Community Alternatives Program for Children (CAP/C)

Announcement

October 2017 Listening Session

PRESENTATION

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

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

You can email comments to medicaid.capc@dhhs.nc.gov

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

Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

EPSDT is Medicaid’s benefit program for children and adolescents under age 21. CAP/C beneficiaries might be able to benefit from this program. Visit the ESPDT web page for more information.

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

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

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.

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

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.

    Forms for Case Managers

    CAP Forms

    Contacts

    CAPC Team Assignments

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