Alternative Benefit Plan (ABP)

Template B3b – Alternative Benefit Plan Mandatory Enrollment Assurances

Statute: 1937(a)(1)(b) and (a)(2)

Regulation: 42 CFR 440.310 and 440.315

INTRODUCTION

The State must provide assurances concerning its processes related to individuals who are subject to mandatory enrollment in an Alternative Benefit Plan. In this template the State provides these assurances and information concerning how it identifies individuals who are potentially exempt from enrollment at time of enrollment, as well as how it identifies individuals who are mandatory enrollees but have become exempt from enrollment.

BACKGROUND

Certain individuals who are being considered for mandatory enrollment or are already enrolled in an Alternative Benefit Plan on a mandatory enrollment basis may meet the exemption criteria. For those already enrolled as mandatory participants they may have a change in their circumstances so that they meet one or more of the criteria at 42 CFR 440.315 for exemption from mandatory participation.

The State must have processes in place to identify these individuals and exclude them from mandatory enrollment. Such individuals who were enrolled as mandatory participants must be offered the opportunity to disenroll from the Alternative Benefit Plan and receive their benefits through the standard State plan benefit package. Individuals initially determined to be exempt or who become exempt after enrollment as mandatory participants may also be offered the opportunity to participate or continue to participate in the Alternative Benefit Plan on a voluntary basis, but must be fully informed of the option. In this template the State provides assurances concerning these requirements and describes its processes for complying with them.

In addition, the template captures information concerning how the State must meet the additional requirements listed below.

• The State must act upon requests promptly for exempt individuals who choose to disenroll from an Alternative Benefit Plan.

• The State must have a process in place to ensure that exempt individuals have access to all standard State plan benefits and services while disenrollment requests are being processed.

TECHNICAL GUIDANCE

All States are required to complete this template as all eligibility groups, even if the group itself is not exempt from enrollment, may include individuals that are exempt.

First the State affirmatively assures that it will identify individuals who are exempt from mandatory enrollment prior to enrollment.

The State provides this affirmative assurance by checking the box next to the assurance. If the State does not check this box, the system will not accept this template for review and approval.

Next the State selects from the options offered the method it will use to determine if an individuals is exempt from enrollment. Select the appropriate option or options and provide a thorough description of the processes the State will use to identify these individuals.

If “Other” is selected the State must identify the other process it will use and provide a complete and thorough description of the process.

Review Criteria

The description of the identification processes should be sufficiently clear, detailed and complete to permit the reviewer to determine that the State’s election meets applicable federal statutory, regulatory and policy requirements.

Next the State must affirmatively assure that it will inform individuals being considered for enrollment, but who are exempt from mandatory participation, of their exempt status and must comply with the requirements related to voluntary enrollment.

The State must also affirmatively assure that it will inform previously mandatory Alternative Benefit Plan enrollees who become exempt, and thus potential voluntary enrollees, that they are now exempt and are subject to the voluntary enrollee requirements.

The State provides these affirmative assurances by checking the box next to the assurances. If the State does not check this box, the system will not accept this template for review and approval.

Next the State must:

• Select from the options presented one or more methods it uses to identify individuals who have become exempt from mandatory enrollment in an Alternative Benefit Plan.

• If “Other” is selected, identify and describe the other process that is used.

• Select one of the options presented concerning the frequency with which reviews are conducted to determine if mandatory enrollees are exempt.

• If an “Other” frequency is selected, indicate and describe it.

Review Criteria

If “Other” is selected for either the process or frequency, the accompanying description should be sufficiently clear, detailed and complete to permit the reviewer to determine that the State’s election meets applicable federal statutory, regulatory and policy requirements.

The State must affirmatively assure that it will promptly process all requests by exempt individuals for disenrollment form an Alternative Benefit Plan and has a process in place to ensure that such individuals have access to full standard State or Territory State plan benefit package while the disenrollment is being processed.

The State provides this affirmative assurance by checking the box next to the assurance. If the State does not check this box, the system will not accept this template for review and approval.

Next the State must describe the process it uses for complying with the requirements in this assurance.

Review Criteria

The accompanying description of the process used should be sufficiently clear, detailed and complete to permit the reviewer to determine that the State’s election meets applicable federal statutory, regulatory and policy requirements.

Finally, the State may provide additional information concerning how it complies with mandatory enrollment requirements in the Other Information text box provided.

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