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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.
Supported Employment
Supported Employment Services provide assistance with choosing, acquiring, and maintaining a job for participants ages 16 and older for whom competitive employment has not been achieved and /or has been interrupted or intermittent.
Supported employment services include: Pre-job training/education and development activities to prepare a participant to engage in meaningful work-related activities which may include career/educational counseling, job shadowing, assistance in the use of educational resources, training in resume preparation, job interview skills, study skills, assistance in learning skills necessary for job retention; and assisting a participant to operate a micro-enterprise.
 This assistance consists of: (a) aiding the participant to identify potential business opportunities; (b) assistance in the development of a business plan, including potential sources of business financing and other assistance including potential sources of business financing and other assistance in developing and launching a business; (c) identification of the supports that are necessary in order for the participant to operate the business; and (d) ongoing assistance, counseling and guidance once the business has been launched; coaching and employment support activities that enable a participant to complete job training or maintain employment such as monitoring supervision, assistance in job tasks, work adjustment training, and counseling, transportation between work or between activities related to employment (other forms of transportation must be attempted first); employer consultation with the objective of identifying work related needs of the participant and proactively engaging in supportive activities to address the problem or need.
Day Supports
Day supports provide assistance with acquisition, retention, or improvement in self-help, socialization and adaptive skills, which take place in a non-residential setting, separate from the home or facility in which the participant resides.
Day supports shall focus on enabling the participant to attain or maintain his or her maximum functional level and shall be coordinated with any physical, occupational, or speech therapies listed in the Person Centered Plan. In addition, habilitation services may serve to reinforce skills or lessons taught in school, therapy, or other settings.
This service meets the day programming needs of participants who choose to attend or receive services provided by a licensed facility, such as an adult day vocational program (ADVP) or Developmental Day. Community activities that originate from a licensed day facility will be provided and billed as Day Supports. On site attendance at the licensed facility is not required to receive services that originate from the facility.
Day Supports may include prevocational activities. The following criteria differentiate between prevocational and vocational services.
- Prevocational Services are provided to persons who are not expected to join the general work force or participate in a transitional sheltered workshop within one year of service initiation.
- If compensated, individuals are paid at less than 50% of the minimum wage.
- Services include activities that are not directed at teaching job-specific skills but at underlying habilitative goals (e.g.: attention a span, motor skills, attendance, and task completion).
Personal Care Services
 Personal Care Services under North Carolina state plan differ in service definition or provider type from the services to be offered under the waiver. Personal Care services under the waiver include support, supervision and engaging participation with eating, bathing, dressing, personal hygiene and other activities of daily living. Support and engaging participant participation is non-habilitative and describes the flexibility of activities that may encourage the participant to maintain skills gained during active treatment and/or habilitation while also providing supervision for independent activities of the participant. This service may include preparation of meals, but does not include the cost of the meals themselves. Engaging participant in utilizing skills gained during active treatment and/or habilitation is key and may be provided outside of the individual's residence.
When specified in the Person Centered Plan, this service may also include such housekeeping chores as bed making, dusting and vacuuming, which are incidental to the care furnished, or which are essential to the health and welfare of the participant, rather than the participants' family. Personal Care also includes assistance with monitoring health status and physical condition, assistance with transferring, ambulation and use of special mobility devices.
Respite Services
Respite Care is a service that provides periodic relief for the family or primary caregiver as detailed in the Person Centered Plan. In order to be considered the primary care giver, a person must be principally responsible for the care and supervision of the participant, and must maintain their primary residence at the same address as the covered participant. This service may be provided in the participant's home or in an out-of-home setting. There must be clear justification outlined within the Person Centered Plan for Respite Care Services.
Specified training requirements for direct care staff must be clearly documented within the Person Centered Plan for the task that will be performed for Respite Care services.
Residential Supports
Residential Supports provides assistance with acquisition, retention, or improvement in skills related to activities of daily living, such as personal grooming and cleanliness, bed making and household chores, eating and the preparation of food, and the social and adaptive skills necessary to enable the individual to reside in a non-institutional setting.
Habilitation, training and instruction are coupled with elements of support, supervision and engaging participation to reflect the natural flow of training, practice of skills, and other activities as they occur during the course of the person's day. This service is distinctive in that it includes habilitation and training activities, as well as care and assistance with activities of daily living when the individual is dependent on others to ensure health and safety. Interactions with the person are designed to achieve outcomes identified in the person centered plan. Support and supervision of the person's activities to sustain skills gained through habilitation and training is also an acceptable goal of Residential Supports.
This service is provided to individuals who live in licensed community residential settings, foster homes, as well as unlicensed alternative family living homes that serve one adult. This service also provides assistance; support, supervision, and monitoring that allow individuals to participate in home or community activities.
Home and Community Supports
Home and Community Supports is a habilitation service. Home and Community Supports enables the individual to acquire and maintain skills that will allow him/her to function with greater independence in the community. Home and community supports provide habilitation, training and instruction coupled with elements of support, supervision and engaging participation to reflect the natural flow of training, practice of skills, and other activities as they occur during the course of the participant's day. Support combined with supervision of the participant's activities to sustain skills gained through habilitation and training is also an acceptable goal of home and community supports. This service is not to be used for participants receiving Residential Supports.
Home and Community Supports consist of an integrated array of individually designed habilitative services and supports that are described in the Person Centered Plan. This service is distinctive from personal care services by the presence of training activities in combination with support, supervision, and monitoring as described in the Person Centered Plan. This service can be delivered in a participant's private home or in a variety of community settings to which the participant chooses to attend.
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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