Topics Related to Community Alternatives Program (CAP/C & CAP/DA) Providers

The Community Alternatives Program for Disabled Adults (CAP/DA) §1915(c) Home and Community-Based Services (HCBS) waiver application has been renewed by the Centers for Medicare and Medicaid Services (CMS), effective Nov. 1, 2019 through Oct. 31, 2024.

Session Law 2017-57, Section 11H.13/(a) was amended to appropriate funding to be used to increase the rate for in-home aide services to no more than three dollars and ninety cents ($3.90) paid per 15-minute billing unit provided under the Community Alternatives Program for Disabled Adults (CAP/DA) waiver pursuant to Clinical Coverage Policy 3K-2, effective Jan. 1, 2019.

A renewal application for § 1915 (c) Home and Community-Based Services (HCBS) waiver for the Community Alternatives Program for Disabled Adults (CAP/DA) was submitted to the Centers for Medicare & Medicaid Services (CMS) on Mar. 1, 2019 for review and approval.

NC 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.

Effective Dec. 1, 2018, the North Carolina Medicaid Uniform Screening Tool (NCMUST) application and operation of the Level 1 PASRR screen process transitioned from a NC Medicaid vendor to NC DHHS ITD and NC Medicaid.  The transition enables NC DHHS to achieve a more efficient screening process for PASRRs and provide NCDHHS with direct knowledge of issues and barriers that may impact the timely processing of PASRR Level 1 screens and Level 2 evaluations. 

Effective Jan. 31, 2019, NC Medicaid’s Community Alternatives Program for Children (CAP/C) approves specialized medical equipment and supplies for an adaptive car seat and a vehicular transport vest for participants in CAP/C when all qualifying conditions are met per the CAP/C Clinical Coverage Policy, 3K-1.

This announcement is to inform Community Alternatives Program for Children providers of revisions to the technical changes in Clinical Coverage Policy, 3K-1, Community Alternatives Program for Children (CAP/C)

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.

The Community Alternatives Program for Disabled Adults (CAP/DA) Waiver allows Adult Day Health (ADH) centers licensed to provide overnight respite to be providers of CAP/DA Institutional Respite.

As previously communicated, Reimbursement Rate Increase, North Carolina Medicaid retroactively increased the rate for Personal Care Services and the Community Alternatives Program for Children.