As COVID-19 Upends Section 1915(c) Waiver Services, Appendix K Grants New Flexibilities

Photo of Sharon Krevor-Weisbaum

By Sharon Krevor-Weisbaum

COVID-19 is transforming the provision of long-term supports and services to individuals with chronic illnesses, disabilities, or other functional limitations. As the news media has highlighted, the coronavirus has spread with terrifying speed through Maryland’s nursing homes. But COVID-19 also poses unprecedented challenges for home- and community-based services providers. These providers must safeguard the health of staff and participants, secure medical supplies in a tight market, and address staffing challenges—all while navigating ever-changing legal, regulatory, and public health landscapes.

Recognizing these challenges, the federal government recently approved Maryland’s COVID-19 Appendix K, which outlines new flexibilities for organizations that provide home and community-based services through Section 1915(c) waivers. The Appendix K provisions were made retroactive to March 13, 2020, and will remain in effect until March 12, 2021. Stakeholders can learn more about Appendix K by watching a series of webcasts or by reading explanatory materials on the Developmental Disabilities Administration (“DDA”) website. The lawyers at Brown, Goldstein, & Levy are analyzing Appendix K and other guidance from the Department of Health and are here to assist with any problems you encounter.

Although Appendix K covers many aspects of waiver services, a few changes are worth highlighting. For instance, in order to address the increased cost of providing services to participants who have tested positive for COVID-19, DDA has increased the payment rate by up to 50 percent for directly supporting such participants. Providers may request the increased rate starting the date the participant tested positive and may bill that increased rate for up to 21 consecutive days while the participant is in isolation—but remote and telehealth services are not eligible for the increased rate. DDA also may provide some reimbursements to providers for additional costs associated with Personal Protective Equipment (PPE) as an administrative claim.

As many providers face staffing challenges, DDA also has loosened requirements as to who can deliver services. Under Appendix K, providers may hire parents, siblings, and spouses to deliver services to participants, and those services may be provided in alternative sites like the family home. In order to expedite delivery of these services, DDA also has waived certain training requirements for direct support professionals, although such professionals still must complete CPR and First Aid training as well as training on the participant’s specific needs as set forth in the participant’s person-centered plan. Certain licensure requirements for healthcare professionals also have been suspended, and registered nurses and licensed practical nurses now may both delegate nursing tasks to unlicensed individuals.

Although the new Appendix K flexibilities are not a cure-all, they may provide some support to providers in these extraordinary times. If you would like to learn more about Appendix K and the accompanying guidance from the Department of Health, or if you would like to discuss other challenges related to waiver services, do not hesitate to contact us.

Authored by

Sharon Krevor-Weisbaum Managing Partner