Medicaid, write to: 1115waivers@dhcfp.nv.gov
Meetings
Upcoming meetings are posted here
Resources
Learn more about Nevada Medicaid here