Community Alternatives Program for Disabled Adults (CAP/DA)

The Community Alternatives Program for Disabled Adults (CAP/DA) waives certain NC Medicaid requirements to provide home and community-based services to adults 18 years of age and older with disabilities who are at risk of institutionalization. Services provide an alternative to institutionalization for customers in this group who prefer to remain in their primary private residences, and would be at risk of institutionalization without these services.

Update: Combined CAP/C and CAP/DA Waivers

In 2011, the Division of Medical Assistance (DMA) implemented a project to merge the Community Alternatives Program Waivers, Community Alternatives Program for Children CAP/C and Community Alternatives Program for Disabled Adults CAP/DA. In March 2014, The Centers for Medicare and Medicaid Services (CMS) implemented an HCBS Final Rule to encourage states to combine waivers that targets similar populations.

Between 2011 -2015 work groups met to identify waiver processes to aid in the merger of these two waivers. These work groups analyzed the six waiver assurances and case management practices to identify similarities, differences and methods for consolidation. Recommendations from these work groups were used to draft the proposal of the combined 2015 CAP waiver. This draft waiver will be submitted to CMS for review and approval in December 2015.

Prior to the waiver submission to CMS, the waiver will be posted for a second 30-day public comment period to allow review of changes made to the waiver based on comments and recommendation received. Areas updated in the proposed waiver include the following:

Proposed Waiver Document

  1. Main Module
  2. Major Changes
  3. 1-f: Level(s) of Care
  4. Brief Waiver Description
  5. Public Input
  6. Transition Plan
  7. Appendix A
  • A-1: State Line of Authority for Waiver Operation
  • A-4: Role of Local/Regional Non-State Entities
  • A-5: Responsibility for Assessment of Performance of Contracted and/or Local/Regional Non-State Entities
  • A-7: Distribution of Waiver Operational and Administrative Functions
  1. Quality Improvement: Administrative Authority: a-i
  2. Quality Improvement: Administrative Authority: a-ii
  3. Appendix B
  • B-1-a: Target Group(s)
  • B-1-b: Target Groups – Additional Criteria
  • B-3-a: Unduplicated Number of Participants
  • B-3-b: Limitations on the Number of Participants Served at Any Point in Time
  • B-3-c: Reserved Waiver Capacity
  • B-4: Eligibility Groups Served in the Waiver
  • B-6-c: Qualifications of Individuals Performing Initial Evaluation
  • B-6-d: Level of Care Criteria
  • B-6-e: Level of Care Instruments
  • Quality Improvement: Level of Care
  • B-7: Freedom of Choice
  1. Appendix C
  • Appendix C1/C3: Service Specification
  • Quality Improvement – Qualified Providers
  • Appendix C-5: Home and Community Based Settings
  1. Appendix D
  • Appendix D-1-c: Service Plan Development
  • Appendix D-1-d: Service Plan Development Process
  • Appendix D: Quality Improvement
  1. Appendix E
  • Appendix E-1-j: Participation Direction of Services: Overview (9 of 13) 
  • Appendix E-1-m: Involuntary Termination of Participant Direction
  • Appendix E-2-b-iii: Informing Participant of Budget Amount
  1. Appendix F:
  • Appendix F-1: Opportunity to Request a Fair Hearing
  1. Appendix G
  • Appendix G-2-a: Use of Restraints
  • Appendix G-2-b: Use of Restrictive Interventions
  • Appendix G-2-c: Use of Seclusion
  • Appendix G: Quality Improvement
  • Appendix G: Quality Improvement a-ii
  • Appendix G-b-i: Methods for Remediation/Fixing Individual Problems
  1. Appendix I
  • Appendix I-1: Financial Integrity
  • Appendix I-1-2: Rate Determination Methods
  • Appendix I-3-d: Payments to State or Local Government Providers
  1. Appendix J Appendix J-2-c-i: Factor D derivation

This public comment posting provides an opportunity to share additional comments or recommendations to the changes made to the proposed waiver. Any additional comments or recommendations will be carefully considered for possible inclusion in the draft waiver prior to the final submission to CMS.

The 30-day public comment period starts on Tuesday, October 20, 2015 and will end on Thursday, November 19, 2015. You can submit your comments to this email address  or you can call this voice mail number (919) 855-4210 to leave a comment.

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)


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


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 


CAP/DA Lead Agency List

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

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