230.11 NHHPP/NHHPP-M: Coverage Under the Alternative Benefit Plan (ABP) SR 18-23, 04/18 (MAM-A)

All NHHPP/NHHPP-M recipients are automatically placed in the Alternative Benefit Plan (ABP).

. All recipients designated as medically frail (NHHPP-M) may choose between two health plans: the ABP or NH's standard Medicaid plan.

. Both plans offer very similar coverage with the following differences:

- the ABP does not offer access to long-term care (LTC) services unless the individual is receiving non-Medicare skilled nursing facility (SNF) services, whereas NH's standard Medicaid plan does offer these LTC services. This means that if non-SNF LTC services are required, he or she can only get these services by choosing the standard Medicaid benefit plan, as long as he or she meets LTC level of care; and

- NH's standard Medicaid Plan does not offer chiropractic services, whereas the ABP does offer chiropractic services. The ABP does not limit the number of visits for some services. This means that if the recipient requires chiropractic services, he or she can only get these services under the ABP.

. Individuals designated as "medically frail" have the right to switch back and forth from the ABP to the standard Medicaid plan at any time. Medically Frail NHHPP recipients are never "locked in" to their benefit plan. The effective date of any change in plan made during District Office business hours is the next calendar day. Any change in plan made during non-business hours is effective the next business day following the date the information is entered or uploaded into New HEIGHTS. If, for example, an NHHPP-M recipient changes plans on Friday at 11 PM, the information will be uploaded into New HEIGHTS on Monday, and the change in plan will be effective Tuesday.

References: He-W 512, RSA 126-A:5,XXIV-XXVI, RSA 126-A:5-b, RSA 126-A:67, 42 CFR 435.119, Section 1902(a)(10)(A)(i)(VIII) of the Social Security Act (SSA) [42 USC 1396a(a)(10)(A)(i)(VIII)], Section 1906 of the SSA [42 USC 1396e], Section 1937 of the SSA [42 USC 1396u-7]