CMS Allows States To Extend PHE-Era Flexibilities For HCBS

The U.S. Centers for Medicare & Medicaid Services (CMS) has extended a COVID-19 pandemic-era waiver that will allow home- and community-based service (HCBS) providers to take advantage of flexibilities in their state programs.

The Appendix K waiver allowed HCBS providers more wiggle room during emergencies, such as the COVID-19 pandemic. CMS introduced the waiver to support states in responding to the unique challenges brought on by the public health emergency.

Under the previous policy, these flexibilities were set to expire six months after the expiration of the PHE — Nov. 11.


However, the new guidance suggests that these flexibilities may remain in effect for a longer period of time beyond the six-month timeframe.

“In the name of minimizing disruption to beneficiaries, providers and states, CMS is issuing this extension of the Appendix K expiration date,” CMS wrote in its guidance. “States are nevertheless strongly encouraged to submit their section 1915(c) waiver actions and section 1115 demonstration amendments as quickly as possible to minimize Appendix/Attachment K extensions for unreasonably long periods of time.”

In its guidance, CMS also wrote that if a state has not submitted a waiver action or demonstration amendment to incorporate certain Appendix K flexibilities, the flexibility would expire on Nov. 11.


During the PHE, states utilized various flexibilities permitted under Appendix K — the use of telehealth or remote service provisions, increased payment rates and the expansion of self-directed service delivery models — to make changes to their HCBS programs.

Although it is likely good news for HCBS providers, Darby Anderson — EVP and chief government relations officer at Addus HomeCare Corporation (Nasdaq: ADUS) and the public policy committee chair for the Partnership for Medicaid Home-Based Care (PMHC) — said he was not surprised by the move.

“I don’t think lapsing of Appendix Ks alone is a daunting challenge for most states — but coupled with the redeterminations and other requirements of unwinding from the PHE — I think any additional responsibilities on states are taxing at this time,” Anderson wrote in an email to Home Health Care News. “We have seen states struggle of late with the timely submission and receiving approval from CMS of submitted waiver amendments, so this will add to the volume of amendments to draft and submit and for CMS to approve.”

Because of that, CMS recommends states still submit their waiver submission as soon as possible.

Some of the flexibilities provided through the Appendix K authority during PHE have proven to be sound policy, Anderson said.

“Although they change current policy requirements, they have not had any detrimental impact on beneficiaries, created benefits for direct care workers and/or efficiencies for providers,” Anderson wrote. “Online or other virtual in-service training capabilities creating flexibility for direct care workers and other telehealth capabilities are just a couple of examples.”

States will not need to amend existing and approved Appendix K applications to take advantage of the extended expiration date, CMS said.

Instead, the new guidance serves as the “necessary documentation for states’ approved Appendix K applications to expire on either Nov. 11 or the effective date of the section 1915(c) waiver amendment,” whichever comes later, the agency wrote.

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