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Expanding the Substance Use Disorder (SUD) Continuum of Care Waiver

The Centers for Medicare and Medicaid Services approved Colorado’s Expanding the Substance Use Disorder Continuum of Care Section 1115 demonstration waiver (1115 SUD waiver) effective January 1, 2021 through December 31, 2025. This demonstration will run for five years and provide the state with authority to provide high-quality, clinically appropriate treatment to participants with substance use disorders.

Goals of this waiver include:

  • Increased rates of identification, initiation, and engagement in treatment
  • Increased adherence to and retention in treatment
  • Reductions in overdose deaths, particularly those due to opioids
  • Reduced utilization of emergency departments and inpatient hospitals settings 
  • Fewer readmissions to the same of higher level of care where the readmission is preventable or medically inappropriate 
  • Improved access to care for physical health conditions among beneficiaries

Federal Resources

CMS 1115 Waiver Documents

Extension Request to Colorado's 1115 SUD Waiver Demonstration

Colorado is requesting the Centers for Medicare and Medicaid Services (CMS) extend the current 1115 “Expanding the Substance Use Disorder (SUD) Continuum of Care” Waiver. HCPF is proposing an extension to the current SUD demonstration, implementing all pending amendments, and including presumptive eligibility for long term services and supports. Accordingly, HCPF is proposing to rename the demonstration, “Comprehensive Care for Colorado.”

The extension would authorize: 

  • A no change to the Substance Use Disorder (SUD) waiver authority. This Demonstration component will continue to provide the State with authority to provide high quality, clinically appropriate SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an Institution for Mental Disease (IMD).
  • Presumptive eligibility (PE) for the Long Term Services and Supports (LTSS) population will allow eligible individuals in identified crisis situations to self-declare eligibility.

In addition, Colorado is requesting that the following programs in pending 1115 amendments be incorporated into the Demonstration:

  • Re-entry services for adults and youth transitioning from correctional facilities — Submitted April 1, 2024 
  • Reimbursement for acute inpatient and residential stays in Institutions for Mental Disease for individuals diagnosed with a serious mental illness (SMI) or serious emotional disturbance (SED) — Submitted April 1, 2024
  • Continuous eligibility for children 0-3 years and 12 months of continuous coverage for individuals leaving incarceration — Submitted April 1, 2024
  • Health Related Social Needs (HRSN), housing and nutrition supports — Submitted August 12, 2024

The proposed draft extension application and other related materials are available below.

Colorado Draft 1115 Extension Request
Full Public Notice 
Abbreviated Public Notice

Public Hearings

HCPF invites the public to attend public hearings in person or join by teleconference/webinar to provide comments and feedback on Colorado’s 1115 Waiver renewal.  

  • Wednesday, September 25, 2024 from 6pm to 7:30pm MST, during the State Medical Assistance and Services Advisory Council Meeting (Night MAC) via web conference and teleconference only. Registration Link
  • Thursday, October 3, 2024, from 12pm to 2pm MST, HCPF Office (303 E 17th Avenue) Conference Room 11, via web conference, teleconference or in person.  Registration Link

Reasonable accommodations will be provided upon request. Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Please notify 303-866-3438 or the 504/ADA Coordinator at hcpf504ada@state.co.us at least one week prior to the meeting to arrange.

Amendment to Colorado's 1115 SUD Waiver Demonstration

Amendment #2: Submitted to CMS August 12, 2024

HCPF submitted an amendment to the current 1115 SUD waiver, which would authorize:

  • Housing services including pre-tenancy & housing navigation services, tenancy sustaining services, rent/temporary housing for up to 6 months (including utilities), and one-time transition and moving costs;
  • Nutrition services including meals or pantry stocking, medically-tailored meals, and nutrition counseling/education.  

1115 SUD Demonstration HRSN Amendment Request  
 

Amendment #1: Submitted to CMS April 1, 2024

HCPF submitted an amendment to the current 1115 SUD waiver, on April 1, 2024 to CMS, which would authorize:

  • Continuous eligibility for ages 0-3 and adults leaving a Colorado Department of Corrections (DOC) facility;
  • Prerelease services for individuals transitioning from correctional facilities; and
  • Reimbursement for acute inpatient and residential stays in institutes for mental disease (IMD) for individuals diagnosed with a serious mental illness (SMI) or serious emotional disturbance (SED).

1115 SUD Demonstration Amendment Request

CMS 1115 Reports

Narrative Reports (Part B)

Demonstration Year 1 (2021-2022)

Demonstration Year 2 (2022-2023)

Demonstration Year 3 (2023-2024)

Metric Reports (Part A)

Demonstration Year 1 (2021-2022)

Demonstration Year 2 (2022-2023)

Demonstration Year 3 (2023-2024)

Demonstration Year 4 (2024-2025)

Trend Graphs

Demonstration Year 1 (2021-2022)

Demonstration Year 2 (2022-2023)

Demonstration Year 3 (2023-2024)

Demonstration Year 4 (2024-2025)

Budget Neutrality

Demonstration Year 1 (2021-2022)

Demonstration Year 2 (2022-2023)

Demonstration Year 3 (2023-2024)

Demonstration Year 4 (2024-2025)

Annual Stakeholder Forum

Demonstration Year 2 (2022-2023)

Demonstration Year 3 (2023-2024)

Demonstration Year 4 (2024-2025)

Stakeholder Forums

HCPF held stakeholder overview forums virtually in May to review the proposed Health Related Social Needs (HRSN) amendment to the 1115 SUD Waiver, and provided an opportunity for participants to ask questions. These opportunities for the public to attend the forums were held on the following dates and times:

  • May 9, 2024 & May 14, 2024- View slides. English recording or Spanish recording, both with English ASL included.

HCPF held two public hearings in person and virtually in June 2024 for the proposed Health Related Social Needs (HRSN) amendment to the 1115 SUD Waiver.

  • June 20, 2024 & June 24, 2024 - HCPF reviewed FAQ content in hearing, prior to opening up for comment. 

Submitting Comments

During the public comment period, comments may be submitted via one of the following methods:

  • During one of the Public Hearing Meetings
  • Email to hcpf_1115waiver@state.co.us  
  • Fax to 303-866-4411, Attn: 1115 SUD Demonstration Amendment
  • Mail your comments to:
    Colorado Department of Health Care Policy and Financing
    Attn: Public Comment - 1115 SUD Demonstration Amendment
    303 E. 17th Avenue
    Denver, CO 80203

Additional Information

  • You can request a printed copy of the full amendment application and other documents by:
    • Sending an email to hcpf_1115waiver@state.co.us  
    • Faxing your request to 303-866-4411
    • Mailing your request to:
      Colorado Department of Health Care Policy and Financing
      Attn: Public Comment - 1115 SUD Demonstration Amendment
      303 E. 17th Avenue
      Denver, CO 80203
  • Colorado Register Demonstration Notice