Maine DHHS Press / News Release

February 22, 2019

Maine DHHS Pursues Flexibility to Strengthen Behavioral Health and Substance Use Services

Augusta, MAINE - The Maine Department of Health and Human Services (DHHS) announced today plans to seek federal flexibility that would allow Maine to better address the opioid epidemic as well as improve the continuum of behavioral and mental health services.

The Centers for Medicare and Medicaid Services (CMS) is extending financial support to states over a five-year period to improve outcomes for Medicaid members struggling with addiction, including opioid use disorder, and care for individuals with Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED). The Department will seek what is known as a section 1115 waiver, which permits states to test new ways to deliver and pay for health care services that align with the objectives of the Medicaid program.

"With this waiver application, DHHS is committing to advancing a seamless system of community-based, residential, and institutional substance use disorder and behavioral health services, including prevention to promote the wellbeing of children in our state," said DHHS Commissioner Jeanne Lambrew. "That much-needed demonstration will yield critical information about how we can improve the delivery of these services."

"We will work with stakeholders to advance the health of MaineCare members who rely on these services, from prevention and early intervention to appropriate care in the right settings," said Director of MaineCare Services Michelle Probert.

"Seeking this waiver marks a critical step forward in expanding options for treatment of opioid addiction that Governor Mills highlighted in her recent Opioid Response Executive Order," said Opioid Response Director Gordon Smith.

States may now request to waive the long-standing federal "Institutions for Mental Disease (IMD) Exclusion," which prohibits the use of federal Medicaid financing for care provided to adult patients in mental health and Substance Use Disorder (SUD) residential treatment facilities larger than 16 beds. The waiver would expand access to SUD treatment options for adults on MaineCare.

In addition to supporting residential and inpatient care, the waiver directs participating states to improve community-based mental health care for adults and children as part of these demonstrations, while maintaining current state spending on mental health and addiction treatment services. CMS has outlined comprehensive goals related to these waiver opportunities, which provide a framework for states to advance their own initiatives.

More than 20 states have already been approved for IMD Exclusion waivers, with more still pending. As part of this process, DHHS will host public hearings on the concepts and work with stakeholders to develop a robust proposal and implementation plan. The Department plans to focus on the care continuum from early intervention to how best to deliver community-based supports while ensuring higher-level services are available when needed.

A 30-day comment period on the waiver opens today, followed by a public hearing in Augusta on March 6 and another in Portland on March 7. Comments and questions can be submitted by email to: Policy.DHHS@maine.gov or by mail to: Division of Policy/MaineCare Services, 242 State St. 11 State House Station, Augusta, Maine 04333-0011.

More information, including the proposed waiver application, can be found at www.maine.gov/dhhs/oms/rules/demonstration-waivers.shtml.