March 24, 2020

COVID-19 Waivers and Flexibilities of Federal Regulations Free Up North Carolina to Respond Effectively

Risk mitigation has taken on an entirely different meaning when it comes to the provision of service during a pandemic.  Instead of a focus on high accountability reporting, “crossing t’s and dotting i’s”, the entire country is taking measures to waive the usual requirements that may slow down the provision of services.  The federal and NC declarations of state of emergency have been critical hoops to get through to allow for these waivers.   

1135 Federal Waiver 

The US Department of Health and Human Services has provided waiver authority to temporarily put aside standard requirements for states for them to adequately address the spiked physical and behavioral healthcare needs from the coronavirus.  North Carolina filed their request for the 1135 waiver with the Centers for Medicare and Medicaid Services (CMS) on March 17th.  The approval of the 1135 waiver for North Carolina is expected quickly.  As of March 23, the approval had not yet come through.  Here are some of the temporary waivers and flexibilities that our state has requested: 

Single Stream Funding and Risk Reserves Freed Up for COVID-19 Response 

LME/MCOs have received a formal communication from NC DHHS addressing the use of State funds for the remainder of the State Fiscal Year 2019-2020 and flexibilities including the following:   

 In addition to the waivers the 1135 will allow, NC DHHS is granting other flexibilities for LME/MCOs that include:   


NC DHHS is providing a staggered implementation of telehealth waivers to reimbursement rules in order to get the most needed waivers and flexibilities in place.  On a recent webinar with providers, Medicaid CMO Dr. Shannon Dowler stated that they will begin with telemedicine and telepsychiatry codes and later will provide waivers and flexibilities to specialized services such as occupational and physical therapies and finally work to provide needed temporary changes for LEAs and CDSAs.  Retroactive to March 10, 2020, telehealth billing waivers and flexibilities include: 

Appendix K and Long-Term Care for Innovations and TBI Waivers, CAP/C and CAP/DA 

NC DHHS is seeking approval from CMS for an Appendix K to the 1915(c) Medicaid waivers in North Carolina that include:  Innovations for individuals with intellectual and developmental disabilities, Traumatic Brain Injury, Community Alternative Programs/Children (CAP/C), Community Alternative Programs/Disabled Adults (CAP/DA).  Appendix K must be approved by CMS.  LME/MCOs received guidance from NC DHB on the temporary flexibilities, including: 

On March 23rd, Governor Cooper issued his most recent Executive Order and it included some temporary limitations  on visitations at long-term care facilities [beginning on Wednesday, March 25], including:  skilled nursing facilities, adult care homes, family care homes, mental health group homes and ICF-IDD facilities.  NC DHHS has posted multiple resources related to long term care services at their COVID 19 website.

i2i Center Provides a Resource Center 

i2i has devoted a webpage to resources, including public policy and health and wellbeing, as information becomes available.