Community Alternatives Program for Disabled Adults (CAP/DA)
What is CAP/DA?
A Medicaid Home and Community-Based Services (HCBS) program authorized under section1915(c) of the Social Security Act and complies with 42 CFR § 440.180, Home and Community-Based Waiver Services. This waiver program provides a cost-effective alternative to institutionalization for a Medicaid beneficiary who is medically fragile and at risk for institutionalization if home- and community-bases services approved in the CAP/DA waiver were not available. These services allow the beneficiary to remain in or return to a home and community-based setting. This waiver supplements, rather than replaces, the formal and informal services and supports already available to an approved Medicaid beneficiary.
Who is eligible for CAP/DA?
- A disabled adults 18 years old and older.
- An individual who is determined to require a level of institutional care under the State Medicaid Plan.
- An individual who needs at least one or more CAP/DA home-and community-based services based on a reasonable indication of need assessment that must be coordinated by a CAP/DA case manager.
What Home- and Community-based services are approved in the CAP/DA waiver?
- Adult day health;
- CAP In-home aide;
- Equipment, modification and technology;
- Meal preparation and delivery;
- Respite services - Institutional respite and In-Home Aide respite;
- Personal Emergency Response Services (PERS);
- Specialized medical supplies;
- Goods and services – Participant, Individual-directed, Pest eradication, Nutritional services, Non-medical transportation and Chore services-declutter and garbage disposal;
- Community transition;
- Community integration;
- Training, education and consultative;
- Coordinated caregiving;
- Case management – case management and care advisement;
- Personal assistance;
- Financial management; and
- Consumer directed services
What is Consumer Directed Services?
Consumer-direction is a service delivery model that allows a CAP/DA Medicaid beneficiary or designated representative to act in the role of employer of record to direct their personal care services by:
- Freely choosing who will provide care to meet medical and functional needs;
- Independently recruiting, hiring, supervising, and firing (when necessary) an employee (personal assistant);
- Independently setting a pay rate for an employee (personal assistant); and
- Assigning work tasks for the employee (personal assistant) based on medical and functional needs.
How to make a CAP/DA referral?
Contact a local CAP/DA case management entity in the county of residence of the applicant to request a CAP/DA referral.
If you are a CAP/DA case management entity or a qualified home- and community-based provider, a referral can be completed in the e-CAP system.
A referral may also be made by calling 919-855-4340 or faxing the completed referral form to 919-715-0052
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CAP/DA Waiver Application and Updates
CAP/DA Standard Operating Procedures
- CAP Willing Qualified Provider
- Seclusion and Restraint Free Policy Guidance
- Assessment of Reasonable Indication of Need
- Waiver Entry Management
NC Medicaid Clinical Section
Community Alternatives Program for Disabled Adults Waiver Application Submitted
The Community Alternatives Program for Disabled Adults Waiver Application was submitted to The Centers for Medicare & Medicaid Services (CMS) Trareview and approval on March 1, 2019.
Click here to view the CAP/DA Renewed Application.
NC Medicaid has requested from CMS an extension period to continue to administer the CAP/DA waiver through CMS’ review and approval process.
During the public comment period (Jan. 4 – Feb. 4, 2019), a total of 300 comments were received. From those comments three (3) sections were updated in the draft waiver application, Appendix B, C and D. The updates were made only to provide additional clarity; the intended business processes were not changed. Click here to view a summary of the comments.
Home and Community-Based Services Waiver Orientation and Educational Training
During the month of June 2019, NC Medicaid Long-Term Services and Supports held a Community Alternatives Program for Disabled Adults (CAP/DA) Home- and Community-Based Services (HCBS) waiver orientation and educational training for CAP/DA HCBS providers.
Training provided an in-depth overview of the newly implemented workflow and business steps to render CAP/DA services as outlined in the renewed CAP/DA HCBS waiver application and the amended CAP/DA Clinical Coverage Policy, 3K-2.
Community Alternatives Program for Disabled Adults Waiver Application Stakeholder Sessions
The CAP/DA unit within NC Medicaid held informational webinars for stakeholders in Jan. 2019 to learn about the proposed changes included in the waiver application and gave stakeholders an opportunity to make comments.
Comments pertaining to the renewal CAP/DA waiver application may also be forwarded to Medicaid.email@example.com or by calling 919-855-4343. An electronic version of the renewal application is available on the NC Medicaid, NCTracks and e-CAP websites and a paper version can be accessed at each county Department of Social Services office.
NC Medicaid engaged stakeholders through statewide listening sessions, focus groups, work sessions, public comments and information sharing. The recommendations gathered from these stakeholder engagements informed the design of the proposed renewal CAP/DA HCBS waiver.
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.
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|
Annual Community Alternatives Program (CAP) Consumer-Direction Beneficiary Education and Enrichment Training
North Carolina Medicaid held annual training and educational sessions in consumer-direction during the months of July and August 2018. The annual trainings were for individuals currently participating in the consumer-direction program and for those individuals interested in participating in the consumer-direction program. The educational and enrichment trainings will consist of:
- Overview of consumer-direction
- Eligibility to consumer-direct
- Enrollment requirements
- Recruitment of employees
- Managing a budget
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.
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