FEATURED ARTICLE
North Carolina’s Shift to A Managed Care System: CAP-I/DD Changes Robin Jacobs
ELLEN GLASGOW SAID “ALL CHANGE IS NOT GROWTH, as all movement is not forward.”
Her sentiments should be placarded on the walls of the Divisions’ office in Raleigh. She is right, and it looks as though the state of North Carolina is playing a reverse game of musical chairs. North Carolina’s CAP I-DD Waiver is experiencing a lightening speed array of changes, taking the individuals receiving services for a whirlwind ride through the human services system.
NCWaivers
On January 1, 2012 North Carolina will operate within two waivers, NC New CAP-I/DD Waiver and the NC Innovations Waiver. Many individuals have already experienced the changes to the new CAP-I/DD wavier to include:
• Reductions in habilitative services to meet the 129 hr/month limit
• Removal of Home Supports
• Removal of Enhance Services for Behavioral Needs
• Discontinued Use of Respite on Residential Support billing dates
There will be two waivers as the current waiver will end as of 12/31/2011 and the state is transitioning to the 1915 b/c waiver system.
The second wavier, the Innovations Waiver is a model of the Piedmont Behavioral Health (PBH) System currently being used in Cabarrus, Davidson, Rowan, Stanly, Union. North Carolina’s goal is to have all Local Management Entities operating as Managed Care Organizations (MCO) and providing the Innovations wavier by 2013. In April 2005, North Carolina began a pilot project under the authority of this waiver which capitated services for mental health, developmental disabilities, and substance abuse services (MH/DD/ SAS) in a five-county area.
According to the state “The goals of this capitated health plan initiative are to”:
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• Better tailor services to the local consumer by adopting a consumer-directed care model and focusing on community-based rather than facility- based care.
• Enhance consumer involvement in planning and providing services through the proliferation of MH recovery model concepts.
• Demonstrate that care can be provided more efficiently with increased local control.
PBH has merged with currently existing LMEs to transition many of its participants into the Innovations Waiver. There have been major changes with other LMEs as they prepare to become MCOs. Some of the changes within the Innovations Wavier as noted on the DMH website and other state handouts include:
• LMEs will become MCOs. MCOs write the plans, determine the rates of the services, and determine which providers will be allowed into their networks.
MCOs are the managers of services and funding.
• The Person Centered Plan (PCP) Changed to the Individualized Service Plan (ISP)
• Case Management is no longer an option. Plans will be developed by Care Coordinators within the MCOs.
• Name Changes/Services transitions: Home & Community Supports to In-Home Skill Building/In- Home Intensive Support/Community Networking; Individual Caregiver Training and Education to Natural Supports Education;
• Community Guides will assist individuals with locating resources and additional supports
• No enhanced Level of Personal Care or Respite • No Transportation Service Offered
• Waiver Cost Limit: The maximum amount of all NC Innovations waiver services per participant is $135,000 per waiver year.
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