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Community Alternatives Program for Children (CAP/C)

CAP/C Waiver Due to Hurricane Florence

Stakeholder Engagement

NC Medicaid holds two CAP/C stakeholder listening sessions per year to solicit feedback from stakeholders about their waiver participation experience. This feedback aids in streamlining workflow, mitigating inconsistences and gaps in service provisions and identifying efficient strategies to meet the needs of medically fragile children served through the CAP/C program.  These listening sessions are held in the months of April and October of each year.

Dates:  Oct. 30, 2018 - 12:30 p.m. - 2:30 p.m.
           Oct. 30, 2018 - 5:30 p.m. - 7:30 p.m.

In-Person: 1985 Umstead Drive
                Kirby Building, Conference Room 297
                Raleigh, NC 27699

Webinar:  If you are unable to attend in-person, please register via the webinar:
               https://attendee.gotowebinar.com/rt/8351645527236760834

The link will provide the option to select the session of your choice.  After registering, you will receive a confirmation email containing information about joining the webinar.  

Note: A call-in number will be provided upon registration.  If you do not have computer access, to register for the webinar contact Rachel Lane 919-855-4375.

NC Medicaid will solicit feedback from stakeholders regarding proposed changes to the CAP/C Clinical Coverage policy focusing on the following areas:

•    Criteria for medical fragility
•    Definition of program terms and services
•    Requirements for conflict-free case management

You will have three options to make a comment: 

Option #1:  Verbally state your comment - Telephone lines will be unmuted and you will be directed to state your comment based on the three areas of focus listed above. Each speaker will be allotted two minutes to share comments.

Option # 2:  Physically type in your comment using the chat box – Place your cursor in the chat box window and begin typing your comment. The chat box will remain open through the duration of the listening session for you to type your comment based on the three areas of focus listed above. Your comment will be read out loud by a member of NC Medicaid in the order it was received in the chat box.   

Option # 3:  Email or fax your comment to Medicaid.capc@dhhs.nc.gov or 919-715-0052.  Your comment will be read out loud by a member of NC Medicaid.   
 

NC Medicaid Clinical Policy Clarification on CAP/C Travel

We have heard from some beneficiaries expressing concern about the NC Medicaid CAP/C travel policy. The statement below is intended to clarify the policy.

Medicaid CAP/C staff is convening stakeholder engagement groups to review the CAP/C clinical coverage policy in specific areas to determine if the policy is clear and concise, and to determine if language leaves possible interpretation that the policy unintentionally creates barriers for the beneficiary to access the service or providers to render the service. The work groups will continue until the end of September to finalize their recommendations. No changes to current policy have been implemented since the CMS approval of the CAP/C on March 1, 2017, and the method in which respite was designed has not changed. 

We agree that CAP/C is a home- and community-based services waiver program that promotes community inclusion and integration. This person-centered approach to care planning allows for accommodation with what is important “for” the person receiving CAP/C and their family as well as what is important “to” them. Because it is a waiver, there is flexibility in structure and service delivery that may not be accommodated in regular state plan services.

Each participant in the CAP/C waiver is permitted to plan and participate in vacation time with his or her family regardless of the location of the vacation, in or outside of North Carolina (regulatory requirements must be met when a vacation is planned outside of North Carolina). Families are permitted to use their in-home care provider for up to 14 days per year for vacation time. A plan revision for approval is not required; the parent, assigned case manager and the provider agency simply coordinate and arrange for care coverage during the vacation time. So not to exhaust a family’s respite time and to correctly utilize the appropriate waiver service, respite hours are not authorized during planned and unplanned vacations; in-home aide or pediatric nurse hours are authorized and are permitted to be used. 

Children receiving CAP/C services who are also receiving state plan private duty nursing (PDN) are eligible to travel with their families and receive PDN services when a physician indicates the child is able to travel safely and nursing care is needed during this therapeutic leave time. Planning is required by the physician and private duty nursing agency to obtain the physician’s order and ensure that the nurse is licensed to deliver care in North Carolina.   

Dave Richard
Deputy Secretary, NC Medicaid

Focus Groups

The CAP/C Home and Community-Based Services Waiver is in its second year of operation. As part of Medicaid's ongoing effort to meaningfully evaluate the administration of CAP/C, the CAP/C unit will conduct quality reviews of the Clinical Coverage Policy, 3K-1, Community Alternatives Program for Children (CAP/C), in the following areas:

  • Eligibility requirements for waiver participation
  • Definitions of terms, coverage and limitations
  • Care coordination through provider networks

Medicaid is seeking volunteers to participate in one of three focus groups to assist with the quality review of the above listed areas. The goals of the quality review will be to evaluate the policy's:

  1. Clarity, conciseness, and ease of application for beneficiaries receiving services and providers rendering services. 
  2. Coverage criteria to identify unintended barriers that may limit access to care and needed services.
  3. Care coordination activities to ensure interest-free case management services are being administrated. 

The results of the review will serve as a basis for future revisions to the CAP/C Clinical Coverage Policy and  waiver amendment.

An interest meeting regarding this initiative will be held on June 26, 2018 from noon - 1 p.m. by webinar. The quality analysis review of the CAP/C Clinical Coverage Policy will begin the week of July 2, 2018 and conclude on September 30, 2018. The recommendations from the three groups will be shared with the CAP/C Advisory Committee for additional discussion.

If interested in participating, email Rachel Lane at  rachel.lane@dhhs.nc.gov and provide to your name, contact information and the focus group of your preference; or indicate your willingness to participate in one of the focus groups by registering and attending the webinar on June 26.

Listening Session Comments

Summary of trends from Listening Session held on Oct. 19, 2017

Stakeholder Engagement - June 22, 2017

About CAP/C Consumer-Direction

The CAP/C program has begun implementation of consumer-direction for the 1915(c) Home and Community-Based Services Waiver, Community Alternatives Program for Children (CAP/C)

Consumer-direction is a service delivery model that allows a CAP/C 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.

In-home aide and pediatric personal care services are consumer-directable for CAP/C beneficiaries. State Plan Nursing is not a directable service. The option to consumer-direct is not available to CAP/C beneficiaries approved for State Plan Nursing service.

Stakeholder engagement was initiated in April 2017 to design a statewide consumer-direction program for the Community Alternatives Programs. From that engagement, provisions to monitor health, safety, and well-being and requirements to determine readiness and eligibility to self-direct were identified and outlined in an updated self-assessment questionnaire. The newly updated self-assessment questionnaire replaces the self-assessment questionnaire that is included in Appendix G of the CAP/C Clinical Coverage Policy, 3K-1.

Statewide trainings were conducted in the months of June and July 2017 to case management entities and CAP/C beneficiaries or designated family members to build competencies in consumer-direction. Required competencies include an understanding of the following:

  • Overview of consumer-direction;
  • Roles and responsibilities of key players in consumer-direction including the: consumer-direction beneficiary or designated representative, care advisor, financial manager, employee (personal assistant), representative, and DMA;
  • How to complete the self-assessment questionnaire and evaluate responses;
  • Identifying training needs for the beneficiary or designated representative and the employee (personal assistant);
  • How to ensure health, safety, and well-being of the consumer-directed beneficiary;
  • Planning for emergencies and disasters;
  • Strategies for hiring the right employee (personal assistant);
  • Developing a solid person-centered plan of care;
  • How to report critical incidents and understand mandatory reporting of abuse, neglect, and exploitation;
  • Recognizing signs of fraud, waste, and abuse of public funds; when to make a report; and how to make a report;
  • Understanding how pay rates are used to develop a consumer-directed budget; and
  • Internal Revenue Services (IRS) requirements and Department of Labor (DOL) laws pertaining to consumer-direction.

An individual interested in enrolling in the consumer-direction option of CAP must meet the following requirements:

  • Participate in consumer-direction orientation and training;
  • Display cooperativeness with current plan of care;
  • Understand the rights and responsibilities of directing his or her own care;
  • Be willing and intellectually capable to assume the responsibilities for consumer-directed care, or select a representative who is willing and capable to assume the responsibilities to direct the beneficiary’s care; and
  • Complete a self-assessment questionnaire to determine intellectual ability to direct care, ensure health and safety, and identify training opportunities to build competencies to aid in consumer-directed care.

To ensure all CAP beneficiaries are served at the appropriate level of care; a complete change of status is required to transition a beneficiary from the traditional option to the consumer-direction option of CAP. The change of status for consumer-direction must include the following: completed comprehensive interdisciplinary needs assessment, self-assessment questionnaire, financial management agency referral form, updated emergency back-up and disaster plan, freedom of choice form, and individual risk agreement (if applicable).

  • Case management agencies interested in enrolling beneficiaries in the consumer-direction option of CAP must complete the following items:
  • Participate in consumer-direction training sponsored by NC Medicaid.
  • Submit a managed change request to update Medicaid Provider Enrollment Agreement to include all consumer-directed services eligible to bill.
  • Update any existing policies, procedures and freedom of choice documents to include consumer-direction.

Case management agencies that have not participated in training may contact Racine Monroe at racine.monroe@dhhs.nc.gov or 919-855-4388 to receive a training packet.

Consumer-Direction Materials

CAP/C case management entities training presentation 

CAP/C beneficiaries and families training presentation 

Consumer-direction technical guide

Consumer-direction overview

Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

EPSDT is Medicaid’s benefit program for children and adolescents under age 21. CAP/C beneficiaries might be able to benefit from this program. Visit the EPSDT web page for more information.

CAP/C Waiver Approved by CMS

We are pleased to announce the Community Alternatives Program for Children (CAP/C) 1915(c) Home and Community-Based Services (HCBS) waiver has been approved by the Centers for Medicare & Medicaid Services (CMS). The waiver took effect March 1, 2017.

The work and input of families, advocates and providers during the process of revising the waiver is a clear indication of how we can make our system better for all involved by working together. We still have a significant amount of work to do in the implementation of the waiver and related policies, and continued involvement is essential for this process. 

For now, we should celebrate that beginning March 1, 2017, we were able to start the process of determining eligibility and begin serving the children who had to be placed on a waiting list during the submission process.  

Thank you again for your support and guidance during this process, and I look forward to our continued collaboration to assure that children with complex medical needs are provided high quality service through our Medicaid program.

For more information, read the February, 2017, Special Medicaid Bulletin, CAP/C Waiver Renewed by Centers for Medicare & Medicaid Services, or click on one of the links below: 

Dave Richard
Deputy Secretary for NC Medicaid

Direct Service Provider (DSP) Interface

The Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) waivers rely on an electronic system called e-CAP to manage CAP eligibility determination activities, service plan development and monitoring tasks. As a way of streamlining processes and promoting a multidisciplinary team approach, NC Medicaid implemented a direct service provider interface (DSP) in March 2017. Click here for more information

NC Medicaid 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 will be 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.

Webinar Trainings

In preparation for the newly amended Community Alternatives Program for Children (CAP/C) Home and Community-Based Services waiver, NC Medicaid hosted a series of introductory webinar trainings for the CAP/C case management entities, CAP/C beneficiaries and their families and CAP/C direct service providers.

Feb. 23, 2017 - New Waiver Objectives

Feb. 27, 2017 - Eligibility Criteria

Feb. 28, 2017 - How will waiver services meet my needs?

Feb. 21, 23, 27 and 28, 2017 - DSP Waiver Objectives

Jan. 16, 2018 - Service Plan Development

CAP/C Waiver Services

  • Assistive technology
  • CAP/C in-home aide
  • Care advisor
  • Case management
  • Community transition service
  • Financial management services
  • Home accessibility and adaptation
  • Motor vehicle modifications and adaptation
  • Participant goods and services
  • Pediatric nurse aide services
  • Respite services (institutional and non-institutional)
  • Specialized medical equipment and supplies
  • Training, educaiton and consultative services

Resources

CAP Forms

CAPC Case Management Providers

Contact

NC Medicaid Clinical Section
Phone: 919-855-4340
Fax: 919-715-0052
Email: Medicaid.capc@dhhs.nc.gov