Community Alternatives Program for Disabled Adults (CAP/DA)

Announcement

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.

The DHHH wants to hear how CAP/DA is working for you. Come share your insights, concerns and recommendations with DHHS leaders at an upcoming listening session. You can share anything you would like, and DHHS is especially interested in comments regarding:

  • How you learned about CAP/DA
  • Services currently benefiting your family
  • Positive impacts of CAP/DA
  • Suggestions for strengthening 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. 

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

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

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

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

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

Update to Community Alternatives Program for Disabled Adults (CAP/DA) Consumer-Direction Model of Care

Consumer-direction is a service delivery model that allows a CAP/DA 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.

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 . The newly updated self-assessment questionnaire replaces the self-assessment questionnaire that is included in Appendix G of the CAP/DA Clinical Coverage Policy, 3K-2

Statewide trainings were conducted in the months of June and July 2017 to case management entities to build competencies in consumer-direction. Required competencies include an understanding of the following:

  • 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

Consumer-direction technical guide

Consumer-direction overview

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.

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.

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

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