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supplies are “medically necessary” and prescribed by a physician. Other items may be listed in the service plan that specifically describe how that item will be used to maintain the community placement due to the disability. Follow rules in section, MA-2360, Medicaid Deductible for Allowable Expenses.

For CAP deductible beneficiaries, apply allowable medical expenses toward the monthly deductible. Cost of Care cannot be applied prior to the effective date of the Service Plan/Plan of Care date.

For keying instructions refer to NC FAST Job Aid: Managing Spend Down Evidence.

VI. CAP PARTICIPATION

The CAP effective date is the latest of the following:

A. The date of the Medicaid application;

B. The CAP Effective Date on the DHB-2193, Memorandum of CAP Waiver Enrollment Status;

C. The date of de-institutionalization; or

D. The effective date stated in a state court resolution or a court order.

VII. RECERTIFICATION

All recertifications must be completed as ex-parte by first using electronic data sources and available agency records to determine continued eligibility. The local agency will receive the DHB-2193, Memorandum of CAP Waiver Enrollment Status and Service Plan/POC Summary from the CAP case management entity.

A. The caseworker is required to:

1. Conduct all electronic matches, including Online Verification System (OVS);

2. Check other available records; and

3. Contact the beneficiary only when continuing eligibility cannot be determined by the available information.

B. Continued Need Review

The CAP case management entity will complete a Continued Need Review (CNR) assessment annually to determine the continued need for CAP services based on medical, functional, and psychosocial care needs of the beneficiary for safe community living.