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Date ArticleType
11/7/2017 Payment/Reimbursement
CMS Releases Section 1115 Template for Opioid Abuse and IMD Coverage Model

Last week, the Centers for Medicaid and CHIP Services (CMCS) released a State Medicaid Directors’ Letter (SMDL) template for the submission of Section 1115 Research and Demonstration Waivers aimed at addressing the opioid abuse crisis. 

Of note, CMCS also has specifically framed a waiver of the long-standing Institutions for Mental Disease (IMD) exclusion.  The IMD exclusion disallows federal matching for institutionalized individuals ages 21-64 residing in buildings with 16 or more beds.

Under the Section 1115 waiver guidance, states receiving waiver approval would be able to draw down federal matching funds for Medicaid services in such buildings.  Room and board are not covered unless such facilities qualify as inpatient facilities under Section 1905(a) of the Social Security Act (e.g., a licensed Medicaid provider including hospitals and nursing facilities). More details can be found in the CMS letter to Medicaid Directors here.