NC Innovations Waiver

On Nov. 22, 2023, The Centers for Medicare, and Medicaid Services (CMS) approved North Carolina Medicaid to continue certain Appendix K flexibilities in the 1915 (c) Innovations Waiver and TBI (Traumatic Brain Injury) Waiver amendment, effective March 1, 2024. 

CMS allows States to use Appendix K during emergency situations. During the public health emergency, it was used to support waiver members to remain safe in their communities during the public health emergency. Some of the Appendix K flexibilities will end Feb. 29, 2024. NC Medicaid will work with the LME-MCO’s to support members in transitioning from the Appendix K flexibilities that will be discontinued in the Innovations and TBI Waiver amendments by March 1, 2024.

What does this mean for Innovations Waiver Members?

Innovations Waiver members will be able to continue using the Appendix K flexibilities until Feb. 29, 2024. On March 1, 2024, Innovations Waiver members will be able to use the following approved flexibilities, which will be considered ongoing and included in the approved amendment:

• Home delivered meals (up to seven meals per week/one per day).
• 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 to be delivered via telehealth.
• Allow members to receive services in alternative locations: hotel, shelter, church or alternative facility-based settings under specific circumstances.
• Remove the requirement for members to attend the day supports provider once per week.
• Increase the Innovations waiver cap from $135,000 to $184,000 per waiver year.
  • This is a change from the initial requested increase of $157,000 and takes into account the Innovations Direct Care Worker increase.
• Allow parents of minor children receiving Community Living and Support to provide this service to their child who has been indicated as having extraordinary support needs up to 40 hours/week.
• Allow Supported Living to be provided by relatives.
• Allow relatives as providers for adult waiver members to provide above 56 hours/week, not exceeding 84 hours/week of Community Living and Supports.
• Community Navigator service will be available only to members who self-direct one or more of their services through the agency with choice or employer of record model.
• Added 350 Legislated Innovations Waiver slots. Waiver slots were not part of the Appendix K flexibilities but were added to align with legislative requirements.

What does this mean for TBI Waiver Members?

TBI Waiver members will be able to continue using the Appendix K flexibilities until Feb. 29, 2024. On March 1, 2024, TBI Waiver members will be able to use the following approved flexibilities, which will be considered ongoing and included in the approved amendment:

• Home Delivered Meals (up to one meal per day)  OR (up to seven meals per week/one per day).
• Resource Facilitation: The support provided under this service will now be provided under Tailored Care Management.
• Remove the requirement for beneficiary to attend the Day Supports provider once per week.
• Allow direct care services to be provided in a hotel, shelter, church, or alternative facility-based setting or the home of a direct care worker under specific circumstances.
• Allow real-time, two-way interactive audio and video telehealth for the following services:
  • Life Skills Training
  • Cognitive Rehabilitation
  • Day Supports
  • Supported Employment
  • Supported Living
  • Community Networking
• Allow relatives of TBI Waiver members to provide up to 40 hours total of:
  • Life Skills Training and/or
  • Personal Care

NC Innovations Waiver

The Centers for Medicare and Medicaid Services (CMS) approved a technical amendment to North Carolina’s 1915(c) Innovations which allows exception to the $135,000 waiver limit.  This change is effective May 1, 2020. 
NC Innovations beneficiaries may exceed $135,000 Waiver Cost Limit to ensure health, safety and wellbeing, if the follow criteria is met:

• The individual lives independently without his or her family in a home that s/he owns, rents or leases and,
• The individual receives Supported Living Level III and,
• The Individual requires 24 hour support.

Individuals requesting services and supports in excess of the $135,000 cost limit must make this request through the Individual Support Plan or Plan Update process.  Services and Supports that exceed the $135,000 must be prior approved by the beneficiary’s LME/MCO and must be related to the beneficiary’s needs and not for the convenience of the provider agency or caregiver. 

NC Medicaid has implemented flexibilities on how Medicaid providers and beneficiaries receive Medicaid services in the wake of COVID-19. Utilization and prior approval limits for specific State Plan Medicaid services will be relaxed for all Medicaid beneficiaries impacted by COVID-19 including individuals participating in the NC Innovations Waiver and the NC TBI Waiver.

• I/DD & TBI COVID-19 Frequently Asked Questions
• Email your question or comments to: BHIDD.COVID.Qs@dhhs.nc.gov