1. Department of Health and Human Services Stakeholder Engagement
Community Alternatives Program 1915(c) HCBS Waiver August 17, 2016
Department of Health and Human Services Stakeholder Engagement

2. Implementing an extended waiver
How to apply utilization limits in an extended waiver
Waitlist
A state specifies the maximum number of unduplicated participants who will be served during each year the waiver is in effect.
The limit on the number of individuals who participate in the waiver may result in a waiting list for waiver services. Eligible applicants must be deferred until capacity becomes available as a result of turnover or the appropriation of additional funding.
CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement

3. Implementing an extended waiver
Modifications
The total cost of modifications cannot exceed the approved amount over the life (CMS approved 5 year waiver cycle) of the waiver. Participants not in the waiver for the full five years will receive the benefit prorated to 1/5 of the amount/each year of participation.
Each year of participation – 1 year from CAP effective date
7/01/2010-6/30/2015 = $10,000
7/01/2011-6/30/2015 = $8,000
7/01/2012-6/30/2015 = $6,000
7/01/2013-6/30/2015 = $4,000
7/01/2014-6/30/2015 = $2,000
7/01/2015-6/30/2016 = $2,000
6/30/2016-new waiver is approved = $2,000
The waiver entry year will be used to assess the amount for modifications going forward and will retro back to April 2016
CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement

4. CAP/C waiver amendment proposal
Overview of the proposed changes and their impact
Determination of CAP nursing and nurse aide hours
CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement

5. Service provision comparison
Waiver Services
State Plan Services
Cap Nursing
Private Duty Nursing
Nurse care to individuals with a skilled need that requires intervention every 2-4 hours
Nurse care to individual with a skilled need that requires intervention every 2-4 hours
In-Home Care
Personal Care
Personal care to individuals with two or more limited to extensive Activities of Daily Living (ADLs) needs
Personal and home maintenance care to individuals with limited ADLs and Instrumental Activities of Daily Living (IADLs) needs
Pediatric Nurse Aide
No comparable service
Personal care to individuals with two or more extensive ADLs needs that fall in the Nursing Assistant (NA) I and NA II categories
Cap Nursing
Nurse care to individuals with a skilled need that requires intervention every 2-4 hours
In-Home Care
Personal care to individuals with two or more limited to extensive Activities of Daily Living (ADLs) needs
Pediatric Nurse Aide
Personal care to individuals with two or more extensive ADLs needs that falls in the Nursing Assistant (NA) I and NA II categories
Private Duty Nursing
Nurse care to individual with a skilled need that requires intervention every 2-4 hours
Personal Care
Personal and home maintenance care to individuals with limited ADLs and Instrumental Activities of Daily Living (IADLs) needs
No comparable service
CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement

6. Service provision comparison
Waiver Services
State Plan Services
Respite
No comparable service
Temporary relief for waiver beneficiary or primary caregiver
Case Management
Not available in North Carolina’s SPA
Coordinating activities of assessing, care planning, monitoring, linking, referring and follow-up to maintain community integration and inclusion
Comparable services offered through other resource agencies that provide case management
Children’s Developmental Service agencies
Department of Social Services
Private Duty Nursing agencies
CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement

7. Next Steps Meeting the needs of medically fragile children
Waiver services supplement rather than replace informal and formal supports, so how do we:
Structure needed supports within waiver guidelines and comply with the Social Security Act?
Manage care needs and maintain cost-neutral service provisions?
Use Medicaid to its fullest to optimize cost-neutral service provisions?
What supports are needed and how much?
What supports are available?
How do we leverage available supports?
CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement