The Alternative Treatment Plan program provides an avenue to monitor patient care to ensure that appropriate medical services are provided, and to identify alternative treatment strategies that are acceptable to the patient and family which will maximize patient outcomes while conserving the use of benefits.

Policy:
An alternative treatment plan allows the ability to maximize patient outcomes with modification of benefits in order to provide medically necessary services that otherwise would not be covered by defined contract benefits.  The following information would be expected when an alternative treatment plan is created:

• A referral and request must be received for a case evaluation to determine if intervention could significantly affect the quality of life and/or the recovery of the patient in a most cost effective manner or setting.
• A treatment plan developed by the care manager based on patient needs, safety, efficacy, medical appropriateness and cost of benefit.
• Approval given by the department supervisor, the patient's primary physician and the member/patient.
• Approval by the medical director, if medical necessity or appropriateness is in question.

**Alternative treatment plans are subject to an ongoing review process.  Approval of the alternative treatment plan is not a guarantee of future alternative benefits and are not subject to the appeal process**