Alternative Benefit Plan (ABP)

Medicaid and CHIP Program (MACPro)

OMB: 0938-1188

IC ID: 205312

Documents and Forms
Document Name
Document Type
Form and Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Alternative Benefit Plan (ABP)
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR 430.12

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10434 ABP ABP Form.pdf Yes Yes Fillable Fileable
Instruction AB Plans General Background 111612.docx Yes No Printable Only
Instruction B1 AB Plans Amendement_Draft_111912.docx Yes No Printable Only
Instruction B2 AB Plans Populations_Draft_111912.docx Yes No Printable Only
Instruction B3a AB Plan Vol Assurances_Draft_111912.docx Yes No Printable Only
Instruction B3b AB Plans Mand Assurances_Draft_111912.docx Yes No Printable Only
Instruction B4 AB Plans Select-Cost Shar_Draft_111912.docx Yes No Printable Only
Instruction B4a,b,c ABP Benefit Packages_Draft_111912.docx Yes No Printable Only
Instruction B4d ABP Sec-Approved Package_Draft_111612.docx Yes No Printable Only
Instruction B5 AB Plan Benefit Assurances_Draft_111912.docx Yes No Printable Only
Instruction B6 ABP Benchmark Equiv_Draft_111912.docx Yes No Printable Only
Instruction B7 ABP Benchmark Equiv Assur_Draft_111912.docx Yes No Printable Only
Instruction B8 ABP Service Del Systems_Draft_111912.docx Yes No Printable Only
Instruction B9 ABP Employer Spon Ins_Draft_111912.docx Yes No Printable Only
Instruction B10 ABP General Assurances_Draft_111912.docx Yes No Printable Only
Instruction B11,12,13 ABP Admin Table_Draft_111912.docx Yes No Printable Only
Instruction B14 ABP Base Benchmark Admin_Draft_111912.docx Yes No Printable Only
Instruction B15 ABP Termination Phase Out_Draft_111912.docx Yes No Printable Only
Instruction B16 ABP Payment Methodologies_Draft_111912.docx Yes No Printable Only
Instruction B17 ABP State Benefits Table_Draft_111912.docx Yes No Printable Only
Instruction B18 AB Plan Components_Draft_111912.docx Yes No Printable Only

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 56 0 56 0 0 0
Annual IC Time Burden (Hours) 728 0 728 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
ABP - Webinar Transcript ABP Webinar.pdf 01/09/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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