Update: TBI Waiver 1915 (c) and Appendix K Flexibilities

Amended waiver submitted to the Centers for Medicare and Medicaid Services

UPDATE: To avoid a disruption in care and support consumers and their families, NC Medicaid is extending Appendix K temporary flexibilities until Feb. 29, 2024, while the Centers for Medicare & Medicaid Services (CMS) reviews the Innovations and Traumatic Brain Injury Waiver amendments.  

Appendix K flexibilities were implemented during the Public Health Emergency and were scheduled to end effective Nov. 11, 2023. The Centers for Medicare and Medicaid Services (CMS) is allowing states to continue Appendix K flexibilities beyond Nov. 11, 2023, if the state submits a 1915(c) waiver amendment making some or all of the Appendix K flexibilities permanent.

To avoid a disruption in care and support consumers and their families, NC Medicaid is extending Appendix K temporary flexibilities until Feb. 29, 2024, while the Centers for Medicare & Medicaid Services (CMS) reviews the Innovations and Traumatic Brain Injury Waiver amendments.  

After the amended 1915(c) TBI Waiver becomes effective, only the flexibilities which are permanently added to the 1915(c) TBI Waiver will continue.   NC Medicaid recognizes the need for time to transition from the various flexibilities ending and is requesting CMS to make North Carolina’s 1915(c) TBI Waiver amendment effective March 1, 2024.  NC Medicaid will communicate formal approval of this extension request as soon it is available from CMS.

NC Medicaid has submitted a 1915(c) TBI Waiver amendment to (CMS) to make the following Appendix K flexibilities permanent:

  • Allow home delivered meals (up to seven meals per week/one per day)
  • Allow real time two-way interactive audio and video telehealth for Life Skills Training, Cognitive Rehabilitation, Day Support, Supported Employment; Supported Living and Community Networking to be delivered via telehealth.
  • Allow waiver individuals to receive services in alternative locations: hotel, shelter, church, or alternative facility-based settings.
  • Remove the requirement for the beneficiary to attend the day supports provider once per week.
  • Allow relatives as providers for TBI waiver individuals to provide Personal Care and/or Life Skills Training (or a combination of those two services) up to 40 hours/week total.

Contact

Medicaid Contact Center, 888-245-0179

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