Beginning January 20, 2011, Pathways LME began conducting reviews for designated services related to Community Alternatives Program for Intellectual/Developmental Disabilities (CAP I/DD) services for all Medicaid Waiver Recipients whose Medicaid originated from counties in Smoky Mountain LME, Mental Health Partners, Mecklenburg LME and Pathways LME Catchment area. This includes authorization of services on initial Plans of Care (POC) as well as performance of the Continued Need Reviews (CNR), Revisions and Provider Changes.

• DUE PROCESS   http://ncdhhs.gov/dma/provider/priorapproval.htm

• Request For Log In / Password Assistance into Portal
• Request for Log In/Password for Plan Upload
• Register for ZixMail
• Further questions???   Email  CAPsupport@pathwayslme.org

North Carolina Medicaid

NC Medicaid Toll Free Number

1-888-510-1150

NC Medicaid FAX Numbers

Medicaid Mental Health/ Substance Abuse

877-339-8753

Medicaid Developmental Disabilities

877-339-8754

Medicaid Residential (Program & Family Type) and Retrospective Review

877-339-8757

Medicaid Psychiatric Residential Treatment Facilities (PRTF)

877-339-8760

You have two options for completing the Authorization Request form:

Option 1. CTCM (may be completed on your PC)

• CTCM Form (Excel)

Option 2. CTCM (may be completed manually or on your pc and printed)

• CTCM Form (Word)

Required Documents for CAP Authorization Requests

   All Submissions must include:

• Recipient’s Name
• Date of Birth
• Medicaid ID number
• Provider’s Medicaid Provider number
• Provider’s NPI number
• Provider’s contact information
• Description of requested service
• Start date
• Required signatures
• Supporting documentation
• Clinical information to determine Medical Necessity

  Initial and Concurrent Requests must include:

• I/DD TCM contact information
• Complete PCP with Crisis Plan
• Current MR2
• NC SNAP
• Current Psychological
• Supporting assessments
• Cost Summary
• CTCM   

  Revisions (adding, discontinuing or changing a service) must include:

• PCP Update/Revision
• Cost Summary
• CTCM
• Supporting assessments

  Change of Provider must include:

• PCP Update/Revision
• Cost Summary
• CTCM to discharge previous provider
• CTCM to add new provider

Additional CAP I/DD Information

• NC DHHS  CAP I/DD Website

  Waiver Manuals:

• Manual for 2008 Waiver Comprehensive Waiver (Released 7/21/10)
• Manual for 2008 Supports Waiver (Released 7/21/10)
• Manual Revisions (Released 7/22/10)
• Supports Waiver Self Direction Option

  Cost Summaries: Support (9/17/10) | Comprehensive (9/17/10)

• Clinical Coverage Policy 8M
• CAP-I/DD Staff Training and Competencies

  Links

• Division of Mental Health, Developmental Disabilities and Substance Abuse Services
• DMA Clinical Coverage Policy with Service Definitions (PDF)
• Division of Medical Assistance - Publications and Reports
• NCDHHS Training Web Site