Institutions for Mental Diseases Waiver for Serious Mental Illness/Substance Use Disorder
Beginning Jan. 1, 2021, the Centers for Medicare & Medicaid Services approved the 1115 IMD waiver for serious mental illnesses and substance abuse disorder. The Oklahoma Health Care Authority coordinated and collaborated with the Oklahoma Department of Mental Health and Substance Abuse Services to submit and implement the waiver. The IMD waiver for SMI/SUD provides access to mental health and substance use treatment by allowing:
- Medicaid coverage and reimbursement for services provided to eligible adults with SMI/SUD, ages 21-64, within IMDs;
- Individuals under the age of 21 to receive residential SUD services within an IMD as well as qualified residential treatment programs; and
- Medically necessary services covered under the waiver including:
- residential substance use disorder treatment;
- facility-based crisis stabilization; and
- inpatient treatment services within IMDs.
OHCA and CMS negotiate and agree upon special terms and conditions (often referred to as “the waiver”) which includes:
CMS Approval Letter
Received by OHCA on Dec. 22, 2020, CMS’ approval letter outlines the reasons for approval as well as the demonstration’s effective date of Dec. 22, 2020 through Dec. 31, 2025.
Expenditure Authorities
A listing of the specific expenditure authorities CMS will allow the state to make, with federal matching funds included, on items, programs or services that were not previously allowed, but are permitted under the demonstration; and
OK IMD Waiver for SMI/SUD Special Terms and Conditions
The numerous special terms and conditions CMS requires Oklahoma meet to fulfill the State’s obligations under the demonstration, including eligibility and enrollment, program benefits, monitoring and reporting requirements, and much more.
CMS also posts the waiver with any accompanying amendments and extensions or renewals. Visit Medicaid.gov for more information on the IMD for SMI/SUD waiver.
OHCA is required to report to CMS quarterly as well as annually and provides a comprehensive program evaluation for each waiver timeframe approved, generally every three years. Within the first 6 months of the waiver’s approval, OHCA will submit a proposed evaluation design for the first five-year approval period.
IMD Waiver for SMI/SUD Monitoring Protocols
IMD Waiver for SMI/SUD Monitoring Reports
| Year | Q1 | Q2 | Q3 | Q4 (Annual Report) |
|---|---|---|---|---|
| 2021 | SMI - Part B SUD - Part B |
SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
| 2022 | SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
| 2023 | SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
| 2024 | SMI - Part A | Part B SMI - Annual Assesment SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
| 2025 | SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
| 2026 | SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
SMI - Part A | Part B SUD - Part A | Part B |
IMD Waiver Budget Neutrality Reports
2023 - Q1 | Q2 | Q3 | Q4
2024 - Q1 | Q2 | Q3 | Q4
2025 - Q1 | Q2 | Q3 | Q4
2026 - Q1 | Q2 | Q3 | Q4
