In the approved Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) waiver applications, the initial enrollment process includes an independent assessment review. The independent review is intended to provide an unbiased review of an individual seeking enrollment in the CAP/C or CAP/DA waiver.
In January 2020, NC Medicaid announced the awarding of the Comprehensive Independent Assessment Entity (CIAE) contract to recommend enrollment in the waiver programs. However, the contract for the CIAE was canceled in February 2020.
To ensure the waiver enrollment administrative processes are executed as approved in each waiver application, until the award of a contract to an external CIAE vendor, NC Medicaid will implement an internal independent assessment review process. This internal independent assessment process will begin in October 2020 with a go-live date of Oct. 19, 2020.
The interim CAP/C and CAP/DA waiver enrollment business processes will comprise of the following:
- To request initial enrollment in CAP/C or CAP/DA, interested individuals must voice a request of participation, and a referral will be generated electronically through the e-CAP system. The referral may be requested directly to a CAP/C or CAP/DA case management entity, completed in the e-CAP portals, or submitted directly to NC Medicaid. Upon the receipt of the referral, a member of NC Medicaid will work closely with the applicant and the primary practitioner to assist in determining clinical eligibility (medical fragility and level of care).
- Upon the approval of the service request, a case management entity chosen by the approved applicant, will be assigned to complete the in-home comprehensive assessment to identify indication of risks, gaps in the service provision, or stress on the primary caregiver(s).
- Upon the recommendation that the applicant needs at least one of the home- and community-based services approved in the CAP/C or CAP/DA waiver, the applicant will be notified of his or her approval to enroll in the CAP/C or CAP/DA waiver. The applicant must sign an enrollment form, which confirms an agreement to enroll in the waiver program.
For both the CAP/C and CAP/DA waivers, the case management entities will complete the annual reassessment of need, known as the continued need assessment (CNR). NC Medicaid will approve all annual reassessments for CAP/C beneficiaries.
In October, informational sessions will be provided to the case management entities, providers, and CAP beneficiaries to review the new initial enrollment process, to address and answer questions, and to report the start and cut-off dates of old and new business processes.
Medicaid Contact Center: 888-245-0179