March 24, 2020                                                 COVID-19 SPECIAL EDITION
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.    

Below are details on all the measures that have been taken to date.
1 135 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 17 th .  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:  

Details on 1135 Waiver Request

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:    


Telehealth  Changes Under  
COVID-19 
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:  

Get Details

Governor's Executive Order
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 .

Message from Kody Kinsley, Deputy Secretary for Behavioral Health and I-DD   
On March 23, 2020, NC DHHS held a conference call with 1600 MH/IDD/SUD Consumers, Providers and LME/MCOs to provider an update on COVID-19 and to answer questions.  As a follow up to the call, he shared the information on: 

  • Governor Cooper Issues a New Executive Order  
  • CDC Updates List of Who is High Risk
  • Secretary Cohen Calls for Health Care Volunteers
  • NC Pushes for Federal Changes to Make Food, Healthcare More Accessible 
  • Hospitals Urged to Cancel Elective and Non-urgent Procedures and Surgeries
  • Medicaid Changes Policies to Encourage Telemedicine 
COVID-19 Information & Resources
All of us are daily keeping an eye on the news concerning the COVID-19.  To stay on top of the information you need to serve Medicaid consumers, i2i has created a COVID-19 webpage that we are updating daily with news and information as we receive it.  We are also collecting this information and will send out via our email distribution list.  

If you have an important resource you would like to share, please email jean@i2icenter.org 



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