Community Alternatives Program for Disabled Adults (CAP/DA)

Announcements

Waiver Renewal Application Listening Sessions

The 1915 (c) Home and Community-Based Services Waiver for the Community Alternatives Program for Disabled Adults (CAP/DA) is scheduled to expire on Sept. 30, 2018. The NC Division of Medical Assistance (DMA) must submit a waiver renewal application to the Centers for Medicare and Medicaid Services (CMS) no later than June 1, 2018, 90 days prior to the expiration of the waiver, to ensure the continuation of the waiver. In addition to the waiver renewal application, the Clinical Coverage Policy, 3K-2, Community Alternatives program for Disabled Adults (CAP/DA), will be revised to support the clinical operation of CAP/DA.

To initiate the planning activities for the expiring waiver, DMA is seeking input in future waiver processes and clinical components for a renewal waiver with an effective date of October 1, 2018. Listening sessions will take place across North Carolina from Oct. 24 through Nov. 8. These events are open to all stakeholder groups including beneficiaries, case management agencies, providers and Divisions within the Department of Health and Human Services. Below are the locations, dates, and times for each session. Please attend the session that works best for you.

Listening Sessions

Oct. 24, 2017, 10 a.m.-noon: Henderson County Library, 301 N. Washington St., Hendersonville, NC. Register here.

Oct. 25, 2017, 9-11 a.m.: Guilford County DSS, 1203 Maple St., Greensboro, NC. Register here

Oct. 31, 2017, 1:30-3:30 p.m.: Dix Campus, Brown Bldg., Room 104, 801 Biggs Dr., Raleigh, NC. Register here.

Nov. 1, 2017, 10 a.m.-noon: Beaufort DSS, 632 W. 5th St., Washington, NC. Register here

Nov. 8, 2017, 10 a.m.-noon: Mecklenburg County Health Dept., 2845 Beatties Ford Road, Charlotte, NC. Register here

You can also email your comments to medicaid.capda@dhhs.nc.gov

Consumer-Direction Training Sessions for Case Management Entities

The CAP unit of the Division of Medical Assistance will host several training sessions on consumer-direction for CAP/DA case management entities. The sessions will provide detailed information about the consumer-direction option of CAP.

The sessions will be held June 28-July 24, 2017, at various locations throughout the state. Below are the options of locations, dates, and times for each session. Contact Rachel Lane at 919-855-4375 or rachel.lane@dhhs.nc.gov to register.

June 28, 2017, 10 a.m.-1 p.m.
Haywood County Health and Human Services
157 Paragon Parkway
Clyde, NC 2872

June 29, 2017, 10 a.m.-1 p.m.
Cabarrus County Department of Social Services
1303 S. Cannon Blvd.
Kannapolis, NC 28083

July 6, 2017, 2-5 p.m.
Wake County-Dorothea Dix Campus
Brown Building
801 Biggs Drive
Raleigh NC 27603

July 13, 2017, 10 a.m.-1 p.m.
Guilford County Health Department
1203 Maple St.
Greensboro, NC 27405

July 18, 2017, 10 a.m.-1 p.m.
Robeson County Department of Social Services
20 Glen Cowan Road
Lumberton, NC 28360

July 20, 2017, 10 a.m.-1 p.m.
New Hanover Northeast Regional Library
1241 Military Cutoff Road
Wilmington, NC 28405

July 24, 2017, 10 a.m.-1 p.m.
Pitt County Center
403 Government Circle Suite 2
Greenville, NC 27834

 

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

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) 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.

February 23 - New Waiver Objectives

February 27 - Eligibility Criteria

February 28 - How will waiver services meet my needs?

February 21, 23, 27 and 28- DSP Waiver Objectives

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