The Arc of North Carolina :: North Carolina Action Alert

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Children and adults who qualify receive developmental disability services through a variety of Medicaid waivers and also through some limited state-funded services. For those of you who are not familiar with the waiver, we have created a Service System Information Page on our website.

The Community Alternatives Program for Persons with Mental Retardation/ Developmental Disabilities (CAP-MR/DD)

is a special Medicaid program started in 1983 to serve individuals who would otherwise require care in an intermediate

care facility for people with the mental retardation/developmental disabilities (ICF/MR). It allows these individuals the

opportunity to be served in the community instead of residing in an institutional or group home setting. CAP-MR/DD

operates under a Medicaid home and community-based services waiver granted by the Health Care  Financing

Administration (HCFA). HCFA approves the services, the number of individuals that may participate, and other aspects

of the program. The participants must be at risk of institutionalization.  The Medicaid cost for community care must be

cost effective in comparison to the cost of ICF/MR care.


The CAP-MR/DD program is administered by the Best Practice and Community Innovations Team in the Community Policy

Management Section of the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services. The

Local Management Entities are responsible for operation at the local level. The Division of Medical Assistance, as the State

Medicaid Agency, provides oversight in relation to Medicaid and waiver issues.

Waivers Fact Sheet

To read comprehensive information about the waivers please visit the NC MH/DD/SAS waivers page

Comprehensive Waiver

Supports Waiver

11/03/08

New Document added on the new waivers implementation

Transition to Home Supports

Please visit the Division's website to get the most up-top date documents on the new waivers at:

http://www.ncdhhs.gov/mhddsas/cap-mrdd/index.htm

10/29/2008

10/29/08 CAP Update Memo

Attachment referenced in above update

Please visit the Division's website to get the most up-top date documents on the new waivers at:

http://www.ncdhhs.gov/mhddsas/cap-mrdd/index.htm

Handouts of Waiver Information from the Goldsboro Training on 10/22/08

Power Point Presentation

Waiver Transition Process and Letter

Waiver Transition Process Flow Chart

CAPMRDD Core Values

Process for Accessing CAP Services (Access and eligibility for new applicants)

Prioritization Tool and Instructions

Risk Identification Tool (This will become a part of the person's plan)

Services Grid for Home Supports and similar services

Termination Letter/Notification of Rights

Hearing Timeline

Cost Summary Supports Waiver

Cost Summary Comprehensive Waiver

Attestation Procedures (NEW procedures for enrollment of existing Home and Community Supports and Personal Care Providers as Home Support Providers. Also included are the procedures for the use of the Attestation Letter with Adult Day Health, Crisis Services, Day Supports, Home and Community Support, Personal Care, Residential Supports, Respite, and Supported Employment.)

Attestation Letter (as referenced above in the procedures)

Handouts of Waiver Information from the Goldsboro Training on 10/8/08

The materials below were handed out to the attendees of the new waiver information meeting.

Overview

Power Point Presentation

Power Point Presentation (part 2)

Transition Flow Chart

Case Manager Transition Instructions

Risk Identification Tool

Prioritization Tool

Prioritization Tool Instructions

New Waiver Service Definitions Posted 9/30/08

The CAP-MR/DD Waiver Service Definitions for both new waivers have been posted on the Division's CAP-MR/DD page.

New Waiver Implementation Update

The DMH/DD/SAS and the DMA submitted the two new waiver applications (Supports Waiver and Comprehensive Waiver) to the Centers for Medicaid and Medicare (CMS) as scheduled on August 1, 2008. We are grateful to each of you who participated in the development of the two new waivers. The waivers will be implemented on November 1, 2008, pending CMS approval. The Divisions are now involved in the multiple tasks associated with implementation of the two new waivers. We are committed to working with individuals, families, LMEs and service providers to ensure a seamless transition to the new waivers and extend our appreciation in advance for your patience during this transition period.

Please read Implementation Update # 48 for detailed information about the new waivers

The current Community Alternatives Program for MR/DD (CAP-MR/DD Waiver) will expire 10/31/08. The NC Divisions of MH/DD/SAS and Medical Assistance are drafting new Waivers to begin 11/1/08. Representatives of these Divisions will provide information and respond to feedback at six 2-hour Public Forums.

The Division of MH/DD/SAS has been working on the new waivers. As you may recall from our last E-Alert, the current CAP-MR/DD waiver expires in August 2008 and the Legislature has mandated the development of tiered waivers. The state has requested and is expected to receive authority to extend the current waiver until the end of December 2008 in order to have adequate time to develop a waiver plan that best meets the needs of North Carolinians.

The development of tiered waivers will mean that the waiver that a person receives will be based on their support needs; i.e. Tier 1 will support people with greater independence and less support needs while Tier 4 will serve people with medical fragility and significant behavioral support needs.

The Arc continues to advocate for more flexibility in the waivers, the ability for families and individuals to self direct their supports and services, and for more ability for the Local Management Entities (LMEs) to manage the waivers. To date, the Division has been receptive to input and is attempting to make the waivers user-friendly.

We want to continue to provide positive and rational feedback on how to make the waivers work best for individuals and families. To that end, we really want to know your thoughts. For now the feedback that would be most helpful are your thoughts on what is currently working, what is hopelessly broken, and what needs to be repaired with the current waiver. Please let us know what you want to see in the new waivers so that we can formulate our advocacy position.

Send an e-mail to lguzman@arcnc.org with what you would like to see with new waivers. Your ideas and suggestions will be used to shape our positions and advocacy as the new waivers are developed.

As drafts of the new waiver plan begin to emerge we will make sure you have the information and we'll make sure you know how to provide your input and feedback. For those of you who are not familiar with the waiver, we have created a Service System Information Page on our website.

On December 19, 2007 staff from The Arc of NC attended a waiver meeting in Raleigh. Staff from the division of DD/MH/SAS gave an overview of the process for developing new CAP-MR/DD waivers.

The current CAP-MR/DD waiver expires in August 2008 and last session, the Legislature mandated the development of tiered waivers. The Division intends to develop 3 separate tiered waivers to replace the current waiver (The Arc of NC is recommending 4 tiers, not 3). The waiver that a person receives will be based on their support needs; i.e. Tier 1 will support people with greater independence and less support needs while Tier 3 will serve people with medical fragility and significant behavioral support needs.

We are notifying you today of these developments because over the next few months there are going to be public comment periods, opportunities for people to participate in the development of the new waivers and a need for feedback on the proposed new waivers.

The timeline for the development of these new waivers will be very quick. The Division plans to have the waivers submitted to The Division of Medical Assistance (DMA) by March 2008.

The Arc of NC will be actively involved throughout the entire waiver development process. The Arc is drafting recommendations that we will send to the Division (we will share these through the E-alert network) and that we will use to guide our advocacy around this critical issue.