Appendix K Approved!

May 01, 2020

Karen Kimsey, Director of DMAS, announced on the call this morning that the second Appendix K had been approved by CMS late yesterday.  The full document can be found here:

https://www.medicaid.gov/state-resource-center/downloads/va-combined-2-appendix-k-appvl.pdf

The specific text re Retainer Payments is:

  • Retainer payments may be provided for circumstances in which providers have experienced significant decline in service utilization due to COVID-19 containment efforts because the waiver participant is sick due to COVID-19; or the waiver participant is sequestered and/or quarantined based on local, state, federal and/or medical requirements/orders. The state will implement a distinguishable process to monitor payments to avoid duplication of billing. Payments may be made to providers of Adult Day Health, Group Day Services, Community Engagement, Community Coaching, and Community Guide, which all include personal care. Retainer payments will be billed up to 100% percent of the current rates and can only be billed for members that are not receiving planned services and only for the amount of service authorized.

  • The retainer time limit may not exceed the lesser of 30 consecutive days or the number of days for which the state authorizes a payment for “bed-hold” in nursing facilities or intermediate care facilities.


And the text re provision of services in another location is:

  • For DD waivers, permit the delivery of Group Day Services, Community Engagement,and Community Coaching in residential settings to include licensed settings delivering Group Home Residential, Sponsored Residential and Supported Living as well as the private unlicensed homes of individuals.


The last “authority” regarding employment allowances does not apply to DBHDS Licensed providers. Those providers already have allowances granted by DBHDS.

This is great news!  And DMAS is working as quickly as possible to operationalize and publish the Memo with details and instructions.