Effective February 1, 2013, Mecklenburg County CAP-MR/DD waiver recipients will transition to the NC Innovations Waiver. Relatives and Guardians who are currently approved to provide Home Supports to the CAP-MR/DD recipient living in the same home will be eligible to provide Community Networking, Day Supports, Residential Supports, In-Home Intensive Supports, In-Home Skill Building and/or Personal Care based on the individual needs of the consumer as established in their Individualized Service Plan (ISP) and approved Service Authorization Request (SAR). Please remember, the Relative as Direct Support Employee Process only applies to Relatives/Legal Guardians and other relatives of adult NC Innovations Waiver participants who live in the home of the participant. Application should be submitted no later than January 4, 2013 to insure approval prior to February 1, 2013.
Relative as Provider/Relative as Direct Support Employee InfoShare Presentation
Chuck Hill presented "Relative as Provider/Relative as Direct Support Employee" at the December 12, 2012 InfoShare. This presentation is for Providers, Agencies with Choice, and Employers of Record that employ relatives/legal guardians (who live in the home of the NC Innovations waiver participant) to provide NC Innovations waiver (currently CAP/MR) services to their family member and will be required to comply with the NC Innovations Waiver Relative/Legal Guardian as Direct Support Employee Process. The presentation includes an overview of the Relative as Direct Support Employee Process including the application process and timelines.
Facts Regarding Relative as Provider/Relative as Direct Support Employee Process
- The Relative/Legal Guardian as Direct Support Employee Process is a component of the NC Innovations Waiver Policy.
- The NC Innovations Waiver Policy is based on federal requirements.
- North Carolina CAP-MR/DD consumers who’s Medicaid originates from Mecklenburg county will transition to the NC Innovations Waiver.
- Providers, Agencies with Choice, and Employers of Record who are actively serving these consumers will be required to have a contract with the MeckLINK Behavioral Healthcare.
- Providers, Agencies with Choice, and Employers of Record that employ relatives/legal guardians (who live in the home of the NC Innovations waiver participant) to provide NC Innovations waiver services to their family member will be required to comply with the NC Innovations Waiver Relative/Legal Guardian as Direct Support Employee Process.
- The Relative/Legal Guardian as Direct Support Employee Process only applies to Relatives/Legal Guardians of adult (age 18 and older) CAP-MR/DD recipients transitioning to the NC Innovations Waiver.
- The waiver services that relatives or legal guardians may provide are: Community Networking, Day Supports, Personal Care, In-Home Skill Building – Individual, In-Home Skill Building – Group, Intensive In-Home Support, and Residential Supports.
- Relatives/Legal Guardians hired as the direct support employee prior to MeckLINK Behavioral Healthcare joining the NC Medicaid Waivers may qualify for being grandfathered under the Relative/Legal Guardian as Direct Support Employee Process under the Part B Application Process.
- Provider Agencies/Agencies with Choice/Employers of Record seeking approval for hiring or maintaining Relatives/Legal Guardians living in the home of the participant as the Direct Service Employee under the Relative/Legal Guardian as Direct Support Employee Policy must insure the relative or legal guardian meets the requirements for employment that any other person would need to meet including all necessary licensures and/or certifications (i.e.: if the care being provided would ordinarily require a licensed nurse, CNA I or CNA II, the relative or guardian providing care would be required to be a licensed nurse, CNA I or CNA II.)
- It is mandatory that provider agencies identify back-up staff for each employee inclusive of employees under the Relative/Legal Guardian as Direct Support Employee Process.
- The Relative/Legal Guardian as Direct Support Employee Process is an administrative process. Approval can only be granted for services and hours/units that have been authorized and are a part of the consumer’s approved PCP/ISP.
- When a relative/legal guardian is approved to be the direct support worker under this policy, a neutral advocate shall be assigned shall be assigned to ensure that decisions are being made in the best interest of the consumer.
- Approval under the Relative/Legal Guardian as Direct Support Employee Process normally only allows for a maximum of 40 hours/per week of services provided by any Relative/Legal Guardian residing in the consumer’s residence. MeckLINK Behavioral Healthcare must grant specific additional approval for the Relative/Legal Guardian to provide more than 40 hours/per week under the Part C Application Process.
- Provider agencies that have been given approval for a relative or guardian under the Relative/Legal Guardian as Direct Support Employee Process must seek re-approval annually.
- The Relative/Legal Guardian does not have an entitlement to be the direct support employee for the waiver recipient living in the same home with them.
Relative/Legal Guardian as Direct Support Employee approvals can be discontinued if the relative/legal guardian fails to implement the service in compliance with the Medicaid service definition, fails to document the service and/or the need for exceptional care, or otherwise creates a potential health and/or safety issue for the consumer.
Currently MeckLINK Behavioral Healthcare is only reviewing application for grandfathering under the Part B Application Process. A Part C Application must be submitted and approved for the Relative/legal Guardian to provide more than 40 hours a week. All applications should be submitted no later than January 4, 2013 to insure approval prior to February 1, 2013.
Documents
Relative as Direct Support Employee Presentation
Transition from CAP-MR/DD to Innovations as Direct Support Employee
Relative as Direct Support Employee Fact Sheet
Relative-Legal Guardian as Direct Support Employee Decision Tree
Relative-Legal Guardian as Direct Support Employee Part B Application Process Map
Relative-Legal Guardian as Direct Support Employee Part B Application
Relative-Legal Guardian as Direct Support Employee Part C Application Process Map
Relative-Legal Guardian as Direct Support Employee Part C Application
Submit Applications to
MeckLINK Behavioral Healthcare
Provider Relations and Network Development Unit
Attention: Chuck Hill
429 Billingsley Road, 2nd Floor
Charlotte, NC 28211