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

Annual Community Alternatives Program (CAP) Consumer-Direction Beneficiary Education and Enrichment Training

The Division of Medical Assistance (DMA) will host an annual training and educational session in consumer-direction during the months of July and August 2018.  The educational and enrichment trainings will consist of:

  • Overview consumer-direction
  • Eligibility to consumer-direct
  • Enrollment requirements
  • Recruitment of employees
  • Managing a budget

You will have the flexibility to participate in this annual training in-person or by webinar. The training dates are listed below:

Tuesday, July 31, 2018 from 2 to 4:30 p.m. in person at:
Dorothea Dix Park
Brown Building
801 Biggs Drive, Room 104
Raleigh, NC 27603

Wednesday, Aug. 1, 2018 from 5 to 7 p.m. by WEBINAR

Monday, Aug. 6, 2018 from 2 to 4:30 p.m. in person at:
Guilford Co. Dept. of Health and Human Services, Roomm 123
1203 Maple Street
Greensboro, NC 27405
Thursday, Aug. 9, 2018 from 5 - 7 p.m. by WEBINAR

Tuesday, August 14, 2018 from 2:00-4:30pm in person at:
New Hanover Library- Northeast Branch
Oleander Room
(located on the side of the Northeast Library building facing Military Cutoff Road)
1241 Military Cutoff Rd
Wilmington, NC 28405

Registration information will be provided by June 4, 2018. 

You may consult with a CAP case management entity or a representative at DMA if you have any questions. 

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

The Division of Medical Assistance held five (5)  listening sessions across North Carolina to allow interested stakeholders to participate in a collaborative dialogue focused on key areas of the waiver renewal.  These sessions were held in the months of  March and April in the cities of Raleigh, Kannapolis, Lenoir, Hendersonville and Greenville , and included 125 stakeholders. 

During the sessions, focus groups concentrated on topics to determine how well the programs are working, areas for improvement, and creative ways to meet the needs of patients who receive CAP/DA services. Common comment trends included:

  • Provide greater access to transportation
  • Increase rates
  • Provide more training and education to beneficiaries and providers of the program
  • Provide opportunity to use more technology for engagement with beneficiaries

Many of the participants commented that they found the sessions engaging and that the groups allowed for a more focused dialogue and the opportunity to hear creative thoughts and other opinions.  The comments from these listening sessions will be incorporated in the renewal application for the CAP/DA HCBS waiver, which will expire on Sept. 30, 2018.   

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. 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)

Contacts

CAP/DA Lead Agency List

Medical Assistance Clinical Section
Phone: 919-855-4340
Fax: 919-715-0052
Email: medicaid.capda@dhhs.nc.gov