Appendix K and end of public health emergency

May 15, 2023

Appendix K and end of public health emergency

The COVID-19 pandemic was declared a federal public health emergency in January 2020. In response, several policy changes were temporarily put into place throughout the declared public health emergency, including the allowance of certain flexibilities that were approved Federally by Centers for Medicare and Medicaid Services though the Appendix K process regarding the Family Supports and Community Integration and Habilitation waivers.

CMS granted approval of certain Appendix K flexibilities for a period of up to six months after the end of the PHE for COVID-19. This additional six-month timeframe allows for planning and preparations necessary for teams to transition away from the use of Appendix K flexibilities at the end of the PHE.

On Jan. 30, 2023, the Biden-Harris Administration announced its intent to end the national emergency and public health emergency declarations related to the COVID-19 pandemic on May 11, 2023. Since the Appendix K flexibilities are directly tied to the end date of the PHE, the Bureau of Developmental Disabilities Services has updated its guidance on the unwinding of the Appendix K Flexibilities and Code Waiver Document.

This guidance document is intended to provide notice of timelines for the unwinding of the temporary policy changes to allow the system to transition back to pre-COVID-19 operations. The updated document is available by clicking here.

The DDRS is a program of the Indiana Family & Social Services Administration. If you have questions about DDRS programs and services, visit us online at