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CAP MR/DD SERVICES
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 Centers for Medicare and Medicaid
Services (CMS). CMS 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.
COMMUNITY SUPPORT FOR ADULTS
Community Support consists of mental health and substance abuse
rehabilitation services and supports necessary to assist the person
in achieving and maintaining rehabilitative, sobriety, and recovery
goals. It is designed to meet the mental health/substance abuse
treatment, financial,
 social, and other treatment support needs of
the recipient as well as assist the recipient in acquiring mental
health/substance abuse recovery skills necessary to successfully
address his/her educational, vocational, and housing needs.
The Community Support Professional provides coordination of movement
across levels of care, directly to the person and their family and
coordinates discharge planning and community re-entry following
hospitalization, residential services and other levels of care. This
includes providing “first responder” crisis response on a 24/7/365
basis to consumers experiencing a crisis.
The service activities of Community Support consist of a variety of
interventions:
- Identification and intervention to address barriers that
impede the development of skills necessary for independent
functioning in the community.
- Family psycho-education.
- Development and revision of the recipient’s Person Centered
Plan.
- One-on-one interventions with the community to develop
interpersonal and community coping skills, including adaptation
to home, school, and work environments.
- Therapeutic mentoring.
- Symptom monitoring, monitoring medications and self
management of symptoms.
- Community Support includes case management to arrange, link
or integrate multiple services as well as assessment and
reassessment of the recipient’s need for services.
Community Support workers inform the recipient about benefits,
community resources, and services, assist the recipient in accessing
benefits and services, monitor the provision of services; consult
with identified providers, include their input into the Person
Centered Planning process, inform all involved stakeholders, and
monitor the status of the recipient in relationship to the treatment
goals.
The organization assumes the roles of advocate, broker, coordinator,
and monitor of the service delivery system on behalf of the
recipient.
A service order for Community Support services must be completed by
a physician, licensed psychologist, physician’s assistant or nurse
practitioner according to their scope of practice prior to or on the
day that the services are to be provided.
COMMUNITY SUPPORT FOR CHILDREN
Community Support services are services and supports necessary to
assist the youth ages 3 to 17 years of age or younger (20 years old
or younger for children enrolled in Medicaid) and their caregivers
in achieving, rehabilitative, and recovery goals.
Services are psycho-educational and supportive in nature and
intended to meet the mental health or substance abuse needs of
children and adolescents with significant functional deficits or
who, because of negative environmental, medical or biological
factors, are at risk of developing or increasing the magnitude of
such functional deficits.
Included among this latter group are those at risk for atypical
development, substance abuse, or serious emotional disturbance (SED)
that could result in an inability to live successfully in the
community without services and guidance.
The service activities of Community Support consist of a variety of
interventions:
- Education and training of caregivers and others who have a
legitimate role in addressing the needs identified in the Person
Centered Plan.
- Preventive and therapeutic interventions designed for direct
individual activities.
- Assist with skill enhancement or acquisition, and support
ongoing treatment and functional gains.
- Development of the consumer’s Person Center Plan, and
one-on-one interventions with the consumer to develop
interpersonal and community relational skills, including
adaptation to home, school, work and other natural environments.
- Therapeutic mentoring.
- Symptom monitoring and self-management of symptoms.
Community Support includes case management to arrange, link or
integrate multiple services as well as assessment and reassessment
of the recipient’s need for services.
 Community Support workers also inform the recipient about benefits,
community resources, and services, assist the recipient in accessing
benefits and services, and arrange for the recipient to receive
benefits and services; and monitor the provision of services.
The Community Support Professional provides coordination of movement
across levels of care, directly to the person and their family and
coordinates discharge planning and community re-entry following
hospitalization, residential services and other levels of care.
This service includes providing “first responder” crisis response on
a 24/7/365 basis to consumers experiencing a crisis.
A service order for Community Support services must be completed by
a physician, licensed psychologist, physician’s assistant or nurse
practitioner according to their scope of practice prior to or on the
day that the services are to be provided.
DIAGNOSTIC ASSESSMENT
An initial contact with a potential consumer can be accomplished
with the completion of a Diagnostic Assessment. This assessment is
intended to provide a face to face evaluation of a person’s mental
health, developmental disability or substance abuse status that
results in a report which evaluates the clinical and functional
condition of the person at the time of the interview.
The purpose of the interview is to provide recommendations regarding
whether the recipient meets the target population criteria, and may
include an order for Enhanced Benefit services. The recommendation
may provide the basis for the development of an initial Person
Centered Plan which initiates the identification of goals
appropriate for the individual’s treatment.
A diagnostic assessment will include the following:
- A description of the presenting problem.
- Strengths and weaknesses of the consumer's general and
behavioral health history; biological, psychological, family,
social, developmental and environmental dimensions.
- Problem summary.
- Diagnoses on 5 axes of DSM-IV.
- Evidence of an interdisciplinary team approach to
assessment.
- Recommendation regarding the individual’s eligibility for
target population.
- Evidence of recipient participation as well as other
caregivers, guardians or family as appropriate.
CASE MANAGEMENT
This service includes service coordination activities provided by a
qualified professional who is
 able to facilitate treatment for the
consumer. Case Management is designed to meet the educational,
vocational, residential, mental health/ behavioral health treatment,
financial, social and additional non-treatment needs of the
recipient.
Case Management includes the arrangement, linkage or integration of
multiple services as they are needed or being received by the
consumer. It includes assessment and reassessment of the recipient’s
need for case management services; informing the recipient about
benefits, community resources, and services; assisting the recipient
in accessing benefits and services; arranging for the recipient to
receive benefits and services; and monitoring the provision of
services.
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