2016-17 Amendment Process - CAP/C 1915(c) Waiver

Announcements

• CAP/C Waiver Approved by CMS

We are pleased to announce the Community Alternatives Program for Children (CAP/C) 1915(c) Home and Community-Based Services (HCBS) waiver has been approved by the Centers for Medicare & Medicaid Services (CMS). The waiver took effect March 1, 2017.

The work and input of families, advocates and providers during the process of revising the waiver is a clear indication of how we can make our system better for all involved by working together. We still have a significant amount of work to do in the implementation of the waiver and related policies, and continued involvement is essential for this process. 

For now, we should celebrate that beginning March 1, 2017, we are able to start the process of determining eligibility and begin serving the children who had to be placed on a waiting list during the submission process.  

Thank you again for your support and guidance during this process, and I look forward to our continued collaboration to assure that children with complex medical needs are provided high quality service through our Medicaid program.

For more information, read the February 2017 Special Medicaid Bulletin, CAP/C Waiver Renewed by Centers for Medicare & Medicaid Services, or click on one of the links below: 

• 1915(c) waiver document
• List of changes (crosswalk) to the CAP/C Clinical Coverage Policy based on public comments
• Clinical Coverage Policy 3K-1, Community Alternatives Program for Children
• Special Medicaid Bulletin regarding new reimbursement rate for respite nursing service

Dave Richard
Deputy Secretary for Medical Assistance

• CAP/C Nursing Services will be Offered Through Private Duty Nursing

In preparation of the newly amended waiver, nursing services, which used to be offered as a CAP/C waiver service, will now be offered through State Plan Private Duty Nursing (PDN). DMA will begin the transition process from CAP/C nursing to private duty nursing (PDN) in the month of February 2017. The number of nursing hours approved for the CAP beneficiary will remain the same during the transition.

The transition of nursing services will not require the case management agency or the assigned service provider to make any changes or revisions to the CAP service plan or the PDN care plan(s). Ongoing approval of nursing hours will be reassessed against the newly revised PDN policy, as well as Early and Periodic Screening, Diagnosis and Treatment (EPSDT) requirements during the next annual reassessment which occurs after September 2017.

As the assigned Case Manager, you are responsible for monitoring your CAP/C child’s initial transition to PDN and conducting quarterly reviews thereafter to ensure services are rendered per your CAP/C child’s plan of care.

DMA will host office hours throughout March 2017 on Wednesdays from noon to 1 p.m. in person or by phone for family members who have questions or concerns. Interested individuals are able to schedule 20 minute appointments to discuss concerns, provide suggestions and ask questions. In-person appointments will be held in Raleigh at the DMA office, Kirby Building, 1985 Umstead Drive, Raleigh, NC and require advance scheduling.

All plan of care revisions and change in status assessments currently in the e-CAP/C workflow, musts be submitted and approved by Feb. 28, 2017.

If you have any questions, please consult your CAP/C consultant. 

• Effective Feb. 5, 2017 - Prior Approval for CAP/C and CAP/DA

Effective Feb. 5, 2017, N.C. Division of Medical Assistance (DMA) will implement a prior approval (PA) process for the Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) home and community-based services waivers for Level Of Care (LOC) and CAP waiver services. A PA record will be created and electronically transmitted to NCTracks for each new LOC determination decision made after Feb. 5, 2017, and for each currently approved CAP waiver service for all currently eligible CAP beneficiaries. Click here for more information. 

• Direct Service Provider (DSP) Interface Coming in March 2017

The Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) waivers rely on an electronic system called e-CAP to manage CAP eligibility determination activities, service plan development and monitoring tasks. As a way of streamlining processes and promoting a multidisciplinary team approach, the N.C. Division of Medical Assistance (DMA) will implement a direct service provider interface (DSP) in March 2017. Click here for more information

CAP/C Waiver Services Reference Guide

*NEW * Introductory Webinar Trainings

In preparation for the newly amended Community Alternatives Program for Children (CAP/C) Home and Community-Based Services waiver, the Division of Medical Assistance (DMA) will host a series of introductory webinar trainings for the CAP/C case management entities, CAP/C beneficiaries and their families and CAP/C direct service providers.

The following chart provides the schedules for the introductory webinar trainings.

​CAP/C Case Management Entities; please register for one of the training webinar series using the following links:

Feb. 23 - https://attendee.gototraining.com/rt/2629611081386916353

Feb. 27 - https://attendee.gototraining.com/rt/5191331337105114881

CAP/C Beneficiary or primary caregiver; please register for one of the training webinar series using the following link: https://attendee.gototraining.com/rt/6551318369012979713

Direct Service Providers: This is a joint training with VieBridge for the Direct Service Provider Webinar series listed on the e-CAP website: https://www.ncecap.net/CAPCProd/main.aspx.