NC Medicaid Guidance on Sunsetting of Innovations Waiver Appendix K Flexibilities

Plan of Care

Allow extension of development of

person-centered plan.

Yes

Effective March 31, 2024, there will be no extensions of the person-centered planning process.

Allow extension up to 90 days for Level of Care (LOC) redetermination.

Yes

Effective March 31, 2024, no LOC redetermination extensions will be allowed. If this flexibility was utilized and the waiver member is outside of the 90-day time frame, a redetermination must be completed.

Allow Support Intensity Scale (SIS) assessment/reassessment to be waived.

Yes

Effective March 1, 2024, no SIS assessments/reassessments will be waived. If the waiver member has not completed a SIS assessment, one must be scheduled by Feb. 29, 2024.

Note: If the member did not use this flexibility, a SIS assessment does not have to be scheduled by Feb. 29, 2024.

Allow for an increase in service hours from what is in the person-centered plan without prior authorization.

Yes

Effective March 1, 2024, prior authorization to request service hours will be required according to Clinical Coverage Policy 8P available on the Program Specific Clinical Coverage Policies webpage. Services listed in the person-centered plan must be within the $184,000 waiver cap.

Provide retainer payments for direct care workers to address emergency related issues.

Yes

Effective March 24, 2024, retainer payments will no longer be available for direct care workers.

Waive $135,000 waiver limit.

No

The Innovations Waiver cap has increased from $135,000 to $184,000.

Services/Service Providers

Allow for additional services to be provided by relatives who live in the home of the adult waiver member to include Community Networking Supported Employment for 90 days.

Yes

Effective, March 1, 2024, relatives of waiver members ages 18 and older may only provide Community Living and Support services.

Allow home delivered meals up to seven meals per week/one per day.

No

Home delivered meals is now a waiver service available to individuals not receiving a per diem residential service.

Assistive Technology, Equipment and Supplies Services - waive requirement for Letter of Medical Necessity or Prescription from the Physician, Nurse Practitioner or Physician’s Assistant for ongoing supplies or replacement equipment for which member has an already established authorization.

Yes

Effective March 1, 2024, documentation of medical necessity by a physician, physician assistant, or nurse practitioner will be required to request assistive technology, equipment, and supplies services.

Allow access to real time two-way interactive audio and video telehealth for Community Living Support including Day Support, Supported Employment, Supported Living, and Community Networking.

No

Members may access Community Living Support; Day Support, Supported Employment, Supported Living, and Community Networking via telehealth.

• Telehealth is not intended to replace a full meaningful day, but rather to complement it. Services that support community integration are not eligible for 100% telehealth delivery.
• The provider shall document any platform used to conduct telehealth activities is in accordance with the requirements of the Health Insurance Portability and Accountability Act (HIPAA).
• The use of telehealth shall not exceed 25% of the authorized service hours per week

(i.e. if an individual is authorized 40 hours a week, the individual may use the real time two-way interactive audio and video telehealth 10 hours week).

Remove requirement for member to attend Day Supports provider once per week.

No

Beneficiaries are not required to attend Day Supports provider once per week. Individuals may maximize their time in the community.

Community Navigation service is only available if the member is self-directing one or more of their services through the Agency with Choice or Employer of Record Model.

No

Community Navigation services are used to support members self-directing waiver services; therefore, it will only be available for individuals participating in self-direction.

Allow legally responsible persons of minor waiver members who reside in the home and out of the home to provide, Day Supports, Supported Employment, Community Living and Supports, and Community Networking when other providers are not available.

Yes

Effective March 1, 2024, legally responsible persons of minor waiver members who reside in or outside of the home may provide Community Living and Supports services.

Allow direct care services to be rendered in a hotel, shelter, church, or alternative facility-based settings or the home of direct care worker under specific circumstances.

No

Waiver members may receive services in alternative locations under specific circumstances.

• If a member has been displaced from their home due to public health emergency or state of emergency.
• If the caretaker of the member becomes ill and is not able to care for the individual
• If the member’s health and safety is at risk due to family health concerns.

Allow parents of minor children receiving Community Living and Support to provide this service (up to 40 hours and not exceeding 56 hours) to their child.

No

Parents of minor children enrolled in the waiver may continue to provide Community Living and Support services to their child who has been indicated as having extraordinary support needs.

Family members living under the same roof as the waiver individual may provide services. Objective written documentation is required as to why there are no other providers available to provide the services.

Note: Written objective documentation may be provided in ISP or separate document.

Family members who provide these services must meet the same standards as providers who are unrelated to the individual.

Examples of situations meeting the criteria of no other providers available might include:

• Individuals living in a remote area unserved or underserved by other providers.
• Individuals with documented complex medical or behavioral needs, which do not require skilled nursing services, are best met by the family member.
• Individuals who require services at hard-to-staff hours.
• Numerous providers have been unsuccessful at appropriately supporting the individual; or
• Numerous providers have assessed the situation and responded in writing that they cannot provide services.

Note: This does not apply to parents of minor children who are also the Employer of Record (EOR).

Allow relatives of individuals receiving Supported Living to provide this service; service by relative may be provided prior to background check and training for 90 days.

Yes

Supported Living services provided by a relative is allowed. The relative must complete background check and training prior to rendering services.

Allow relatives as providers for adult waiver members to provide Community Living and Supports service over 56 hours/week not exceeding 84 hours/week.

No

Community Living and Supports service providers may be a relative of an adult waiver member.

Family members living under the same roof as the waiver individual may provide services. Objective written documentation is required as to why there are no other providers available to provide the services.

Note: Written justification should be provided in the ISP or separate document.

Family members who provide these services must meet the same standards as providers who are unrelated to the individual.

Examples of situations meeting the criteria of no other providers available might include:

• Individuals living in a remote area unserved or underserved by other providers.
• Individuals with documented complex medical or behavioral needs, which do not require skilled nursing services, are best met by the family member.
• Individuals who require services at hard-to-staff hours.
• Numerous providers have been unsuccessful at appropriately supporting the individual.
• Numerous providers have assessed the situation and responded in writing that they cannot provide services.

Allow respite to be provided when family is out of state due to evacuation/displacement until they return home. Out of home respite may be provided more than 30 days on a case-by-case basis.

Yes

Waiver services may be covered out of state only to members living in counties bordering another state; the agency providing services must be an enrolled NC Innovations Provider Agency located within 40 miles of the border of the county.

Allow payment for Community Living and Supports for member while in acute care hospital or short-term institutional stay, when a waiver participant is displaced from home because of COVID-19 and such supports are not otherwise available for up to 30 consecutive days.

Yes

Effective March 1, 2024, payment may not be allowed for Community Living and Supports for a member currently in an acute care hospital or short-term institutional stay.

Allow waiver members to receive fewer than one service per month for 90 days without being subject to discharge from the waiver.

Yes

Effective March 1, 2024, all waiver members must receive at least one waiver service per month to remain on the waiver.

Allow existing staff to continue to provide service, for 90 days, when CPR and NCI recertification has lapsed. This applies to Community Living and Supports, Crisis Services, Community Networking, Day Supports, Respite, Residential Supports, Supported Living, and Supported Employment.

Yes

All staff of the listed services shall have current CPR and NCI certification.

Waive the face-to-face requirements for monthly and quarterly care coordination/member meetings for individuals receiving residential support, new to waiver, or relative as provider.

Yes

Effective March 1, 2024, monthly and quarterly care coordination meetings shall occur face-to-face.

Waive the face-to-face requirements for quarterly care coordinator/member meetings. Individuals who do not receive at least one service per month will receive monthly monitoring (which can be telephonic) as quarterly meetings are not sufficient for such individuals.

Yes

Effective March 1, 2024, monthly and quarterly care coordination meetings shall occur face to face.

Waiver services may be covered out of state only to beneficiaries living in counties bordering another state; the agency providing services must be an enrolled NC Innovations Provider Agency located within 40 miles of the border of the county.

Internet/Connectivity Services

This change was not a part of Appendix K flexibilities. CMS requested the State update the amendment to remove access to internet services from the waiver based on affordable connectivity (internet) options available for internet services.

Assistance with internet services was provided to waiver members during the PHE however, it was not implemented as a waiver flexibility.

Yes

The Affordable Connectivity Program is a benefit program that aids with internet services. Waiver members may access the program to determine eligibility at fcc.gov/acp