NC Innovations Waiver Overview
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Overview of the North Carolina Innovations Waiver program that funds services and supports for people with intellectual and developmental disabilities at risk of institutional care; describes goals, eligibility, available services, administrative roles, and how to access the waiver for eligible individuals.
No material clinical or coverage changes in this revision.
Coverage criteria and access process
Coverage criteria and process
Coverage is targeted to individuals meeting eligibility criteria and to services planned within a formal support plan, within budget, and approved for medical necessity.
ALL of the following
ALL of the following
- Documented diagnosis of a developmental disability or related condition that was manifested prior to age 22 and is likely to continue indefinitely.
- Substantial functional limitations in self-care, understanding and use of language, learning, mobility, self-direction, and/or capacity for independent living.
- The individual would benefit from services and supports to promote skill acquisition and to decrease or prevent regression.
ALL of the following
Examples of covered services
- Direct supports to increase life skills in the family home, the individual's own home, group home, or alternative family living (AFL) setting.
- Day programs or supported employment to increase community participation.
- Supports to connect individuals to community resources and supports for community integration.
- Equipment or devices to increase health, safety, or independence.
- Modifications to increase access to the individual's home or vehicle.
ALL of the following
- A formal support plan is developed at least annually to address needs and support goals.
- Services must be planned with a support team and requested in conjunction with the formal support plan.
- All services must be able to be provided within a specified budget and be approved for medical necessity.
ALL of the following
- Potentially eligible individuals are added to the Registry of Unmet Needs.
- As waiver slots become available, individuals are offered an eligibility determination in the order they were added to the Registry (chronological order).
Service categories and planning cadence
| No codes listed |
Authorization, reimbursement, and approval requirements
Local authorization, reimbursement, and care coordination
Alliance Health manages local waiver operations: coordinating access, reviewing and authorizing services, maintaining the provider network, and reimbursing providers for approved services. Each participant will be assigned a care coordinator from Alliance to assist with accessing waiver supports and participants have free choice of companies within the Alliance Provider Network to deliver services.
- Alliance reviews and authorizes services and reimburses providers for approved services
- Care coordinators are assigned to each participant to assist throughout the process
- Participants have free choice of companies within the Alliance Provider Network
Service approval requirements (support plan, budget, medical necessity)
Services must be requested in conjunction with the individual’s formal support plan, be able to be provided within the specified budget, and be approved for medical necessity.
- Formal support plan developed at least annually and used to request services
- All services must fit within a specified budget
- Services require approval for medical necessity
Key terms
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