An independent review of referrals for individuals seeking to enroll in the Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) waivers is intended to provide an unbiased assessment to ensure the enrollment processes are executed appropriately in each waiver application.
A contract will be awarded to an independent organization to perform these reviews. In January 2020, NC Medicaid announced the award of the Comprehensive Independent Assessment Entity (CIAE) contract. However, the contract for the CIAE was canceled in February 2020.
On Oct. 19, 2020, NC Medicaid implemented an interim plan to perform internal assessment reviews until the CIAE contract is awarded. This interim review plan will extend through the awarding of a contract to an independent assessment entity.
There is a review process for applicants to be considered for participation in the waiver programs.
- To initiate a request for enrollment in one of the CAP waivers, a referral should be submitted to NC Medicaid using the eCAP portal or faxing a paper application to NC Medicaid at 919-715-0052.
- Following the initiation of the request for enrollment, a packet of information will be mailed to the applicant. Two key pieces of information should be returned to NC Medicaid:
- Service Request Consent Form
- Selection of Case Management Form
- Upon receiving the required forms (signed and dated), NC Medicaid will work closely with the applicant and the primary practitioner to assist in determining the clinical eligibility requirements (medical fragility for children and level of care for adults).
Providers should try to assist the applicants as much as possible to follow the process above. If applicants have additional questions regarding enrollment in CAP services or if additional support is needed, providers should refer them to the NC Medicaid LTSS office at 919-855-4340.
Contact
NC Medicaid LTSS Office: 919-855-4340