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Effective: November 1, 2011 | |
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03.40.05ar4 - Community Alternative Care (CAC) (Archive) |
Archived: March 1, 2014 |
Community Alternative Care (CAC) is a federally approved home and community-based services program for people who are chronically ill who are:
l Eligible for Medical Assistance (MA) payment of LTC services.
l Certified disabled by the Social Security Administration or State Medical Review Team (SMRT) process.
l Under age 65 at the time of acceptance to the waiver.
Note: People who receive CAC waiver services may choose to either remain on CAC or begin EW services when they turn 65 years of age.
l Assessed through a Long-term Care Consultation (LTCC) and found to need the level of care provided in a hospital.
l Certified by the primary physician to meet the level of care provided in a hospital.
l In need of supports and services beyond those available through the standard MA benefit set according to the LTCC screening.
More information about the disability waivers can be found in the Disability Services Program Manual.
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
Follow standard MA guidelines.
Note: Refer all applicants or their authorized representatives to the appropriate area of the county agency to obtain a LTCC Long-Term Care Consultation. A program to help people make decisions about long-term care and prevent inappropriate nursing home or boarding care placement. LTCC was formerly known as the Pre-Admission Screening Program (PAS). screening if they have not already done so at the time they apply for MA.
Eligibility for waiver services cannot begin before a LTCC is completed, a care plan is developed, and eligibility for MA payment of LTC services has been determined.
Renewals (standard guidelines)
Follow standard MA guidelines.
Disability must be verified by SMRT A unit at DHS that determines disability in consultation with medical professionals appointed by the commissioner. or SSA A federal agency which administers the SSI, RSDI and Medicare programs. through a disability certification.
The Lead Agency Case Manager The health plan, county or tribal agency staff person who provides case coordination or case management services. will verify the following information on the Lead Agency Case Manager/Worker Communication Form (DHS-5181):
l Waiver program conversion or diversion status.
l LTCC date.
l Anticipated start date of waiver services.
Social Security Number (standard guidelines)
Follow standard MA guidelines.
Follow standard MA guidelines.
Residency (standard guidelines)
Follow standard MA guidelines.
Follow standard MA guidelines.
CAC enrollees who are not eligible for the Medicare Savings Programs may be eligible for payment of Medicare premiums as cost effective insurance.
Exception: CAC enrollees who are also enrolled in MA-EPD must have income at or below 200% FPG to qualify for reimbursement of Medicare Part B premiums. Part B premiums must be reimbursed for any month(s) the enrollee’s income was at or below 200% FPG back to the date of MA-EPD eligibility, regardless of the amount of the premium. No cost effective determination is needed.
Household Composition (standard guidelines)
Use a household size of one for all months in which the person receives CAC services.
l If the person is requesting retroactive MA for months before CAC services will begin, follow standard MA household size and deeming guidelines.
l For Medicare Savings Program eligibility, follow the household size and deeming guidelines of the Medicare Savings Program.
l For MA-EPD eligibility, follow the household size and deeming guidelines of the MA-EPD program.
Use Method B for assets and income.
Asset Guidelines (standard guidelines)
l Asset limit:
Only count the assets of the applicant or enrollee in any month the person receives CAC services. Do not deem the assets of a spouse in any month the applicant or enrollee receives CAC services.
The asset limit is $3,000 (household size of one) with the following exceptions:
n There is no asset limit for children under 21.
n Follow the MA-EPD asset guidelines for adults who are concurrently eligible for MA-EPD.
l Transfers:
CAC applicants and enrollees may transfer assets to their spouses without penalty. Asset transfers by applicants, enrollees or their spouses to others may be uncompensated, resulting in a transfer penalty period during which the client is ineligible for MA payment of LTC services, including LTC services received through the CAC waiver. See Transfers for more information on transfers.
l Home Equity Limit:
CAC applicants and enrollees are subject to a Home Equity Limit.
l Annuities:
CAC applicants and enrollees are subject to certain rules regarding annuity interests. See Annuities for more information.
Income standard is 100% FPG.
Only count the income of the applicant or enrollee in any month he or she receives CAC services.
l Do not deem the income of a parent or spouse in any month the applicant or enrollee receives CAC services.
l Exclude child support and RSDI payments received by or on behalf of children under age 18.
Example:
Simon is a disabled adult who is applying for MA under the CAC waiver. He is also eligible for Medicare. His income meets the income standard for CAC and QMB. However, when his wife’s income is deemed to him, their combined income is over the standard.
Action:
Because his wife’s income must be deemed to him under QMB program guidelines, deny QMB for Simon. However, because only his income is used to determine his MA eligibility under the CAC waiver, he is under the income standard for that program. Approve CAC for Simon.
Parents of children who are eligible for CAC may have to pay a parental fee. See Parental Fees for information about when to refer the case to DHS for a parental fee determination.
Exception: Follow MA-EPD income guidelines for adults who are concurrently eligible for CAC and MA-EPD.
Deductions/Disregards (standard guidelines)
Follow standard MA guidelines.
If income is greater than 100% FPG, the person must spend down to 75% FPG. Use a monthly spenddown. Treat the projected amount of CAC services for the month as a medical bill incurred on the first day of the month. The CAC enrollee is responsible for payment of the spenddown amount.
Exception: If the person is concurrently eligible for MA-EPD, follow MA-EPD rules to determine the premium amount.
Covered Services (Prepaid MHCP Manual)
CAC funds the following services in addition to the standard MA services:
l Case management.
l Environmental adaptations and modifications.
l Family counseling and training.
l Foster care.
l Homemaker services.
l Respite care.
l Extended coverage of certain normally covered MA services, such as home health care, personal care attendant services, physical, occupational, respiratory, and speech therapies, prescription drugs, and transportation.
Note: These services are available through CAC only after regular MA services are exhausted.
CAC services are not available during periods of hospitalization.
Service Delivery (Prepaid MHCP Manual)
People who are not enrolled in a managed care plan A health care delivery system under which enrollees receive most medical services through a health plan or network of providers which coordinates the services provided. DHS pays a fixed rate in advance for each enrollee. receive services through fee-for-service A method of payment for health services. The medical provider bills the insurer and is paid for specific individual services. (FFS).
People under age 65 who are eligible for MA due to blindness as determined by the Social Security Administration (SSA) or the State Medical Review Team (SMRT) are excluded from mandatory managed care enrollment. However, people may voluntarily enroll in Special Needs BasicCare (SNBC) if they are:
l Ages 18-64 and are eligible for MA with or without Medicare Parts A and B.
l Certified disabled by SSA or SMRT.
l Reside in any Minnesota county except Clearwater, Beltrami, Hubbard, or Lake of the Woods.
Note: Long-term care services, such as personal care attendant (PCA), private duty nursing (PDN), ICF/DD, county case management, and home and community-based waiver services provided under CAC continue to be paid through fee-for-service (FFS).
Not applicable.
Follow standard MA guidelines.
CAC enrollees who apply for Medicare Savings Programs must meet all requirements for those programs.
Children who do not require the additional services provided by the CAC waiver may be eligible under TEFRA.