Healthy Louisiana Substance Use Disorder 1115 Demonstration Waiver
To maintain access to care for beneficiaries in need of Opioid Use Disorder and Substance Use Disorder (OUD/SUD) services in residential facilities, Louisiana applied for and received approval of an 1115 Demonstration Waiver, effective February 1, 2018 through December 31, 2022. The waiver is necessary to provide services to beneficiaries residing in Institutions for Mental Disease (IMDs) for stays with durations longer than 15 days. An IMD is a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases. CMS allowed the traditionally excluded use of IMDs but placed a day limit of 15 days on its usage. This waiver “waived” the cap of 15 days for Louisiana. As a result of waiver approval, Louisiana is able to receive federal financial participation (FFP), i.e. the Medicaid match, for the continuum of services to treat addictions to opioids and other substances.
Public Notice for 1115 Renewal Application
The Louisiana Department of Health (LDH) Bureau of Health Services Financing (BHSF) and the Office of Behavioral Health (OBH) currently provide critical access to opioid use disorder (OUD) and other substance use disorder (SUD) services, and continue delivery system improvements for these services to provide more coordinated and comprehensive OUD/SUD treatment for Medicaid beneficiaries through the Healthy Louisiana Substance Use Disorder 1115 Demonstration Waiver program.
LDH hereby gives public notice of its intent to seek approval from the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) for a renewal of its application for the Healthy Louisiana Substance Use Disorder 1115 Demonstration Waiver program. This notice revises a prior notice issued on October 29, 2021. The revisions to this public notice include additional detail related to the demonstration’s goals, objectives, hypotheses, health care delivery system, eligibility and cost sharing requirements, expenditure authority, and enrollment and expenditure data.
LDH will conduct a public hearing to present the Healthy Louisiana SUD 1115 Demonstration application to the public and receive comments. This hearing will be held via web conference and by telephone. The information for the hearing is included below. Any comments received during the public hearing will be recorded and incorporated into the final demonstration application, along with LDH’s response.
April 11, 2022
2:00 p.m. to 3:00 p.m. CST
USA 602 333 0032
Conference code: 1935026
LDH is posting the Healthy Louisiana Substance Use Disorder 1115 Demonstration Waiver draft renewal application for public comment from April 6, 2022 through May 6, 2022. CMS regulations require LDH to actively engage the public and give program participants, advocates, providers and other community stakeholders the chance to provide input regarding changes made to current waiver applications prior to submission of final versions to CMS. To request a hard copy, email Missy Graves at Missy.Graves@La.Gov or call (225) 342-2540. Implementation of the provisions of this waiver renewal application is contingent upon CMS approval.
- Full Public Notice – dated April 5, 2022
- Healthy Louisiana Substance Use Disorder 1115 Demonstration Waiver renewal application – dated April 4, 2022
- Appendix 1 – Interim Evaluation Report
- Appendix 2 – 2021 Aggregate EQRO Report
- Appendix 3 – HIT Plan
- Appendix 4 – Budget Neutrality Workbook
- Appendix 5 – Public Notice
Interested persons may submit written comments via electronic mail to Keith Durham at Keith.Durham@La.Gov. Written comments may also be mailed to the Louisiana Department of Health, Attn: Keith Durham, P.O. Box 91030 (Bin #24), Baton Rouge, LA 70821. Mr. Durham is responsible for responding to inquiries regarding this proposed renewal. The deadline for submitting written comments is at 11:59 p.m. on May 6, 2022.
1115 Approval and Special Terms and Conditions (STCs)
CMS approval of the demonstration waiver is conditioned on compliance with set Special Terms and Conditions (STCs). These STCs include an Implementation Protocol, SUD Monitoring Protocol, Mid-Point Assessment, and Evaluation Design and Reports. The Louisiana 1115 Approval letter contains the full list of STCs and the approved Implementation Protocol. In addition, CMS approved the SUD HIT Plan; which is the 1115 SUD Waiver Demonstration Milestone 5.0: Implementation of Strategies to Increase Utilization and Improve Functionality of PDMP.
The Louisiana Department of Health worked with Tulane University’s Department of Health Policy and Management to develop an evaluation design, to be used as a roadmap for conducting an evaluation of the 1115 waiver. On July 16, 2019, Louisiana received approval of the 1115 SUD Demonstration Waiver Evaluation Design.
1115 SUD Approved Monitoring Protocol
The OBH and BHSF teams worked to align Louisiana’s 1115 SUD Monitoring Protocol with the updated versions of the CMS section 1115 SUD demonstration technical specifications manual v2.0, monitoring reporting tools, monitoring protocol tools, and other feedback received from CMS. Louisiana’s 1115 SUD Approved Monitoring Protocol encompasses: required metrics supporting the Implementation Plan milestones; various Health Information Technology (HIT) measures; certain HEDIS and other quality measures; and baseline, annual goals, and overall demonstration targets. Louisiana received the approved monitoring protocol on June 3, 2020.
In accordance with the STCs, Louisiana must submit three (3) quarterly monitoring reports and one (1) compiled annual report for each Demonstration Year (DY). These reports include operational updates, performance metrics, budget neutrality and financial reporting requirements, evaluation activities and interim findings, and SUD health IT measures. All monitoring reports will be posted after CMS approval.
DY3 Q2 Monitoring Report
All archived quarterly and annual monitoring reports can be found here.