CMS OKs AK’s Section 1115 Demo, Expands Behavioral Healthcare Services

September 10, 2019 - CMS approved the second part of Alaska’s Section 1115 Medicaid demonstration waiver addressing behavioral healthcare. The first part, addressing substance abuse care, was approved in November 2018 and went into effect July 1, 2019.

“CMS is pleased to support Alaska’s continued investment in expanding behavioral health treatment,” CMS Administrator Seema Verma said in a press release. “This approval will build on their efforts to provide more comprehensive care to those with substance use disorder and will help enhance the comprehensive services provided to those with behavioral health needs.”

While the need for better behavioral healthcare management has been recognized by employers across the nation, the Last Frontier state is particularly in need of behavioral healthcare reform.

Alaska’s suicide rate consistently hovered around two times the national average from 2006 to 2016.

According to the state’s 2017 Alaska Mental Health Trust Authority Scorecard, Alaska’s suicide rate spiked to 27.1 deaths per 100,000 in 2015 before dropping to 25.3 per 100,000 in 2016. The alcohol-induced death rate was around 2.4 times the national average at 22.9 deaths per 100,000 individuals.

READ MORE: CMS Approves 2 Medicaid Demos to Tackle Substance Abuse Disorders

In nearly every other area, including child maltreatment, those incarcerated with mental illnesses, illicit drug use, and chronic homelessness, the state scored either “uncertain” or “needs improvement” with scores higher than national averages.

The Section 1115 Medicaid demonstration waiver implemented a two-pronged strategy to start reversing this trend.

The waiver sought to create a more integrated health system that decreased administrative and operational challenges in order to streamline Alaska’s previously fragmented system.

The waiver also intended to expand its Medicaid services, particularly through better outreach, prevention, and early intervention across a multitude of behavioral healthcare services.

CMS’s approval will establish residential treatment for substance use disorder (SUD) and adult mental health services, a partial hospitalization program geared toward patients in need of substance abuse care and behavioral healthcare services, and mobile-enabled outreach and interventions.

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With its stunning but brutal landscape, Alaska’s behavioral healthcare programs face a distinct set of challenges to which few other US states can relate. The state’s restricted infrastructure and aggressive environmental conditions, among other factors, have prevented it from implementing authorized services across the state.

Thus, the current waiver will be used to test services within the 1115 Medicaid demonstration in order to evaluate the programs and discern which should be included in the state plan’s amendment.

“CMS is approving waivers of statewideness and amount, duration, and scope for the behavioral health benefits authorized in this demonstration amendment,” the waiver summarized.

The waiver also cited the state’s geographic challenges to justify a phase-in period of five years with the full scope of services available statewide at the end of year three.

The waiver also integrated tribal perspectives, another challenge that is distinct to Alaska.

READ MORE: State Medicaid Orgs Struggle to Provide Behavioral Health Services

The Alaska Native Health Board and the Alaska Native Tribal Health Consortium have expressed concerns including eligibility criteria for the demonstration, eligibility for behavioral healthcare services, for which they desired to extend the services to individuals 65 and older. They also questioned whether the phase-in process would result in certain services being eliminated and unavailable to individuals while the demonstration rolled out.

The state continues to work with the tribal representatives and CMS to address these and other concerns, modified the eligibility language, and assured the tribal representatives that services would not be removed during the phase-in period.

This approval covers the second part of a two-part demonstration.

The first part specifically addressed SUD. At CMS’s recommendation, Alaska divided this part from the rest of the amendment in order to more quickly implement substance abuse care to a state that has suffered from the opioid epidemic.

The SUD segment of this demonstration received CMS’s approval in 2018 and went into effect in July 2019. After two months, Alaska had approved 96 sites to implement substance abuse care under the Section 1115 Medicaid demonstration waiver.

“Medicaid waivers offer the state more flexibility in the types of services health care providers can be reimbursed for, which allows them to offer a wider range of services to their patients,” Gennifer Moreau, director of Alaska’s Department of Health and Social Services, Division of Behavioral Health, said. “Having the complete 1115 waiver approved ensures that Medicaid recipients will have options across the full continuum of care, from early intervention all the way through acute care.”

Alaska is one of 31 states implementing their section 1115 Medicaid demonstration waivers to reform their behavioral healthcare services. Minnesota and Nebraska were also recently approved for such waivers.

And the trend does not stop with Medicaid programs. Expanding behavioral healthcare services, particularly through mobile-enabled technology, has been a growing trend among private payers as well.

In June, Anthem announced that it would be acquiring Beacon Health Options, which is a behavioral healthcare management company. Beacon Health Options serves members seeking substance abuse care as well as mental healthcare and other behavioral healthcare needs.

CMS’s approval of Alaska’s behavioral healthcare expansion went into effective September 3, 2019 and will last until December 31, 2023.