Substance Use Disorder Demonstration

 
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Medicaid & Long-Term Care
 
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What you need to know

​​​​​​​​MLTC's Substance Use Disorder (SUD) demonstration waiver allows Nebraska Medicaid to cover SUD residential services in Institutions for Mental Diseases (IMDs) for Medicaid-enrolled adults ages 21-64. Coverage of residential services allows Medicaid enrollees to receive the appropriate level of care, reducing emergency department visits and increasing referrals for outpatient community-based services upon discharge. This demonstration waiver began on July 1, 2019.

Under the waiver, Nebraska has also increased access to community-based services. In June 2021, the State began ​coverage for Opioid Treatment Program (OTP) to provide Nebraskans additional outpatient treatment options. ​

The Centers for Medicare and Medicaid Services (CMS) approved Nebraska's application for a section 1115 SUD demonstration waiver. MLTC has begun the process of implementing this new waiver authority. The full text of Nebraska's 1115 SUD demonstration agreement with CMS can be found at the following link: Nebraska Section 1115 Substance Use Disorder Program


Program ​Update 

Under the Section 1115 SUD Demonstration Waiver, the State has been able to cover 4,708 stays in Institutions for Mental Diseases (IMDs) that would not have been otherwise covered.

​​IMD Stays (July 1, 2019 – September 30, 2024​​)​
​Total Stays
7,510
Stays Over 15 Days*​
4,708
Stays Under 15 Days​
2,398
​Ongoing Stays**
404
​*Stays over 15 days account for 62.7% percent of IMD stays​. These stays would not otherwise be covered without the 1115 SUD waiver.
**Ongoing Stays include the number of stays still in progress at the end of the reporting period.

NE 1115 SUD IMD STAYS GRAPH
​View the accessible PDF​

Program Information

1115 SUD Renewal Application

In accordance with 42 CFR 431.408, the Nebraska Department of Health and Human Services (DHHS), Division of Medicaid and Long-Term Care (MLTC) submitted the Nebraska Section 1115 Substance Use Disorder (SUD) Demonstration Waiver Renewal application to the Centers for Medicare and Medicaid Services (CMS). The 1115 SUD demonstration waiver, effective July 1, 2019, provides DHHS with the authority to receive federal Medicaid financial participation (FFP) for the coverage of SUD treatment-related stays in Institutions for Mental Diseases (IMDs) for adults ages 21-64. More specifically, the authority allows the state the flexibility to include in managed care capitation rate development IMD stays that exceed the 15-day limit found in 42 CFR 438.6(e). DHHS requested renewal of the waiver for an additional five (5) year period, July 1, 2024, through June 30, 2029.

On June 17, 2024, DHHS received a one-year temporary extension to the 1115 SUD Demonstration Waiver, extending the initial waiver period an additional year, July 1, 2024 through June 30, 2025. DHHS continues to work with CMS on the five-year waiver renewal. ​

​Monitoring Protocol 

Waiver Materials

​Provider Education


​Substance Use Disorder Demonstration Public Forum

​​​​​Opioid Treatment Program

​​Medically Monitored Inpatient Withdrawal Management
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