Community Alternatives Program for Disabled Adults (CAP/DA)

Announcement

Waiver Renewal Application

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.

Projected Waiver Renewal Timeline

  • October-November, 2017 - Listening sessions
  • December 17 - March 2018 - Focus groups
  • February - April 2018 - Waiver drafting and comments
  • March - May 2018 - Internal approval
  • May - June 2018 Submission to CMS for approval
  • September - October 2018 - Statewide Rollout

Stakeholder Engagement of Core Focus Groups

Focus Group Q Focus Group CC Focus Group S Focus Group E
Primary objective is to design the waiver Quality Improvement Strategies and Continuous Quality Improvement Initiatives Primary objective is to identify case management activities and timeliness; safeguards for interest-free case management and eligible providers of CM/HCBS and required responsiblities of partnering entities. Primary Objective is to identify and define HCBS services to maintain and promote community integration civen the changing needs of target population  Primary ojective is to identify and define waiver entry eligibility, health, safety and well-being criteria

Next Planning Initiatives

Information Gathering and Sharing Statewide in a World Café engagement. A World Café engagement is collaborative dialogue focused on specific areas that leads to sharing of knowledge to aide in the design of innovative strategies for potential program implementation. People sit in groups at a table and hold a series of conversational rounds lasting from 20 to 45 minutes about one or more subject matters/questions which are meaningful to the goals at hand. At the end of each round, one person remains at each table as the host, while the other members travel to separate tables. Table hosts welcome newcomers to their tables and share the essence of that table's conversation so far. The newcomers relate any conversational threads they are carrying -- and then the conversation continues, deepening as the round progresses.

Opportunities to participant in a World Café engagement:

March 20, 2018, 9a.m. – 2p.m. in Wake County
Location TBA

March 21, 2018, 9 a.m.-2 p.m. in Cumberland County
Cumberland County Department of Social Services
1225 Ramsey Street
Fayetteville, NC

March 26, 2018, 9 a.m. - 2 p.m. in Cabarrus County
Cabarrus County Department of Social Services
1303 S Cannon Blvd.
Kannapolis, NC 28083

March 27, 2018, 9 a.m. -2 p.m. in Caldwell County
Caldwell County Department of Social Services
2345 Morganton Blvd. SW
Lenoir, NC 28645

March 28, 2018, 9 a.m. -2 p.m. in Henderson County
Henderson County Library
301 N. Washington Street
Hendersonville, NC 28739

April 4, 2018, 9 a.m.-2p.m. in Pitt County
Pitt County Agricultural Center
403 Government Circle Suite 2
Greenville, NC 27834

A register link will be provided to attend one of the World Café engagements in-person.

Past Inititiaves

Listening sessions were held across North Carolina from Oct. 24 through Nov. 8, 2017

Summary of trends from comments:

  • Additional waiver slots
  • Management of behavioral health services to meet mental health and substance abuse needs
  • Expansion of waiver services to meet changing demographic of target population
  • Innovative strategies to meet needs for transportation

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 was 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

Effective March 2017, a Direct Service Provider( DSP) Interface was implemented to streamline CAP/DA case management processes in the areas of eligibility, service plan development and authorization and care coordination. Direct Service Providers authorized to provided CAP/DA services must register to be a DSP user of the e-CAP system by accessing this link.

Webinar Trainings

Feb. 23, 2017 - New Waiver Objectives

Feb. 27, 2017 - Eligibility Criteria

Feb. 28, 2017 - How will waiver services meet my needs?

February 21, 23, 27 and 28, 2017 - DSP Waiver Objectives

Aug. 20, 2017 - Alzheimer's Disease and Related Disorder Priority Slot Management

Consumer Direction Model of Care

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.

Resources

CAP Forms

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)

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

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