Adult Medicaid Manual MA-2280 COMMUNITY ALTERNATIVES PROGRAM (CAP)
VII. CAP-MR/DD
A. Policy Rules
1. Policy rules in II. A. above also apply to CAP-MR/DD cases.
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(VII.A.)
2. Children in CAP-MR/DD may be in M-AABD and also be in I-AS or H-SF, or adults may be in S-AAD if living in a domiciliary care facility.
3. A CAP-MR/DD a/r must have prior approval for ICF-MR by means of the MR-2.
a. One MR-2 is required for CAP-MR/DD in a private residence,
AND
b. Two MR-2’s are required for CAP-MR/DD services to a recipient of S-AAD in a domiciliary care facility.
(1) One MR-2 approved for ICF-MR level of care, and
(2) The second MR-2 recommends domiciliary care with CAP services.
c. ICF-MR Level of Care is assessed and documented on the MR-2, line 11, by a physician or clinical psychologist licensed by the State of North Carolina. Line 11 of the MR-2 will indicate into which CAP-MR/DD waiver, Supports Waiver (C2) or the Comprehensive Waiver (CM) the recipient will be placed.
4. In the Supports Waiver (C2), the CAP-MR/DD a/r, must have a CAP assessment completed to determine the need for the following CAP-MR/DD services;
a. Day Supports,
b. CAP-MR/DD personal care,
c. Respite care: institutional and non-institutional,
d. Adult day health,
e. Home and Community Supports,
f. Behavior Consultant,
g. Supported employment services,
h. Crisis Respite,
i. Crisis Services,
j. Specialized Consultative Services,
k. Augmentative communication devices,
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(VII.A.4.)
l. Personal Emergency Response System (PERS),
m. Home modifications,
n. Specialized Equipment and Supplies,
o. Individual Caregiver Training and Education,
p. Long Term Vocational Supports,
q. Vehicle Adaptations and,
r. Transportation.
5. In the Comprehensive Waiver (CM), the CAP-MR/DD a/r must have a CAP assessment completed to determine the need for the services listed above in VII. 7. A.4., and the following CAP-MR/DD services;
a. Home Supports
b. Residential Supports
6. The CAP-MR/DD Services Branch in DMH/DD/SAS will approve CAP-MR/DD cases.
a. CAP-MR/DD Services will send a letter of approval to the CAP-MR/DD case manager and to the Medicaid eligibility supervisor in the county dss.
b. The case manager will also notify the county dss.
B. Procedures
1. Follow procedures in III.A. above for CAP-MR/DD.
2. Budgeting
Compute the budget with a b.u. of one beginning the month that CAP is effective and following budgeting principles in MA-2250, Income, and MA-2260 Financial Eligibility Regulations – PLA, and MA-3300, Income (Family and Children’s Manual.)
3. The DMH/DD/SAS-405, CAP-MR/DD Plan of Care or CNR, must be completed by the case manager and submitted to DMH/DD/SAS for a determination of eligibility for the CAP-MR/DD program.
4. All other eligibility factors apply.
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(VII.B.)
5. File in the case record:
a. One copy of the MR-2 to document the need for ICF-MR level of care, or
b. Two copies of the MR-2 appropriate, to document the recommendation for domiciliary care with CAP services.
6. Transfers
If a CAP-MR/DD recipient moves to another county, it does not affect his eligibility for CAP services. CAP coverage continues in the new county. This includes recipients participating in the Piedmont Innovations Waiver.
It is important that there is coordination with the lead agencies during CAP transfers to ensure continuous eligibility for services.
a. CAP indicator codes remain in EIS during the transfer process. Do not delete the CAP-MR/DD indicator code when keying a county transfer. Please refer to EIS-3101 for instructions entering information into EIS.
b. If a CAP-MR/DD participating in a Piedmont county moves to a non-Piedmont county, the CAP indicator code remains until the case manager in county #2 notifies the county there is code change. All CAP recipients in Piedmont have CAP indicator code CM. Follow transfer instructions in VII.B.6.c. below.
c. The IMC in county #1 sends the base document to county #2 along with the last profile and a copy of the county transfer letter given to the recipient. The CAP agency is responsible for providing the IMC in county #2 with the approval letter and the CAP Plan of Care.
d. When a non Piedmont CAP recipient coded CM (Comprehensive Waiver) moves to a Piedmont county, transfer case and follow instructions in VII.B.6.c above. If the recipient is coded C2 (Supports Waiver), county#1 changes the code to CM and follows transfer instructions in VII.B.6.c above.
e. Follow county transfer procedures in MA-2221, County Residence.
7. EIS Entries
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