NH DHHS Seeks Demonstration Waiver Extension from CMS to Support and Enhance Access to Behavioral Health Services

Concord, NH – As part of New Hampshire’s ongoing efforts to improve access to behavioral health services in the State, the New Hampshire Department of Health and Human Services (DHHS) announces its intent to request from the Centers for Medicare and Medicaid Services (CMS) a five-year extension of the Substance Use Disorder Serious Mental Illness Serious Emotional Disturbance Treatment and Recovery Access Section 1115(a) Research and Demonstration Waiver. The proposed extension will allow the Department to continue in its efforts to expand the continuum of care for and increase access to substance use disorder and mental health treatment supports for all New Hampshire residents.

In addition to extending the existing authorities as outlined in the approved Special Terms and Conditions dated June 2, 2022, the request also includes a newly proposed component called Community Reentry. This new  demonstration authority would enable DHHS to claim federal reimbursement for beneficiaries who are otherwise eligible and receiving substance use disorder (SUD), serious mental illness (SMI), or Serious Emotional Disturbance (SED) treatment while an inmate of a public institution within NHDOC’s system of state prisons, for a focused package of care coordination and services to be provided during the period 45 days prior to release.

“This extension allows New Hampshire to continue strengthening our behavioral health continuum of care and expand access to critical supports for those in need of substance use and mental health treatment,” said DHHS Commissioner Lori Shibinette. “The addition of Community Reentry would make New Hampshire one of the first states in the nation to implement such a demonstration and we are eager to test the commonsense notion that enhancing care transitions from incarcerated settings will lead to reduced recidivism and potentially savings for the Medicaid program and Department of Corrections.”

Prior to submitting the extension request to CMS, DHHS is seeking comment from the public. The 30-day public comment period is from Monday, August 8, 2022, until Tuesday, September 6, 2022. All comments must be received by 5:00 pm (Eastern) on Tuesday, September 6, 2022. DHHS will host two public hearings during the public comment period:

• Wednesday, August 10, 2022, 5:30 pm 
  Manchester Public Library Auditorium 
  405 Pine Street 
  Manchester, NH 03104

• Thursday, August 18, 2022, 5:00 pm
  Littleton Regional Healthcare 
  600 St. Johnsbury Road 
  Littleton, NH 03561

Additionally, residents may also provide comment at the Medical Care Advisory Committee (MCAC) meeting on August 8, 2022, 10:00 am, Brown Building Auditorium, 129 Pleasant Street, Concord, NH 03301. All MCAC meetings are open to the public.

Through this extension, the State aims to achieve the following objectives:

• Substance Use Disorder (as approved by CMS)
  • Increase rates of identification, initiation, and engagement in SUD treatment; 
  • Increase adherence to, and retention in, SUD treatment; 
  • Reduce overdose deaths, particularly those due to opioids; 
  • Reduce utilization of emergency department and inpatient hospital settings for SUD treatment where the utilization is preventable or medically inappropriate, through improved access to other continuum of care services;  Reduce readmissions to the same or higher level of care, where the readmission is preventable or medically inappropriate; and 
  • Improve access to care for physical health conditions among beneficiaries.
• Serious Mental Illness and Serious Emotional Disturbance (as approved by CMS)
  • Reduce utilization and lengths of stay in emergency departments among Medicaid beneficiaries with SMI/SED while awaiting treatment in IMDs; 
  • Reduce preventable readmissions to IMDs; 
  • 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 beneficiaries with SMI/SED, 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 IMDs.
• Community Reentry (as proposed by the State)
  • Increase time in community following release from incarceration by enhancing care coordination pre-release;
  • Reduce parole violations related to SUD and/or SMI by effectively connecting formerly incarcerated members with community-based providers;
  • Reduce recidivism, especially for SUD-related offenses;
  • Reduce utilization of SUD and/or SMI residential treatment services by formerly incarcerated members; and
  • Reduce utilization of emergency department and inpatient hospital settings for SUD and/or SMI treatment where the utilization is preventable or medically inappropriate, through improved access to other continuum of care services.

For more information about the extension application, submitting public comments, or attending a public hearing or the August MCAC meeting, please visit the Medicaid Waivers & Demonstrations page.