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CAP IDD Waiver Changes Delayed Again


The Autism Society of North Carolina previously provided an update  about major changes that were expected to take place November 1, 2011 for people currently receiving CAP IDD (MRDD) Waiver services. It is our understanding that the Division of Medical Assistance and Division of MHDDSAS have requested another extension of the current waiver until April 1, 2012.

Please see below for excerpts of the information sent out by NC’s Division of Medical Assistance and Division of MH/DD/SA on Tuesday, December 13:

“We have requested April 1, 2012 as a start date for the CAP-I/DD waiver, but are still awaiting confirmation from CMS on their approval of this date. We appreciate the amount of time that recipients, families, case managers, and providers have spent working on developing transition plans. To that end, we have drafted the following guidelines in an attempt to minimize further disruption for recipients and their families. Please review the following bullets to determine if the case manager and recipient/family need to submit an updated revision (authorization request), including the PCP revision form with appropriate signatures, CTCM form, and updated cost summary.

1. If services were authorized to fit the new waiver requirements and the recipient/legally responsible person accepted the plan/services, then a revision (authorization request) does not need to be submitted. Specifically, if a request to change Home Supports services to Home and Community Supports and Personal Care has been approved, those services can be provided.

2. If services currently authorized under the 2008 CAP MR/DD waiver are not in compliance with the new proposed waiver requirements, then a revision (authorization request) does not need to be submitted at this time. A revision for authorization of new services must be submitted by April 1, 2012 to have services meet the requirements under the new waiver.

3. If an authorization request was approved to change services to meet the new waiver requirements, and the recipient/legally responsible person would rather continue with their current services under the 2008 CAP waiver, then the case manager needs to document this information into a case management note and update the PCP and cost summary for the recipient record. This updated PCP will serve as the authorization in the interim until April 1, 2012. The case manager does not submit this information to the UR Vendor. The plan that was to go into effect on January 1, 2011 will now go into effect on April 1, 2012.

4. If a revision request was sent to the UR vendor to change services to meet the new waiver requirements, the UR vendors will process the request with an effective date of April 1, 2012. The case manager will need to contact the UR Vendor if they would like the request that was submitted to be effective January 1, 2011 instead of April 1, 2012.

5. If a CNR (yearly renewal) with an effective date of January 1, 2011 has been approved or is currently being reviewed by a UR Vendor, and the recipient/legally responsible person would rather continue with their current services, then the case manager needs to update the PCP and cost summary to show 3 months of services under the current waiver and 9 months of services in compliance with the requirements of the new waiver. This updated CNR must be submitted to the UR Vendor by April 1, 2012

Please stay in contact with your case manager if you have questions about your particular services or plans.

No Responses

  1. Paula Foster says:

    Has the waiver date changed again? I have been hearing info that it is not rolling out on April1st. Especially since innovations waiver will begin on January 2013.

    I have a Medicaid Appeal scheduled on April 7th to have my son keep his much needed HCS hours. Finding any info on this is becoming difficult, Bo one seems to know. Currently I was able to have him keep his hours while we appeal, so now I need to know, is waiver change starting on April 1st for the reduction of HCS Hours


  2. mahanjk says:

    Paula, There continue to be delays in the CAP waiver approval by the Centers for Medicare and Medicaid Services (CMS). However, as of today, we still have not heard that the April 1 approval date has changed. The Innovations Waiver is rolling out in different places at different times, depending on when the Local Management Entity converts to a managed care model. We are not hearing that that is the reason for the delay in approval; the delay seems to be based on CMS needing more info and/or changes to the CAP waiver plan that the state has submitted, as well as concerens about other unaddressed needs for people with developmental disabilities in the state.

    Short answer: we don\’t know the timeframe. No one does.

  3. mahanjk says:

    So, we heard today the current Supports and Comprehensive CAP – I/DD waiver will be extended to June 28th.

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