N.M. Medicaid waiver limits retroactive coverage, includes IMD provision

The Centers for Medicare & Medicaid Services Friday approved a Section 1115 waiver extending a New Mexico Medicaid demonstration for five years, and authorizing the state to receive federal funding to treat enrollees with opioid and other substance use disorders who are short-term residents in Institutions for Mental Disease. The waiver also authorizes the state to increase Medicaid copayments for inappropriate use of hospital emergency departments or choosing certain high-cost drugs; gradually increase Medicaid premiums; terminate coverage after three months for failure to pay premiums; and eliminate retroactive coverage for new enrollees. Among other changes, the waiver authorizes pilot programs for home visitation and for individuals with serious mental illness; one additional year of funding for the state’s uncompensated care pool and three years of funding for the state’s Hospital Quality Improvement Incentive Pool. CMS last month announced new opportunities for states to design innovative service delivery systems for adults with serious mental illness and children with serious emotional disturbance, including Section 1115 waivers for short-term residential treatment services in an Institution for Mental Disease.