Federal Medicaid officials say they will extend some flexibilities for home and community-based services that emerged during the pandemic in a bid to help the beleaguered disability services sector stay afloat.

In guidance issued this week, the Centers for Medicare and Medicaid Services said that states can continue relying on changes that were adopted during the COVID-19 pandemic while they work to officially incorporate them into their waiver programs.

“States have relied extensively throughout the (public health emergency) on flexibilities permitted under Appendix K to authorize actions in their home and community-based services programs such as the use of telehealth or remote service provision, increased payment rates, expansion of self-direction service delivery models, addition or expansion of services, and expansion of provider networks to include family members and legally responsible individuals,” reads the letter to state Medicaid directors from Daniel Tsai, deputy administrator and director of the Center for Medicaid and CHIP Services at CMS.

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Previously, states were told that flexibilities provided under what’s known as Appendix K would expire by Nov. 11, six months after the end of the public health emergency. Now, however, CMS says that states can act to extend that deadline.

“CMS is issuing this guidance in recognition of the number of section 1915(c) waiver actions already submitted and expected to be submitted by states to incorporate Appendix K flexibilities into the ongoing operations of their HCBS programs,” the letter indicates. “The ability for these waiver actions to be submitted, reviewed and approved by November 11, 2023, to prevent a lapse in authority, is highly uncertain. In the name of minimizing disruption to beneficiaries, providers and states, CMS is issuing this extension of the Appendix K expiration date.”

States have used regulatory flexibilities offered during the pandemic to allow family members to be paid as caregivers, to introduce remote supports and to alter services and reimbursement to address staffing issues, among other things, advocates said.

The extra wiggle room in extending these changes has been long sought by disability service providers who have struggled mightily to attract and retain direct support professionals, among other challenges, in recent years. A survey last fall found that 66% of providers were concerned that vacancy and turnover rates would increase once regulatory flexibilities and COVID-19 relief funding come to an end.

“Providing an extension of Appendix K flexibilities provides time for states to respond and incorporate critical flexibilities into their programs without threat of service lapse and encourages states to consult with beneficiaries and providers to ensure they are renewing the relevant Appendix K flexibilities,” said Lydia Dawson, director of policy, regulatory and legal analysis at the American Network of Community Options and Resources, or ANCOR, which represents disability service providers across the nation.

The bureaucratic change will help ensure continuity for many people with developmental disabilities, advocates said.

“This will certainly mitigate the risk that people with disabilities will experience interruption in services related to these flexibilities,” said David Goldfarb, director of policy at The Arc. “The impact will depend on the state.”

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