COVID-19: Information for Waiver Providers

Phased-In Reopening of Services in the Community

“Appendix K: Emergency Preparedness and Response”

1915(c) Home and Community Based Services

All states that operate 1915(c) waivers can apply for an Appendix K amendment during a declared national emergency. Appendix K activates flexibilities available under the Medicaid 1915(c) authority. It allows things such as providing services in different settings and in different ways such as telehealth. The Appendix K will allow approved flexibilities only for the duration of a federally declared disaster.

All services and programmatic changes taken through an approved Appendix K must be based on situations that arise from the emergency and are temporary in nature. Service changes for participants must be directly related to the COVID-19 emergency and the flexibilities under Appendix K are only authorized for the duration of the emergency.

DDD will issue further guidance on transitioning back to pre-emergency services and conditions.

Some facts about the Appendix K:

  • Hawaii’s application for Appendix K was approved by the Centers for Medicare and Medicaid Services on March 27, 2020.
  • Approval is for one year (March 1, 2020 – February 28, 2021) or the end of the declared national emergency.
  • The flexibilities in Appendix K are available for the state’s use as needed but are not intended to be applied in all situations.
  • DDD developed Operational Guidelines to assist case managers and providers in the implementation of the flexibilities in Appendix K. Operational Guidelines will be updated as necessary and will be posted on this webpage.
  • All changes made to ISPs will revert services back to levels prior to COVID-19 impact; will not be subject to fair hearing and appeal requirements.
Appendix K References

Operational Guidelines Version 4

Rapid Response

Retainer Payment Guidance

Operational Guidelines Version 3

Operational Guidelines Version 2

Appendix K Overview


Resources for Providers on HIPAA and Telehealth

Privacy and HIPAA:

Other Resources

Resources for Waiver Providers