NC Innovations Continuum of Care

​​​​​​​​​The NC Innovations Waiver is designed to provide an array of community-based services and supports that promote choice, control, independence and community membership. These services provide a community-based alternative to institutional care for persons who require an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) level of care (formerly known as Intermediate Care Facility for individuals Mental Retardation (ICF-MR) level of care).   


The continuum of care for those with an NC Innovations Waiver slot is extensive and geared toward safely keeping individuals in their communities with the needed supports and trainings to maximize independence and integration. Services can be provided through Cardinal Innoavtions' existing provider network or through the following:

Agency with Choice/Employer of Record

The NC Innovations Waiver gives people with disabilities clear choice about how they receive services. The NC Innovations Waiver refers to Self-Directed Services as Individual and Family Directed Supports. Two models of Individual and Family Directed Supports available through Cardinal Innovations are:

Cardinal Innovations has developed a webpage with more information on Individual and Family Directed Services to assist members and their families choosing how they wish to direct their services.

Adjustments for Individual Circumstances 

There are several ways to access additional funding for individuals receiving services under the NC Innovations Wavier. The waiver cost limit of $135,000 per year may not be exceeded when pursing additional funding.

Innovations Recipient Service Array

The full array of services and supports available for individuals in NC Innovations Waiver include the following:

  • Universal Supports consist of assistance and interventions generally available to anyone through their existing connections within his or her community. Universal Supports include the following:

    • Natural Supports  include unpaid resources in the community which enhance and help sustain recovery. Examples are family members, governmental supports and non-profit community agencies.

    • Primary Medical Homes​ are a front door for the full range of medical issues, including mental health issues.

    • Prevention services are most commonly provided in school settings, but can be available in other settings to assist with preventing behavioral health disorders diagnoses and/or preventing additional disability from existing diagnoses.

  • Basic Services for ID/DD members provide office-based assessments and testing to assist in determining the appropriate level of supports needed.

    • Psychological Testing​: Licensed psychologist and psychological associates typically provide this ​​service​ for those who need additional diagnostic and treatment recommendations and clarification after an initial assessment. There are a wide array of testing options available.
       
  • Support Services for the ID/DD needs of Innovations Waiver recipients is limited to psychiatric consultation. If mental health or substance use disorder needs are present, the support services provided through those continua of care would be available if admission criteria were met.

    • Psychiatric Consultation provides psychiatric consultation by telephone directly to primary care providers to assist them in managing behavioral health conditions in that setting. 
  • Innovations Waiver services are designed to teach skills, maintain skills, provide support or supervision from either paid staff or through the use of technology or modifications when appropriate, and foster community integration. Services fall under two categories: Base Budget Services and Non-Base Budget Services.

    • Base-Budget Services


      • Community Networking services are intended to provide support for activities that increase a participant's opportunity to develop meaningful community relationships in integrated community settings. Services are designed to promote the maximum participation in community life while developing natural supports within integrated settings.

      • Day Supports is primarily a group service that provides assistance to the participant with acquisition; retention; or improvement in self-help, socialization, and adaptive skills. Day Supports focus on enabling the participant to attain or maintain his or her maximum functional level. Day Supports can be provided in individual or group settings.

      • In-Home Skill Building is a habilitative service, which means it provides training to enable the participant to acquire and build skills that support independent functioning. This service must be provided in a way that meets evidence-based habilitative guidelines, which are outlined in Cardinal Innovations' Clinical Guidelines.

      • In-Home Intensive Support is available to support participants in their private home when the participant needs extensive support and supervision. Habilitation, support, or supervision is provided to assist with positioning and intensive medical needs, as well as preventing/addressing elopement or other behaviors that would result in injury to self or other people.

      • Personal Care services include support, supervision and engaging participation with eating, bathing, dressing, personal hygiene and other activities of daily living. The concepts of supporting the individual and engaging the individual describe the flexibility of activities that may encourage the member to maintain skills gained during habilitation, while also providing supervision for independent activities. This service also provides support for maintaining skills taught during habilitative services.

      • Residential Supports consists of an integrated array of individually designed training, assistance, and supervision that includes community integration activities, skill building and/or physical assistance across adaptive areas such as communication, mobility, self-help, mobility, independent living, and self-determination. Residential Supports provide the array of base budget services outlined here for those living in paid residential settings. Thus Personal Care, In-Home Skill Building and other basic services cannot be billed at the same time as Residential Supports, as this service encompasses all those services together.

      • Respite services provide periodic support and relief to the primary caregiver(s) for the responsibility of caring for the participant. The primary caregiver is the individual(s) with the responsibility of care for the member who has the same primary residence as the member. This service enables the primary caregiver to meet or participate in planned or emergency events.

      • Supported Employment​ services provide assistance with choosing, acquiring, and maintaining a job. Employment options reflect options available to individuals without disabilities such as traditional employment or operating a microenterprise. Supported Employment allows for a continuum of activities necessary for employment from initial support, intermediate support, and long term follow up support.
    • Non-Base Budget Services
      • Assistive Technology Equipment and Supplies are necessary for the proper functioning of items and systems, whether acquired commercially, modified, or customized, that are used to increase, maintain, or improve functional capabilities of members. This service covers purchases, leasing, shipping costs, and (as necessary) repair of equipment required to enable participants to increase, maintain or improve their functional capacity to perform daily life tasks that would not be possible otherwise.

      • Community Transition offers one-time financial assistance for adult participants who transition from a Developmental Center, Community ICF/IID Group, nursing facility, or another licensed living arrangement to a non-provider owned, private living arrangement where the individual is directly responsible for his or her own living expenses. The service is provided when the individual is unable to pay for non-routine expenses such as a security deposit; essential furnishings; and deposits for utility or service access such as telephone, heating, electricity, and water.

      • Community Guide provides support to participants and planning teams that assist in developing social networks and connections within the community. The purpose of the service is to promote self-determination, increase independence, and enhance the individual's ability to interact and contribute in the local community. Some activities of the Community Guide include advocacy, assistance in accessing non-Medicaid services, and informal counseling to help guide the individual in problem solving and decision-making. This service also supports individuals, representatives, and managing employers who direct their own waiver services. Activities may include training for the Individual and Family Directed Supports Agency with Choice option, assisting with development of staff schedules for Agency with Choice, and guidance with managing the participant-directed budget.

      • Crisis Services  is a tiered approach to support waiver participants when crisis situations occur that present a threat to their health/safety or the health/safety of others. These behaviors may result in the participant losing his or her home, job, or access to activities and community involvement. Crisis Services is an immediate intervention to support the person who is primarily responsible for the care of the participant. Crisis Services is provided as an alternative to institutional placement or psychiatric hospitalization.

      • Financial Support Services is the umbrella service for the continuum of supports offered to NC Innovations participants who choose to participate in the Individual and Family Directed Services option with the Employer of Record model. Financial Support Services are provided to assure that funds for self-directed services are managed and distributed as intended. The service also facilitates employment of support staff by the employer.

      • Home Modifications are physical modifications to a private residence that are necessary to ensure the health, welfare, and safety of the participant or to enhance his/ her level of independence. This service includes an exhaustive list of purchases, installation, maintenance, and (as necessary) the repair of home modifications required to enable participants to increase, maintain or improve their functional capacity to perform daily life tasks that would not be possible otherwise.

      • Individual Goods and Services are services, equipment or supplies not otherwise provided through the NC Innovations Waiver or through the NC Medicaid State Plan that address an identified need in the Individual Support Plan that aims to improve and maintain the participant's opportunities for full membership in the community.

      • Natural Supports Education provides training to families and the participant's natural support network in order to enhance the decision-making capacity of the natural support network, provide orientation regarding the nature and impact of the intellectual and other developmental disabilities upon the participant, provide education and training on interventions/strategies, and provide education and training in the use of specialized equipment and supplies. The requested education and training must have outcomes directly related to the needs of the participant or the natural support network's ability to provide care and support to the participant.

      • Specialized Consultation Services​ (SCS) provide expertise, training, and technical assistance in a specialty area (psychology, behavior intervention, speech therapy, therapeutic recreation, augmentative communication, assistive technology equipment, occupational therapy, physical therapy or nutrition). The team must have exhausted their expertise to address the identified need of the individual before requesting SCS. Under this model, a participant's need is assessed and then therapeutic interventions are developed by the SCS professional in collaboration with the team. Family members and paid/unpaid caregivers are trained by the SCS professional to carry out therapeutic interventions. 
  • Crisis Services are designed to address acute symptom exacerbations for those with behavioral health disorders in an effort to either avert an inpatient crisis admission or to facilitate such an admission. Crisis Services range from brief interventions provided by the member's existing provider to intensive 24/7 stabilization and treatment provided in an inpatient setting. Outside of the crisis services listed above in the Innovations service array, the only crisis intervention specifically designed for those with ID/DD diagnoses (non-Innovations) is NC START. The full range of crisis services can be found here​

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