DHHS Section 1915(c) Waiver Appendix K Updates

Section 1915(c) Waiver Appendix K Updates​
Oct 16, 2023
At the beginning of the COVID-19 pandemic, the U.S. Department of Health and Human Services (DHHS) declared a national public health emergency (PHE) and relaxed certain requirements ensuring the health and safety and continued access to healthcare services for Medicaid members. In response to the federal PHE, Maine established temporary changes to its five existing federally approved section 1915(c) Home and Community-Based Services (HCBS) waivers through a standalone Appendix K: Emergency Preparedness and Response amendment.    
​
In accordance with the Centers for Medicare and Medicaid Services (CMS) policy, the default expiration date for Appendix K flexibilities is six months following the end of the federal PHE. However, CMS indicated in its August 2, 2023, State Medicaid Director letter (SMD #23-004) that Appendix K flexibilities may be extended past the original November 11, 2023, deadline. States can avoid a lapse in authority for Appendix K flexibilities that the state has incorporated into section 1915(c) waiver renewals and/or amendments that are still pending approval as of the November 11, 2023, default expiration date.      

Maine has submitted five-year renewal applications, and received CMS approval effective July 1, 2023, for waiver sections: 

• Section 19, Elderly and Adults with Disabilities waiver  
• Section 20, Home and Community Based Services for Adults with Other Related Conditions waiver 

Maine submitted amendment applications but has not yet received CMS approval for waiver sections: 

• Section 18, Home and Community Based Services for Members with Brain Injury waiver 
• Section 21, Home and Community Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder waiver 
• Section 29, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder waiver  

Guidance for Section(s) 19 and 20 Providers: 
Flexibilities not continued through Maine’s recently approved Section 19 or Section 20 1915(c) waiver renewals will revert to current rule as described in the corresponding section of the MaineCare Benefits Manual.  
The Department will issue guidance in the near future detailing the flexibilities continuing through the approved 1915(c) waiver renewals and those that will expire on November 11, 2023.  

Guidance for Section(s) 18, 21, and 29 Providers: 
Appendix K flexibilities related to Section 18, 21, and 29 are extended until such time as CMS approves the submitted 1915(c) waiver amendment applications.  
The Department will issue guidance in the near future detailing the flexibilities extending past the November 11, 2023, expiration date.   

Additional resources are available on MaineCare’s COVID-19 and End of the PHE webpage. 
We plan to update our website resources and provide information through additional e-messages over the coming weeks as information becomes available. In the meantime, please send questions related to this announcement and the end of Appendix K to [email protected]. 

This mailbox is specifically for MaineCare-enrolled providers. If a MaineCare member is seeking PHE Unwinding information, please direct them to the Unwinding webpage at mainecare.gov/unwinding. 

In accordance with federal law and the MaineCare Benefits Manual, the Department must give members the opportunity for a hearing if requested 1) When their service request is denied or takes too long to be processed or 2) the member believes the Department made a mistake stopping, reducing, or suspending their medical eligibility or covered services.