Alternative Benefit Plan (ABP)

B15 Template – Alternative Benefit Plan Termination – Phase-Out Plan

Statute: 1937

INTRODUCTION

This template is used by the State to indicate how it will transition participants from an Alternative Benefit Plan that is being terminated to either another Alternative Benefit Plan or the standard State Plan. It is also used when the State redefines an Alternative Benefit Plan Population that involves removing some beneficiaries from the Alternative Benefit Plan Population. In this case the template is used to describe how these individuals will be transitioned without loss of coverage.

BACKGROUND

States may elect to terminate an existing Alternative Benefit Plan. States may also redefine an Alternative Benefit Plan Population to remove existing participants from the Alternative Benefit Plan. Should either of these happen the State must assure that every plan participant is transitioned to either another Alternative Benefit Plan or the standard State Plan benefit package without an interruption in benefits.

It is especially important that any participant currently undergoing a plan of treatment with a provider under the Alternative Benefit Plan be able to maintain access to such treatment under their new plan with an existing or alternative provider. States must describe how this transition will be carried out with the least amount of disruption possible.

TECHNICAL GUIDANCE

Overall Approach

Provide a narrative description of the State’s overall approach to terminating the Alternative Benefit Plan or terminating individuals from a Plan including the following:

• When beneficiaries will be terminated from the Plan

• If the plan will be phased out, describe how this will be done.

  • By geographic area

  • By eligibility groups

  • Other phase-out approach

• How beneficiaries will be notified of the change in the benefit plan

• Any community outreach activities the State will undertake to assure that beneficiaries are fully informed of the transition

• Any other transitional services the State intends to provide to smooth the transition to another benefit plan

Time Frame for the Termination of the Plan

Select from the options presented the timing of the Alternative Plan termination.

• All participants will be terminated on the same date. Enter the date that the Alternative Benefit Plan will terminate.

• Phase-Out of the Alternative Benefit Plan. Enter the beginning and ending dates of the phase-out,

• Another Phase-Out approach: Describe the other phase-out approach including any dates associated with phases of the transition.

Transition Process

In the text box the State must describe how it will successfully transition all Alternative Benefit Plan participants from the plan that is being terminated to either another Alternative Benefit Plan or the standard State plan benefits and service delivery system.

• The State must describe how it will assure that no beneficiary will have their benefits interrupted.

• For those participants currently undergoing a plan of treatment or who have medical procedures scheduled under the plan being terminated, describe how these participants will gain access to the same or similar treatment under their new benefit plan with minimal disruption.

• Describe any supports the State will implement to assist participants in making the transition to the new benefit plan.

Review Criteria

The State must provide a complete and thorough description of its transition plan for assuring that all Alternative Benefit Plan participants are successfully transitioned to another benefit plan with no interruption in coverage and minimal disruption to any treatment that is currently underway or planned during and immediately following the transition period.