Community Alternatives Program for Disabled Adults (CAP/DA)

Announcement

  • Amended Waiver Adds Alzheimers Slots and Case Management Hours

The N.C. Division of Medical Assistance (DMA) submitted an amended waiver  to the Centers for Medicare & Medicaid Services (CMS) to amend the Community Alternatives Program for Disabled Adults (CAP/DA) 1915(c) Home and Community-Based Services waiver on Dec. 5, 2016. The amendment added the following:

  • 320 slots for a special reserve group of individuals with Alzheimer’s disease; and,
  • 38 additional case management hours for initial and annual assessments and ongoing case management.

The amendment was initiated because, during the 2016 General Assembly session, an appropriations bill provided funds to the CAP/DA program for 320 additional slots to serve the special reserve group. According to SECTION 12H.5.(a)of S.L. 2016-94,

  • “The Department of Health and Human Services, Division of Medical Assistance, shall amend the North Carolina Community Alternatives Program for Disabled Adults (CAP/DA) waiver to increase the number of slots available under the waiver by a maximum of 320 slots. These additional slots shall be made available on January 1, 2017.”

In order to incorporate the additions that were included in the waiver amendment, revisions were made to Clinical Coverage Policy 3K-2, Community Alternatives Program for Disabled Adults (CAP/DA). These revisions are open for public comment through Jan. 28, 2017, on the Proposed Clinical Coverage Policy web page. Public comments can be submitted through that web page or by calling 919-855-4123.

  • 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

* NEW * Introductory Webinar Trainings

Dates and Times Intended Audience Topic
Feb. 21, 1 - 3 p.m  CAP/C and CAP/DA Direct Service Providers (DSP) DSP Waiver Objectives
Feb. 23, 1 - 3 p.m.  CAP/C and CAP/DA Direct Service Providers (DSP) DSP Waiver Objectives
Feb. 27, 10 a.m. - noon CAP/C and CAP/DA Direct Service Providers (DSP) DSP Waiver Objectives
Feb. 28, 1 - 3 p.m.  CAP/C and CAP/DA Direct Service Providers (DSP) DSP Waiver Objectives

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.

CAP/DA Options

There are two options under CAP/DA:

  1. Traditional option (CAP/DA)
  2. Consumer-directed option (CAP/Choice). This is a consumer-directed care option for disabled adults who want to remain at their primary private residence and have increased control over their own services and supports. Customers and their caregivers direct their own services and supports, which are provided in their own primary private residence and community. It offers customers choice, flexibility and control over types of services they receive, when and where services are provided, and who delivers the services.

CAP/DA or CAP/Choice supplement formal and informal services and supports already available to a beneficiary. CAP/DA or CAP/Choice services are for situations where no household member, relative, caregiver, landlord, community, agency, volunteer agency or third-party payer is able or willing to meet all medical, psychosocial and functional needs of the beneficiary.

Fee Schedules

Clinical Coverage Policy 3K-2, Community Alternatives Program for Disabled Adults and Choice Option (CAP/DA-Choice)

CAP/DA Waiver 

CAP/DA Waiver Comparison 

CAP/DA Waiver Services

  • Adult day health
  • Personal care aide
  • Home accessibility and adaptation
  • Meal preparation and delivery
  • Institutional respite services
  • Non-institutional respite services
  • Personal Emergency Response Services
  • Specialized medical equipment and supplies
  • Participant goods and services
  • Community transition services
  • Training, education and consultative services
  • Assistive technology
  • Case management
  • Care adviser (CAP/Choice only)
  • Personal assistant (CAP/Choice only)
  • Financial management services (CAP/Choice only)

Forms

Assessment Only Claims Request

Beneficiary Notice (DMA 3504)

Expanded Waiver Services Requisition Form

Indicator Code Memorandum

Lead Agency Directory Form

CAP/DA-CAP/Choice Change Memorandum

Request for Fiscal Technical Assistance

Risk Mitigation Tool (DMA3073-ia)

Self-Assessment Tool (DMA3072-ia)

Service Authorization Discontinuation

Transfer Checklist

Voluntary Withdrawal of Request for Additional Services

Memorandums

CAP/Choice Memorandum 

Slot Utilization & Waitlist Management Memorandum

Case Management (T1016 and T2041) Calendar Allotment Memorandum 

Waitlist Management Memorandum 

LOC Notification Memorandum 

Fiscal Contract Conversion Memorandum

AQUIP IT Transition Memorandum

Due Process & Prior Approval Memorandum 

Prior Approval Denials & Level of Care Reduction Memorandum 

Contacts

CAP/DA Lead Agency List

Medical Assistance Clinical Section
Phone: 919-855-4340
Fax: 919-715-0052

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