Community Alternatives Program for Children (CAP/C)

Announcements

Listening Session on Oct. 19

The Division of Medical Assistance (DMA) will host a semi-annual CAPC Stakeholder Listening Session for CAPC beneficiaries and families. The session will be held 2-4 p.m. on Oct. 19, 2017.

You will have two options for attendance. Please select only one option:

  1. In-Person at Kirby Building, Room 297, Dix Campus, 1985 Umstead Drive, Raleigh, NC. To register to attend in person, register here.
  2. To call-in by phone, register here.

Purpose of the listening session:

The purpose of the listening session is for DMA to listen to feedback from stakeholder about their experience since the implementation of the newly revised waiver and to receive your comments concerning the following topics:

  • How you learned about CAP/C
  • What CAP/C services provide support to your family
  • How case managers support your access to care
  • How the consumer-directed option works for you
  • Suggestions to strengthen case management services
  • Positive impacts of the new policy on your family
  • Concerns with coverage of the new waiver

Statewide Implementation of Consumer-Direction for the 1915(c) Home and Community-Based Services Waiver, Community Alternatives Program for Children (CAP/C)

Consumer-direction is a service delivery model that allows a CAP/C Medicaid beneficiary or designated representative to act in the role of employer of record to direct their personal care services by:

  • Freely choosing who will provide care to meet medical and functional needs;
  • Independently recruiting, hiring, supervising, and firing (when necessary) an employee (personal assistant);
  • Independently setting a pay rate for an employee (personal assistant); and
  • Assigning work tasks for the employee (personal assistant) based on medical and functional needs.

In-home aide and pediatric personal care services are consumer-directable for CAP/C beneficiaries. State Plan Nursing is not a directable service. The option to consumer-direct is not available to CAP/C beneficiaries approved for State Plan Nursing service.

Stakeholder engagement was initiated in April 2017 to design a statewide consumer-direction program for the Community Alternatives Programs. From that engagement, provisions to monitor health, safety, and well-being and requirements to determine readiness and eligibility to self-direct were identified and outlined in an updated self-assessment questionnaire. The newly updated self-assessment questionnaire replaces the self-assessment questionnaire that is included in Appendix G of the CAP/C Clinical Coverage Policy, 3K-1.

Statewide trainings were conducted in the months of June and July 2017 to case management entities and CAP/C beneficiaries or designated family members to build competencies in consumer-direction. Required competencies include an understanding of the following:

  • Overview of consumer-direction;
  • Roles and responsibilities of key players in consumer-direction including the: consumer-direction beneficiary or designated representative, care advisor, financial manager, employee (personal assistant), representative, and DMA;
  • How to complete the self-assessment questionnaire and evaluate responses;
  • Identifying training needs for the beneficiary or designated representative and the employee (personal assistant);
  • How to ensure health, safety, and well-being of the consumer-directed beneficiary;
  • Planning for emergencies and disasters;
  • Strategies for hiring the right employee (personal assistant);
  • Developing a solid person-centered plan of care;
  • How to report critical incidents and understand mandatory reporting of abuse, neglect, and exploitation;
  • Recognizing signs of fraud, waste, and abuse of public funds; when to make a report; and how to make a report;
  • Understanding how pay rates are used to develop a consumer-directed budget; and
  • Internal Revenue Services (IRS) requirements and Department of Labor (DOL) laws pertaining to consumer-direction.

An individual interested in enrolling in the consumer-direction option of CAP must meet the following requirements:

  • Participate in consumer-direction orientation and training;
  • Display cooperativeness with current plan of care;
  • Understand the rights and responsibilities of directing his or her own care;
  • Be willing and intellectually capable to assume the responsibilities for consumer-directed care, or select a representative who is willing and capable to assume the responsibilities to direct the beneficiary’s care; and
  • Complete a self-assessment questionnaire to determine intellectual ability to direct care, ensure health and safety, and identify training opportunities to build competencies to aid in consumer-directed care.

To ensure all CAP beneficiaries are served at the appropriate level of care; a complete change of status is required to transition a beneficiary from the traditional option to the consumer-direction option of CAP. The change of status for consumer-direction must include the following: completed comprehensive interdisciplinary needs assessment, self-assessment questionnaire, financial management agency referral form, updated emergency back-up and disaster plan, freedom of choice form, and individual risk agreement (if applicable).

  • Case management agencies interested in enrolling beneficiaries in the consumer-direction option of CAP must complete the following items:
  • Participate in consumer-direction training sponsored by the Division of Medical Assistance.
  • Submit a managed change request to update Medicaid Provider Enrollment Agreement to include all consumer-directed services eligible to bill.
  • Update any existing policies, procedures and freedom of choice documents to include consumer-direction.

Case management agencies that have not participated in training may contact Racine Monroe at racine.monroe@dhhs.nc.gov or 919-855-4388 to receive a training packet.

Consumer-Direction Materials

CAP/C case management entities training presentation 

CAP/C beneficiaries and families training presentation 

Consumer-direction technical guide

Consumer-direction overview

 

EPSDT and Due Process Training

The Division of Medical Assistance will host several training sessions on Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) and Due Process for CAP/C case management entities. The sessions will provide detailed information about the EPSDT and Due Process Rights of CAP waiver services and other Medicaid services. This training will also focus on the process to request Medicaid services for a waiver beneficiary who is receiving CAP services.

    Date Time  Location 
Aug. 24, 2017 1:30 - 4:30 p.m.  Haywood Co. Health & Human Services Agency
157 Paragon Pkwy.
Clyde, NC 28721
Aug. 25, 2017 1:30 - 4:30 p.m.  Cabarrus Co. Dept. of Social Services
1303 S Cannon Blvd.
Kannapolis, NC 28083
Aug. 31, 2017 1:30 - 4:30 p.m.  403 Government Circle Suite 2
Greenville, NC 27834
Sept. 1, 2017 1:30 - 4:30 p.m.  New Hanover Co. Dept. of Social Services
650 Greenfield St.
Wilmington, NC 28401

What We Heard During the June 22 Stakeholder Engagement Meeting

Thank you for taking your afternoon to share your thoughts and concerns during the June 22 Community Alternatives Program for Children (CAP/C) Stakeholder Engagement Meeting in Raleigh. Revising and implementing the CAP/C 1915(c) Home and Community-Based Services waiver has been a collaborative process, and while we have made good progress so far, we realize that there is a significant way to go.

During our June 22 meeting, you told us:

  • More communication is needed
  • More details are needed about the effective date of the statewide rollout for consumer-direction
  • Need to address lengthy timelines
  • More training is needed
  • Better explanation about the appeals process
  • Explanation of new requirements for background checks

Medicaid is assessing all the concerns we heard during the meeting, and we will get back with you to discuss how these comments and concerns will be resolved. Look forward to another Stakeholder Engagement Meeting soon. We will post information about this meeting on this website and send it to those of you whose email address we have. We will also forward it with all our case managers so that they may share it for you. If you would like to receive updates on CAP/C, please send your email address and phone number to Rachel Lane at rachel.lane@chhs.nc.gov.

Dave Richard

Deputy Secretary for Medical Assistance

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 were 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: 

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 began 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 does 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 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, had to be submitted and approved by Feb. 28, 2017.

If you have any questions, please consult your CAP/C consultant. Prior Approval for CAP/C and CAP/DA

Effective Feb. 5, 2017, N.C. Division of Medical Assistance (DMA) implemented 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 Launched on March 24, 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) implemented a direct service provider interface (DSP) in March 2017. Click here for more information

Introductory Webinar Training Sessions

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) hosted 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.

Feb. 23 - New Waiver Objectives

Feb. 27 - Eligibility Criteria

Feb. 28 - How will waiver services meet my needs?

Feb. 21, 23, 27 and 28- DSP Waiver Objectives

Consumer-Direction Training Sessions

Case Management Entities

The CAP unit of the Division of Medical Assistance held several training sessions on consumer-direction for CAP/C case management entities. The sessions provided detailed information about the consumer-direction option of CAP.

The sessions were held June 27-July 24, 2017 in person, at various locations throughout the state. 

June 27, 2017 - Haywood County Health and Human Services, Clyde

June 29, 2017 - Cabarrus County Department of Social Services, Kannapolis

July 6, 2017 - Wake County- Dorothea Dix Campus, Raleigh

July 12, 2017 - Guilford County Health Department, Greensboro

July 18, 2017, Robeson County Department of Social Services, Lumberton

July 20, 2017, New Hanover Northeast Regional Library, Wilmington&

July 24, 2017, Pitt County Center, Greenville

CAP/C Beneficiaries and Families

The CAP unit of the Division of Medical Assistance held several information sessions on consumer-direction for CAP/C beneficiaries and families. The sessions will provide detailed information about the consumer-direction option of CAP.

The sessions were held June 27, 2017-July 24, 2017 in person, at various locations throughout the state. 

June 27, 2017 - Haywood County Health and Human Services, Clyde

June 29, 2017 - Cabarrus County Department of Social Services, Kannapolis

July 11, 2017, Wake County- DHHS Kirby Building, Raleigh<

July 12, 2017 - Guilford County Health Department, Greensboro

July 18, 2017, Robeson County Department of Social Services, Lumberton

July 20, 2017, New Hanover Northeast Regional Library, Wilmington&

July 24, 2017, Pitt County Center, Greenville

CAP/C Stakeholder Engagement Plan

In order for DHHS to fully engage stakeholders in the execution and administration of the CAP/C waiver, we have established a working group that consists of families, providers and other advocates to assist in the processes and decisions. Even though there is an established workgroup, all invested CAP/C stakeholders are invited to listen in and participate in workgroup sessions.

April 26 - Summary of Stakeholder Listening Session

June 22 - Agenda

Additionally, we established a specific time period on Wednesday’s from noon to 1 p.m. for families and concerned individuals to meet with DMA staff in order to privately address concerns in a different setting. An appointment is required. To make an appointment, call 919-855-4340.

Case Manager Information

CAP/C Critical Incident Report (DMA-3201)

CAP/C Participation Discontinuation Notice

CAP/C Participation Notice (DMA-3057)

CAP/C Physician's Form (DMA-3063)

CAP/C Service Request Form

CAP/C Service Authorization Discontinuation Notice

Verification of Employment for CAP/C

Contacts

CAP/C Case Management Providers and DMA Consultants by Agency

CAP/C Case Management Providers and DMA Consultants by County

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