New CMS COVID-19 Resources for State Agencies on Medicaid HCBS
Regulation | March 23, 2020
The Centers for Medicare and Medicaid Services published on March 22 new resources for state Medicaid agencies on home and community-based services.
The Centers for Medicare and Medicaid Services published on March 22 new resources for state Medicaid agencies on home and community-based services.
As part of the agency’s ongoing response to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) published on March 22 new resources for state Medicaid agencies on home and community-based services (HCBS). These resources were published along with Medicaid-specific guidance on 1135 waivers and follow previous guidance for state Medicaid agencies.
These new resources include instructions and a template for state Medicaid agencies on filing an Appendix K application for their respective 1915(c) waivers. For context, 1915(c) waivers are the main authority through which states provide Medicaid HCBS, and states can use Appendix K of those waivers to modify their existing 1915(c) waivers in the event of emergencies, including the COVID-19 pandemic.
CMS also announced three states that have approved Appendix K applications. Two of these states, Pennsylvania and West Virginia, include Appendix K provisions for 1915(c) waiver specific to older adults. Key provisions from both states are summarized below. Each of these states may serve as an example for other states considering an Appendix K application. Washington was also approved for Appendix K provisions for waivers serving people with intellectual/developmental disabilities.
The instruction document includes process-oriented items (e.g., allowing electronic signatures, prepopulating certain sections of the application) as well as more substantive examples of flexibilities available through Appendix K. Specifically, CMS cites the following as options states could exercise:
Each of these could make HCBS more accessible to older adults during the pandemic. In addition, the option for states to provide retainer payments could be a key lifeline for providers such as adult day services that are forced to close by their state agencies and/or who do so voluntarily to limit the spread of COVID-19.
Adult day services are in a particularly precarious position during the COVID-19 pandemic. While aging services across the continuum are under immense pressure, adult day services providers are at particular financial risk due to potential closures.
Unlike providers that are likely to remain operational during the pandemic, such as nursing homes, affordable housing communities and home-based services providers, adult day services providers could be forced to close during the pandemic. In this scenario, adult day services providers could lose the revenue they would otherwise bring in, thereby jeopardizing their long-term financial sustainability. This could have serious implications for the availability of adult day services throughout and beyond the COVID-19 pandemic.
Several states have already mandated that adult day services providers close during the pandemic and it is likely more will follow as the pandemic continues. During closure periods, these providers will likely have no or very limited sources of revenue. Some states are already offering retainer payments to closed providers, including Maryland. States should offer retainer payments for adult day services providers that close during the COVID-19 pandemic and should consider the Appendix K application as a potential option to provide these through.
LeadingAge will continue to monitor for updates on Appendix K applications and work in conjunction with our members and state partners to ensure that aging services providers of all types, including adult day services, are able to continue delivering the services older adults need.
Pennsylvania received approval of an Appendix K application for its Community Health Choices waiver, which serves older adults and people with physical disabilities. Provisions in that application are summarized below.
West Virginia received approval of an Appendix K application for its Aged and Disabled waiver, which serves older adults and people with physical disabilities. Provisions in that application are summarized below.