Community Alternatives Program for Children Waiver Renewal

Proposed CAP/C Waiver renewal posted for public comment

Waiver Template Titles

Description of changes made to the CAP/C waiver application  

Major changes

• Consumer-directed care: All participants in this waiver are eligible to direct their care using consumer-directed services, including children at a skill level consistent with private duty nursing care. 
• Determining level of care: When a waiver participant receives services from a 1915(c) HCBS waiver in the state, a reevaluation of the level of care is not required.
• The number of waiver participants served: This waiver will serve 6,000 over the five-year waiver approval cycle. NC Medicaid will seek to enhance funding through the America Rescue Plan Act for 1,000 of the additional 2,000 slots added to the unduplicated participant count.
• Appendix C was updated to expand the service definitions for all waiver services and added two new services (coordinated caregiving and community integration services). 

Waiver Administration and Operation

No substantial changes have been made to this section. The administration and operation of the waiver will be managed by the State Medicaid Agency, NC Medicaid. NC Medicaid will collaborate with contracted vendors and local, government and non-government agencies across the state to conduct administrative functions of the waiver. These entities will be responsible for:

• Participant waiver enrollment
• Waiver enrollment managed against approved limits
• Waiver expenditures managed against approved levels
• Level of care evaluation
• Review of participant service plans

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Utilization management qualified provider enrollment

Participant Access and Eligibility

No substantial changes have been made to this section.

• There is no individual cost limit for this waiver. Still, the applicant’s care needs must be equal to or less than the average per capita cost of the projected institutional limits described in the waiver.
• This waiver is targeted to serve 6,000 unduplicated participants by waiver year five. Each applicant must meet the level of care required to be considered for enrollment in the CAP/C waiver.
• Each applicant must meet the targeted population criteria of medically fragile.
• Applicants meeting a level of care when a new referral is made will automatically meet the level of care required but will need to meet the criteria for medical fragility.
• Applicants transitioning from the CAP/DA waiver will be fast-tracked to the waiver during the identified transition date.

Participant Services

Substantial changes were made to this section. Three new services were added to the waiver application. These services are:

• Attendant Nurse Care
• Community Integration
• Coordinated Caregiving

When qualifying conditions are met, legally responsible persons will be permitted to be the paid caregiver.

Other waiver service definitions that were updated include: 

•  Home accessibility and adaptation services: when qualifying conditions are met, the coverage of fixtures and mirrors and hypoallergenic filters, replacement of storage spaces.
• Goods and services: when qualifying conditions are met to address social determinants, the coverage of CAP-specific protective equipment, thermometer, hypoallergenic pillows, blinds and a housing safety and quality inspection.
• Community Transition and Integration services: when qualifying conditions are met, linkage to health-related legal support.     
• Training, education and consultative services:  when qualifying conditions are met to address social determinants, violence intervention services  

Participant-Centered Planning and Service Delivery

No substantial changes have been made to this section.

Participant Direction of Services

The new service, Attendant Nurse Care, added to Appendix C was added to this section. No other substantial changes were made to this section.

Participant Rights

No substantial changes have been made to this section. Waiver participants will have the right to request an expedited appeal when a service is denied, reduced, or terminated.

Participants Safeguards

No substantial changes have been made to this section.

Quality Improvement Strategy

No substantial changes have been made to this section.

Financial Accountability

No substantial changes have been made to this section.

Appendix J

Substantial changes have been made to this section. The new waiver services and the increase in the direct care worker rates were added to the projections of community and community-based planning to compare against institutional services. The average per capita cost for waiver services is less than the average per capita cost of institutional services.