CMS Releases New State Medicaid Director Letter on Extending Appendix K Flexibilities

Last week, the Centers for Medicare & Medicaid Services (CMS) issued guidance to state Medicaid directors, addressing the expiration of flexibilities provided under section 1915(c) Home and Community-Based Services (HCBS) waiver Appendix K amendments. As the COVID-19 Public Health Emergency (PHE) has ended, CMS recognizes the importance of supporting states and beneficiaries in their transition back to normal operations. The guidance outlines the process through which states can request an extension of their Appendix K flexibilities beyond November 11, 2023.

Throughout the duration of the PHE, states heavily relied on the flexibilities offered under Appendix K to implement various actions within their home and community-based services programs. These actions include, but are not limited to, telehealth or remote service provision, increased payment rates, self-direction service delivery models, expanded services, and the inclusion of family members and legally responsible individuals as part of the provider network.

Previously, CMS had indicated that the authority granted through Appendix K for COVID-19 provisions would expire no later than six months after the conclusion of the PHE. However, recognizing the significance of these flexibilities, CMS now offers states an opportunity to extend the Appendix K provisions beyond that date.

To be eligible for an extension, states must take action by November 11, 2023, to integrate the desired Appendix K provisions into their underlying HCBS programs. This extension applies exclusively to Appendix Ks that have flexibilities incorporated into the underlying section 1915(c) waiver programs. Consequently, the relevant Appendix K will remain in effect until the effective date of the section 1915(c) waiver action, whether it be an amendment or renewal.