SPECIAL BULLETIN COVID-19 #105: NC Medicaid Receives Approval for Expanded Flexibilities for Home and Community Services - NC Innovations and NC TBI Waivers

<p>NC Medicaid has received federal approval of additional flexibilities during the COVID-19 pandemic for the NC Innovations and NC&nbsp;Traumatic Brain Injury waivers.</p>

NC Medicaid has received federal approval of additional flexibilities during the COVID-19 pandemic for the:

  • NC Innovations Waiver, for individuals with intellectual and developmental disabilities (IDD); and
  • NC Traumatic Brain Injury (TBI) Waiver, for individuals who have a TBI diagnosis after age of 21.

During federally declared emergencies, states can submit requests to ease certain waiver requirements through an Appendix K. NC Medicaid received approval of Appendix Ks for all four waivers from the Centers for Medicare and Medicaid Services (CMS), effective March 13, 2020, to March 12, 2021.   

NC Medicaid submitted a second set of Appendix Ks for the NC Innovations and NC TBI waivers to CMS following modifications in scope and coverage during the COVID-19 pandemic were approved effective April 30, 2020, to March 13, 2021:

  • The addition of home delivered meals. Home delivered meals consists of two home delivered meals per day. Home delivered meals are not an option on the same day that an Innovations or TBI waiver member receives Residential Supports. Oral nutritional supplements are excluded from home delivered meals and members who are solely dependent on oral nutritional supplements may not receive home delivered meals.
  • The waiver of the requirement for a letter of medical necessity or prescription from the physicians, nurse practitioner or physician’s assistant for ongoing supplies or replacement equipment for which member has an already established authorization. This applies to assistive technology, equipment and supplies. 
  • Allow for additional 90-day periods for existing staff to continue providing services when staff are unable to complete the hands-on portion of the Crisis Prevention/De-Escalation training or the hands-on portion of the Cardiopulmonary Resuscitation (CPR) training. Where the extension of the waiver of provider determinations falls outside of the expiration date of the Appendix K, the State will submit either an amended Appendix K or a simple waiver amendment.
  • Allow primary Alternative Family Living (AFL) providers to provide Supported Employment, Day Supports or Community Networking to the participant living in the AFL during times that Supported Employment, Day Supports or Community Networking would be regularly provided.
  • Allow legally responsible persons and other relatives of minor waiver beneficiaries who reside in the home and out of the home to provide the following services when other providers are not available: Day Supports, Supported Employment, Community Living and Supports, and Community Networking. (Innovations Only)
  • Allow for additional services to be provided by relatives who live in the home of the adult waiver beneficiary (current waiver only allows for Community Living and Supports) to include Community Networking, Day Supports and Supported Employment for 90 days. There may be more than one 90-day period. (Innovations Only)

Providers must resume compiance with normal NC Medicaid rules and regulations the earliest of the following; as soon as they are able to do so or the end of the public health emergency.


NCTracks Contact Center: 800-688-6696

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