Oklahoma Institutions for Mental Diseases (IMD) for Serious Mental Illness and Substance Use Disorder Section 1115(a) Demonstration Renewal

The Oklahoma Health Care Authority (OHCA) will request federal approval from the Centers of Medicare and Medicaid (CMS) to extend the Section 1115(a) Institutions for Mental Diseases (IMD) Waiver for Serious Mental Illness and Substance Use Disorder demonstration (Project Number 11-W-00363/6).  If approved, the request will renew the current demonstration, ending on December 31, 2025, from January 1, 2026 through December 31, 2030. The waiver demonstration authorizes the State to reimburse short-term residential treatment or inpatient stabilization services in an Institution for Mental Disease (IMD). Demonstration services are provided for beneficiaries with a Substance Use Disorder (SUD), Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED). Prior to the Demonstration, the OHCA was prohibited from using Medicaid funds to pay for SUD and psychiatric treatment in certain residential and inpatient programs larger than 16 beds that meet the CMS definition of an IMD. The Demonstration was implemented to ensure that beneficiaries have access to a full array of SUD and psychiatric treatment services, including inpatient and residential treatment, by allowing Medicaid coverage and reimbursement for services provided to eligible beneficiaries within an IMD.

The requested extension does not change the current approved budget neutrality methodology and does not contemplate any substantive changes to program eligibility, benefits, cost sharing, or program financing that would require modifications to the existing model. Of note, the current approved waiver includes coverage for Qualified Residential Treatment Programs (QRTPs) that meet the definition of an IMD for beneficiaries under age 21. However, there are no QRTP IMD programs in Oklahoma. The OHCA is not requesting renewal of the QRTP IMD authority.

Please view the draft renewal application here:  Section 1115(a) Institutions for Mental Diseases (IMD) Waiver for Serious Mental Illness and Substance Use Disorder Demonstration Waiver Renewal Application and submit feedback via the comment box. Additionally, the OCHA will be conducting two public hearings during which the public may provide oral comments. 

VIRTUAL PUBLIC HEARING
May 21, 2025, at 9:30 a.m.
https://www.zoomgov.com/j/1601846886

PUBLIC HEARING
May 23, 2025, at 10:00 a.m.
Oklahoma Health Care Authority
OHCA Board Room
4345 N Lincoln Blvd.
Oklahoma City, OK 73105
https://www.zoomgov.com/s/1613088585

View the full public notice here:  Oklahoma Institutions for Mental Diseases (IMD) for Serious Mental Illness and Substance Use Disorder Section 1115(a) Demonstration Waiver Renewal Full Public Notice.

View the Oklahoma 1115(a) IMD Demonstration page on the CMS web site here: Oklahoma IMD 1115 Waiver CMS Web Site.

Prior to finalizing the proposed waiver renewal application, the OHCA will consider all written and verbal public comments received. The comments will be summarized and addressed in the final version submitted to CMS.

Tribal Consultation Meeting: 1/7/2025

Circulation Date: 5/16/2025

Comment Due Date: 6/15/2025