Community Alternatives Program for Disabled Adults (CAP/DA)

Announcements

Consumer-Direction for the 1915(c) Home and Community-Based Services Waiver, Community Alternatives Program for Disabled Adults (CAP/DA)

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.

In-home aide services are consumer-directable for CAP/DA beneficiaries. State Plan Nursing is not a directable service. The option to consumer-direct is not available to CAP/DA 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 C 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 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/DA case management entities training presentation

Consumer-direction technical guide 

Consumer-direction overview

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