NH DHHS Receives CMS Approval to Expand Treatment Capacity for Adults with Serious Mental Illness

Concord, NH – The NH Department of Health and Human Services (DHHS) has received approval from the Centers for Medicare and Medicaid Services (CMS) to amend the Substance Use Disorder Treatment and Recovery Access Section 1115(a) Research and Demonstration Waiver. The approved amendment will increase access to treatment for Medicaid beneficiaries with a serious mental illness (SMI) and help reduce the number of people waiting in hospital emergency departments (EDs) for a mental health bed.

The amended waiver will allow the New Hampshire Medicaid Program to pay for short-term stays in Institutions for Mental Diseases (IMDs) provided to Medicaid enrollees between ages 21-64 with SMI and approved for full Medicaid benefits. This effort is an important piece of broader DHHS efforts to establish a community-centered continuum of care that meets the behavioral health needs of all residents. Other advancements include the launch of the Rapid Response Access Point on January 1, 2022; the launch of Critical Time Intervention, which connects people preparing for discharge from psychiatric inpatient settings to services and supports in their home communities to reduce the risk of readmission; expansions of community-based stabilization and supported housing programs; and the establishment of intensive family wrap-around supports.

“Aligned with our Ten Year Mental Health Plan, this is a critical component of statewide efforts to enhance the continuum of care for people with behavioral health needs across the State,” said DHHS Commissioner Lori Shibinette. “This will help expand access to inpatient psychiatric services and alleviate the burden on people waiting in hospital EDs for treatment. While we remain committed to increasing access to community-based alternatives to inpatient care, the amended waiver will also expand the availability of intensive levels of care and treatment for those who need it.”

DHHS will continue to work with providers to enhance the State’s capacity for inpatient treatment services as part of a comprehensive approach to ending the ED boarding wait list. The demonstration will initially extend to hospital level of care IMDs, and DHHS plans to expand to include qualifying residential level of care IMDs in the future.

Through this amendment, the state aims to achieve the following objectives:

• Reduce utilization and lengths of stay in emergency departments among Medicaid beneficiaries with SMI while awaiting mental health treatment in specialized settings;
• Reduce preventable readmissions to acute care hospitals and residential settings;
• Improve availability of crisis stabilization services, including services made available through call centers and mobile crisis units, intensive outpatient services, as well as services provided during acute short-term stays in residential crisis stabilization programs, psychiatric hospitals, and residential treatment settings throughout the state;
• Improve access to community-based services to address the chronic mental health care needs of Medicaid beneficiaries with SMI, including through increased integration of primary and behavioral health care; and
• Improve care coordination, especially continuity of care in the community following episodes of acute care in hospitals and residential treatment facilities.

The demonstration waiver has been retitled the Substance Use Disorder Serious Mental Illness and Serious Emotional Disturbance Treatment and Recovery Access Section 1115(a) Research and Demonstration Waiver. For more information about this approval and future updates, please visit the Medicaid Waivers & Demonstrations web page.