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Waiver Services during COVID-19

Table of Contents

You have the right to receive the home and community-based services (HCBS) you need during the COVID-19 pandemic. If you need additional services due to COVID-19, Appendix K may provide a way for you to receive those services.

What is Appendix K?

Appendix K is a section of HCBS waivers. States can use Appendix K to make temporary changes to waivers in emergency situations. In North Carolina, Appendix K allows LME/MCOs to waive certain waiver requirements and limitations. These temporary changes can help you during the COVID-19 pandemic. They will only last during the state of emergency.

Update July, 2022: The HHS has determined that the public health emergency will continue until October 2022, and Appendix K flexibilities are extended for 6 months after that (mid-April 2023).

Temporary changes for each NC waiver

 CAP/C and CAP/DA

  • Waiver limits on these items may be expanded:
        • home and equipment modifications
        • case management units
        • respite hours
  • Required quarterly visits can be done by phone instead of in person
  • One lunch meal may be covered from another meal delivery service if your regular CAP/ DA meal delivery service can’t come because of COVID-19.
  • Telehealth can now be used for doctor appointments and health education, including for Autism Spectrum Disorder

Read more information about temporary waiver changes under Appendix K.

Innovations and TBI Waiver

It is possible to go over the $135,000.00 waiver limit for extra services if you need them because of COVID-19.

  • You can have increased service hours from those in the Individual Support Plan (ISP) because of COVID-19 issues without prior approval from the MCO.
  • Day Supports, Supported Employment, Community Living and Supports and/or Community Networking can be provided in your home, the direct care staff’s home or a Residential Setting.
  • Relatives caring for adults with waivers can go over 56 hours/week if other caregivers cannot come because of COVID-19. “Relative” means Employers of Record, Managing Employer for Agency with Choice, guardian, parent, or representative.

More information about COVID-19 and Innovations / TBI waivers.

Resources

Additionally, you can watch DHHS’s webinar about these changes at: https://files.nc.gov/ncdma/covid-19/COVID-INNOVATIONS-AND-TBI-WAIVER- providersfinal4132020.pdf

Important information on Appendix K by waiver: https://medicaid.ncdhhs.gov/about-us/covid-19-guidance-and-resources/providers/covid-19-policy-flexibilities#medicaid-1915c-appendix-k-waiver-flexibilities-innovations-tbi-capda-and-capc

Appendix K Summary Chart:  https://medicaid.ncdhhs.gov/media/7421/download

 Appendix K FAQ: https://medicaid.ncdhhs.gov/media/7477/download

 

Posting of the presentation regarding Appendix K, may have some helpful information https://www.ncahec.net/wp-content/uploads/2020/04/COVID-INNOVATIONS-AND-TBI-WAIVER-for-beneficiary-FINAL.pdf

What if I have questions about additional benefits under these programs?

The North Carolina Division of Health Benefits (NC DHB) can help you if you have questions about these program changes or have problems getting the services allowed under Appendix

Call the NC Medicaid Contact Center at 1-888-245-0179; or email your questions to: BHIDD.COVID.Qs@dhhs.nc.gov or Medicaid.COVID19@dhhs.nc.gov

What if I am denied services that I believe I am entitled to receive?

You have the right to request a fair hearing if you believe you have wrongly been denied services. If you believe that your LME/MCO violated your rights related to your request for additional services due to COVID-19, please contact us.

Learn more DRNC’s advocacy around home and community-based services.

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