[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-200535-105":53,"doc-detail-200535-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","nc-medicaid-community-alternatives-program-clinical-coverage-policy-3k-2-for-disabled-adults-capda","NC Medicaid Community Alternatives Program Clinical Coverage Policy - 3K-2 - For Disabled Adults (CAP/DA)","","NC Medicaid Community Alternatives Program Clinical Coverage Policy 3K-2 outlines clinical coverage rules for Disabled Adults (CAP/DA). It establishes procedure, product, and service coverage determinations by describing definitions, eligibility requirements, special provisions including EPSDT-related exceptions, and criteria for when services are covered or not covered. The policy also specifies requirements and limitations on coverage, including prior approval and the CAP/DA participation framework, including service-specific categories and related 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enrolled in a Prepaid Health Plan (PHP): for questions about benefits and services available on or after implementation, please contact your PHP.  \nTable of Contents  \n1.0 Description of the Procedure, Product, or Service ........................................................................... 1  \n1.1 Definitions .......................................................................................................................... 3  \n2.0 Eligibility Requirements .................................................................................................................. 3  \n2.1 Provisions............................................................................................................................ 3  \n2.1.1 General ............................................................................................................ 3  \n2.1.2 Specific............................................................................................................ 3  \n2.2 Special Provisions ............................................................................................................... 4  \n2.2.1 EPSDT Special Provision: Exception to Policy Limitations for a Medicaid Beneficiary under 21 Years of Age .................................................................4  \n2.2.2 EPSDT and CAP/DA Participation ................................................................. 5  \n2.2.3 Local Education Agency Special Provision for Services at school for Beneficiary age 5 through 21 years of age ...................................................... 5  \n3.0 When the Procedure, Product, or Service Is Covered...................................................................... 6  \n3.1 General Criteria Covered .................................................................................................... 6  \n3.2 Specific Criteria Covered.................................................................................................... 6  \n3.2.1 Specific criteria covered by Medicaid............................................................. 6  \n3.2.2 Specific criteria covered by Medicaid............................................................. 7  \n3.2.3 Level of Care Determination Criteria.............................................................. 7  \n3.2.4 Priority Consideration for CAP/DA Participation......................................... 10  \n3.3 Transfers of Eligible Beneficiaries ................................................................................... 11  \n3.4 Medicaid Additional Criteria ............................................................................................ 12  \n3.4.1 Adult Day Health Services ............................................................................ 13  \n3.4.2 Coordinated Caregiving ................................................................................ 13  \n3.4.3 Meal Preparation and Delivery...................................................................... 13  \n3.4.4 Community Services ..................................................................................... 13  \n3.4.5 Equipment, Modification and Technology.................................................... 14  \n3.4.6 Respite Care .................................................................................................. 14  \n3.4.7 Goods and Services ....................................................................................... 15  \n3.4.8 CAP/DA In-Home Aide Service I................................................................. 16  \n3.4.9 Personal Emergency Response Services (PERS) .......................................... 17  \n3.4.10 Specialized Medical Supplies........................................................................ 17  \n3.4.11 Training, Education and Con","cbCairmBK8Am9152","https://ap.wps.com/l/cbCairmBK8Am9152","pdf",1655982,170,"English","# Description of the Procedure, Product, or Service\n## Definitions\n# Eligibility Requirements\n## Provisions\n### General\n### Specific\n## Special Provisions\n### EPSDT Special Provision\n### EPSDT and CAP/DA Participation\n### Local Education Agency Special Provision\n# When the Procedure, Product, or Service Is Covered\n## General Criteria Covered\n## Specific Criteria Covered\n### Specific criteria covered by Medicaid\n### Level of Care Determination Criteria\n### Priority Consideration for CAP/DA Participation\n# When the Procedure, Product, or Service Is Not Covered\n## General Criteria Not Covered\n## Specific Criteria Not Covered\n# Requirements for and Limitations on Coverage\n## Prior Approval\n## CAP/DA Participation","[{\"question\":\"What is the purpose of NC Medicaid CAP/DA Clinical Coverage Policy 3K-2?\",\"answer\":\"It defines the clinical coverage policy for Disabled Adults (CAP/DA), including eligibility, when services are covered, when they are not covered, and coverage limitations.\"},{\"question\":\"What eligibility requirements and special provisions are covered in the policy?\",\"answer\":\"The policy covers eligibility requirements and provisions, including special provisions such as EPSDT-related exceptions and participation rules for CAP/DA.\"},{\"question\":\"What are the main coverage decision points in the policy?\",\"answer\":\"The policy details criteria for when procedures, products, or services are covered and lists general and specific criteria for when they are not covered, along with requirements like prior approval.\"}]","NC Medicaid Community Alternatives Program Clinical Coverage Policy - 3K-2 - For Disabled Adults (CAP/DA) | PDF",59]