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Home  •  Waiver & Medicaid Services  •  CAP/C  •  How to prepare for an initial assessment

Cap/C Waiver

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How to prepare for an initial assessment

Assessments are preferably completed in person. However, there are times when a virtual assessment (either by phone or video conferencing) will take place.

The person completing the assessment will need a list of your child’s providers and their contact info, including address and phone number, as well as the last and next appointment dates for each one. It may be helpful to go ahead and put together a spreadsheet to help you keep track. A sample spreadsheet is provided here to help get you started.

You will also need to provide a list of diagnoses for your child. Those can usually be found in your child’s online health system’s portal or their latest discharge summary. 

The assessor will need a list of hospitalizations, ED visits, visits to urgent care, and emergent visits to your child’s medical provider with date and reason for the visit. If this list is long, then try to include all hospitalizations and only the dates over the last 12 months for the rest.

You will need a list of your child’s medications, including name, dosage, and frequency. Be sure to include all regular and as-needed medications, including over-the-counter medications. This includes medications delivered via IV or subcutaneously. If your child has a port or other type of central line, be sure to let the assessor know. A sample spreadsheet is provided here to help get you started.

If your child has any allergies, be sure to have a list of those with the name of the allergen and the associated reaction. 

If your child has seizures, they will need to know the date of their last seizure. 

If your child is participating in any therapies (i.e., physical, occupational, feeding, vision, hearing, speech, ABA), be sure to have each therapist’s name, contact info, frequency, and length of therapy visit available. If you have a copy of a recent therapy evaluation or re-evaluation to share with the assessor, it may be helpful to include current goals. If your child has a communication device, be sure to share the name and age of the device (if it’s owned).

It will be helpful to think about your child’s level of comfort and any recent and/or recurring pain episodes that they experience. How do you address those? Is it beneficial? 

Think about your child’s musculoskeletal abilities and needs, particularly in the areas of balance, tone, strength, posture, positioning, range of motion, and susceptibility to falls. If your child has fallen in the last 6 or 12 months, list the number of falls. What aspect of their medical condition is increasing their susceptibility to falls? What type of fall prevention methods have you implemented? It may be helpful to discuss this with your child’s PT for their input.

Consider each ADL (Activities of Daily Living) listed below and make note of your child’s ability to complete the tasks independently and what, if any, assistive devices are used. You can refer to this website for age-appropriate developmental milestones (https://www.cdc.gov/ncbddd/actearly/milestones/index.html)

  • Bathing – tub, shower, or sponge
  • Personal Hygiene – brushing teeth, combing hair, shaving, nail care
  • Dressing – clothes, orthotics (If needed), socks, shoes
  • Bed Mobility – rolling side to side, staying in bed
  • Mobility – how your child moves from one place to another, including if differences on flat
    vs. uneven terrain or steps/stairs
  • Transfer – in/out of bed, in/out of vehicle, in/out of tub/shower/equipment
  • Eating – food prep, cut food, feeding, utensil use, tube feeding/equipment setup
  • Toileting – on/off toilet, cleaning assistance, diaper/pullup use (ages 3+), catheter use,       bowel regimen

For any cardiac or respiratory equipment, have a copy of the settings, orders, size, and/or frequency (as relevant) to share with the assessment team. Equipment could include nebulizer, chest PT, pulse oximeter, cardiac monitor, apnea monitor, oxygen, suction machine, trach, cpap, bipap, and/or ventilator.

Have your child’s current height and weight available during the assessment. You will be asked if your child has any feeding difficulties, including, but not limited to, mechanical, sensory, anatomical, or behavioral issues. You will need to provide all the ways your child obtains hydration, calories, and medication (e.g., oral, enteral, parenteral) and their total daily intake of water and nutrition, including a daily feeding schedule. If nutrition/water/medication is obtained in more than one way, then consider what percentage each method contributes to the total. If your child uses a feeding tube, you will need to provide the type, size, brand, frequency of change, and who changes it. If your child uses a feeding pump, you will need to provide the brand and rate. If your child receives IV nutrition, you will need to provide the type of central line, size (when appropriate), and pump brand. 

If your child requires any regular testing such as glucose, ketone, temperature, pulse, blood pressure, respiration, weight/height, head circumference, abdominal circumference, input/output, urine/stool, etc., have a list available, along with frequency and necessity of any interventions.

Have a list of contract information for your DME providers, as well as providers of other Medicaid services such as nursing, home health visits, and supplies. 

Here is a comprehensive printout you can use if you want to write down answers to all of the above in order to be prepared for the assessment. This is NOT required but some people may find it helpful. 

Must meet one of the following nursing experience requirements:

  • A minimum of 1000 hours of experience in the previous two years in an acute care hospital caring for individuals with the care need(s) of individuals at the levels of care specified in this waiver.
  • A minimum of 2000 hours of experience in the previous three years in an acute care hospital caring for individuals with the care need(s) of individuals at the levels of care specified in this waiver.
  • A minimum of 2000 hours of experience in the previous five years, working for a licensed and certified home health agency caring for individuals with the care need(s) of individuals at the levels of care specified in this waiver.
  • A minimum of 2000 hours of experience in the previous five years in an area not listed above that, in the opinion of DHHS, would demonstrate appropriate knowledge, skill, and ability in caring for individuals at one or more of the levels of care specified in this waiver.

Extraordinary Circumstances:

  1. There are not sufficient nurse aides in the waiver participant’s county or adjunct counties through a Home Health Agency/In-home aide agency due to a lack of qualified providers, and the waiver participant needs extensive to maximal assistance with bathing, dressing, toileting, and eating daily to avoid an out-of-home placement.

  2. The waiver participant requires short-term isolation, 90 days or less, due to experiencing an acute medical condition/healthcare issue requiring extensive to maximal assistance with bathing, dressing, toileting, and eating, and the waiver participant chooses to receive care in their home instead of an institution.

  3. The waiver participant requires physician-ordered 24-hour direct observation and/or supervision specifically related to the primary medical condition(s) to assure the health and welfare of the participant and avoid institutionalization, and the legal guardian is not able to maintain full or part-time employment due to multiple absences from work to monitor and/or supervise the waiver participant; regular interruption at work to assist with the management of the waiver participant’s monitoring/supervision needs; or employment termination.

  4. The waiver participant has specialized health care needs that can be only provided by the legal guardian, as indicated by medical documentation, and these health care needs require extensive to maximal assistance with bathing, dressing, toileting, and eating to assure the health and welfare of the participant and avoid institutionalization.

  5. Other documented extraordinary circumstances not previously mentioned places the waiver participant’s health, safety, and well-being in jeopardy resulting in an institutional placement.