The NC Innovations Waiver Program
The NC Innovations Waiver Program 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/IDD). It allows these individuals the opportunity to be served in the community instead of residing in an institutional or group home setting.
The NC Innovations Waiver Program 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/IdD care.
The NC Innovations Waiver 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 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 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 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.
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.
In Home Skill Building
In-Home Skill Building provides habilitation and skill building to enable the participant to acquire and maintain skills, which support more independence. In-Home Skill Building augments the family and natural supports of the participant and consists of an array of services that are required to maintain and assist the participant to live in community settings.
In-Home Skill Building consists of
- Training in interpersonal skills and development and maintenance of personal relationships
- Skill building to support the participant in increasing community living skills, such as shopping, recreation, personal banking, grocery shopping and other community activities
- Training with therapeutic exercises, supervision of self administration of medication and other services essential to healthcare at home, including transferring, ambulation and use of special mobility devices
- Transportation to support implementation of In-Home Skill Building
In-Home Skill Building is provided when a primary caregiver is home or when that primary caregiver is regularly scheduled to be absent. In-Home Skill Building is individualized, specific, and consistent with the participant’s assessed disability specific needs and is not provided in excess of those needs. In-Home Skill Building is furnished in a manner not primarily intended for the convenience of the participant, primary caregiver or the provider/employer of record. It is anticipated that the presence of In-Home Skill Building will result in a gradual reduction in hours as the participant is trained to take on additional tasks and masters skills (fading plan). These services are provided in the participant’s private home and not in the home of the direct service employee. In-Home Skill Building Services must start and/or end at the home of the participant.
Community Networking services provide individualized day activities that support the individual’s definition of a meaningful day in an integrated community setting, with persons who are not disabled. This service is provided separate and apart from the individual’s private residence, other residential living arrangement, and/or the home of a service provider. These services do not take place in licensed facilities and are intended to offer the individual the opportunity to develop meaningful community relationships with non-disabled individuals. Services are designed to promote maximum participation in community life while developing natural supports within integrated settings.
Community Networking services enable the individual to increase or maintain their capacity for independence and develop social roles valued by non-disabled members of the community. As individuals gain skills and increase community connections, service hours should fade; however a formal fading plan is not required.
Community Networking services consist of:
- Participation in adult education;
- Development of community based time management skills;
- Community based classes for the development of hobbies or leisure/cultural interests;
- Volunteer work (defined as work that would be completed by a non-disabled person with no compensation, including direct payment; free memberships etc.);
- Participation in formal/informal associations and/or community groups;
- Training and education in self-determination and self-advocacy;
- Using public transportation;
- Inclusion in a broad range of community settings that allow the individual to make community connections; and/or
- For children, this service includes staffing supports to assist children to participate in day care/after school/ summer programs that serve typically developing children and are not funded by Day Supports.
- Transportation when the activity does not include staffing support and the destination of the transportation is an integrated community setting or a self-advocacy activity.
This service includes a combination of training, personal assistance and supports as needed by the individual during activities. Transportation to/from the individual’s residence and the training site(s) is included.
Payment for attendance at classes and conferences is also included. For individuals who are eligible for educational services under the Individuals With Disability Educational Act, Community Networking does not include transportation to/from school settings. This includes transportation to/from individual’s home or any community location where the individual may be receiving services before/after school.