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feat(ABP 3) Adds ABP 3 form to OneMAC (Mako) (#292)
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* Set up shell for ABP 3

* Add first two sections of ABP 3

* Finish first pass of form

* Add conditional logic to first section

* Add a break between webforms

* Fix copy issues

* Update form title label to reflect Figma

* Fix typos in PRA disclosure statement

* Remove unnecessary label

---------

Co-authored-by: Benjamin Paige <[email protected]>
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@charmcitygavin @benjaminpaige
charmcitygavin and benjaminpaige authored Jan 10, 2024
1 parent 2bdcc7c commit b0b261c
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359 changes: 359 additions & 0 deletions src/services/api/layers/ABP3/v1.ts
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import { FormSchema } from "shared-types";

const ABP3: FormSchema = {
header:
"ABP 3: Selection of benchmark benefit package or benchmark-equivalent benefit package",
sections: [
{
title: "Benefit package details",
form: [
{
description: "Select one of the following",
slots: [
{
rhf: "Radio",
name: "benefit_package_details",
rules: { required: "* Required" },
props: {
options: [
{
label:
"The state/territory is amending one existing benefit package for the population defined in section 1.",
value: "benchmark_amending",
},
{
label:
"The state/territory is creating a single new benefit package for the population defined in section 1.",
value: "benchmark_creating",
},
],
},
},
{
rhf: "Input",
name: "benefit_package_name",
label: "Benefit package name",
rules: { required: "* Required" },
dependency: {
conditions: [
{
name: "benefit_package_details",
type: "expectedValue",
expectedValue: "benchmark_creating",
},
],
effect: { type: "show" },
},
},
],
},
],
},
{
title: "Selection of Section 1937 coverage option",
form: [
{
description:
"The state/territory selects as its Section 1937 coverage option the following type of benchmark benefit package or benchmark-equivalent benefit package under this Alternative Benefit Plan:",
slots: [
{
rhf: "Radio",
name: "section_1937_coverage_option",
rules: { required: "* Required" },
props: {
options: [
{
label: "Benchmark benefit package",
value: "benchmark_benefit_package",
form: [
{
description:
"The state/territory will provide the following benchmark benefit package:",
slots: [
{
rhf: "Radio",
name: "Benchmark_benefit_packag_options",
rules: { required: "* Required" },
props: {
options: [
{
label:
"The standard Blue Cross Blue Shield preferred provider option offered through the Federal Employee Health Benefit Program (FEHBP)",
value: "blue_cross_blue_shield",
},
{
label:
"State employee coverage that is offered and generally available to state employees (state employee coverage)",
value: "state_employee_coverage",
form: [
{
slots: [
{
rhf: "Input",
label: "Plan name",
name: "state_employee_coverage_plan_name",
rules: { required: "* Required" },
},
],
},
],
},
{
label:
"A commercial HMO with the largest insured commercial, non-Medicaid enrollment in the state/territory (commercial HMO)",
value: "commercial_hmo",
form: [
{
slots: [
{
rhf: "Input",
label: "Plan name",
name: "commercial_hmo_plan_name",
rules: { required: "* Required" },
},
],
},
],
},
{
label: "Secretary-approved coverage",
value: "secretary_approved_coverage",
form: [
{
slots: [
{
rhf: "Radio",
name: "secretary_approved_coverage_options",
rules: { required: "* Required" },
props: {
options: [
{
label:
"The state/territory offers benefits based on the approved state plan.",
value: "approved_state_plan",
form: [
{
slots: [
{
rhf: "Radio",
name: "approved_state_plan_options",
rules: {
required:
"* Required",
},
props: {
options: [
{
label:
"The state/territory offers the benefits provided in the approved state plan.",
value:
"approved_state_plan",
},
{
label:
"Benefits include all those provided in the approved state plan plus additional benefits.",
value:
"additional_benefits",
},
{
label:
"Benefits are the same as provided in the approved state plan but in a different amount, duration, and/or scope.",
value:
"different_amount_duration_scope",
},
{
label:
"The state/territory offers only a partial list of benefits provided in the approved state plan.",
value:
"partial_list_of_benefits",
},
{
label:
"The state/territory offers a partial list of benefits provided in the approved state plan plus additional benefits.",
value:
"partial_list_of_benefits_plus_additional_benefits",
},
],
},
},
],
},
],
},
{
label:
"The state/territory offers an array of benefits from the Section 1937 coverage option and/or base benchmark plan benefit packages, the approved state plan, or a combination of these benefit packages.",
value: "array_of_benefits",
},
],
},
},
{
rhf: "Textarea",
name: "benefits_and_limitations",
rules: { required: "* Required" },
label:
"Briefly identify the benefits, the source of benefits, and any limitations.",
},
],
},
],
},
],
},
},
],
},
],
},
{
label: "Benchmark-equivalent benefit package",
value: "benchmark_equivalent_benefit_package",
form: [
{
description:
"The state/territory will provide the following benchmark-equivalent benefit package:",
slots: [
{
rhf: "Radio",
name: "benchmark_equivalent",
rules: { required: "* Required" },
props: {
options: [
{
label:
"The standard Blue Cross Blue Shield preferred provider option offered through the Federal Employee Health Benefit Program (FEHBP)",
value: "blue_cross_blue_shield",
},
{
label:
"State employee coverage that is offered and generally available to state employees (state employee coverage)",
value: "state_employee_coverage",
form: [
{
slots: [
{
rhf: "Input",
name: "state_employee_coverage_plan_name",
label: "Plan name",
rules: { required: "* Required" },
},
],
},
],
},
{
label:
"A commercial HMO with the largest insured commercial, non-Medicaid enrollment in the state/territory (commercial HMO)",
value: "commercial_hmo",
form: [
{
slots: [
{
rhf: "Input",
name: "commercial_hmo_plan_name",
label: "Plan name",
rules: { required: "* Required" },
},
],
},
],
},
{
label: "Secretary-approved coverage",
value: "secretary_approved_coverage",
},
],
},
},
],
},
],
},
],
},
},
],
},
],
},
{
title: "Selection of base benchmark plan",
form: [
{
description:
"The state/territory must select a base benchmark plan as the basis for providing essential health benefits in its benchmark or benchmark-equivalent package.",
slots: [
{
rhf: "Select",
label:
"Is the base benchmark plan the same as the Section 1937 coverage option?",
name: "base_benchmark_plan_same_as_section_1937",
rules: { required: "* Required" },
props: {
className: "w-[150px]",
options: [
{ label: "Yes", value: "yes" },
{ label: "No", value: "no" },
],
},
},
{
rhf: "Radio",
label:
"Indicate which benchmark plan described at 45 CFR 156.100(a) the state/territory will use as its base benchmark plan.",
name: "base_benchmark_plan",
rules: { required: "* Required" },
props: {
options: [
{
label:
"The largest plan by enrollment of the three largest small group insurance products in the state's small group market",
value: "largest_plan_by_enrollment",
},
{
label:
"Any of the largest three state employee health benefit plans by enrollment",
value: "any_of_largest_three_state",
},
{
label:
"Any of the largest three national FEHBP plan options open to federal employees in all geographies by enrollment",
value: "any_of_largest_three_national_fehbp_plan_options",
},
{
label: "The largest insured commercial non-Medicaid HMO",
value: "largest_insured_commercial_hmo",
},
],
},
},
{
rhf: "Input",
label: "Plan name",
name: "base_benchmark_plan_name",
rules: { required: "* Required" },
},
],
},
],
},
{
title: "Additional information",
form: [
{
description:
"Other information related to selection of the Section 1937 coverage option and the base benchmark plan (optional)",
slots: [
{
rhf: "Textarea",
name: "additional_information",
},
],
},
],
},
],
};

export const form = ABP3;
2 changes: 1 addition & 1 deletion src/services/ui/src/components/RHF/Document.tsx
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Expand Up @@ -13,7 +13,7 @@ export const RHFDocument = <TFieldValues extends FieldValues>(props: {
<div className="h-[5px] bg-gradient-to-r from-primary from-50% to-[#02bfe7] to-[66%] rounded-t"></div>
<div className="py-4 px-8 border-2 border-t-0 mt-0">
<div className="mb-3 mt-9">
<FormLabel className="font-bold text-4xl px-8 font-serif">
<FormLabel className="font-bold text-4xl px-8 inline-block leading-[48px]">
{props.document.header}
</FormLabel>
</div>
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8 changes: 4 additions & 4 deletions src/services/ui/src/components/Webform/footer.tsx
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Expand Up @@ -7,19 +7,19 @@ export const Footer = () => {
"All State Medicaid agencies administering or supervising the \
administration of 1915(c) home and community-based services (HCBS) \
waivers are required to submit an annual Form CMS-372(S) Report for each \
approved waiver. Section 1915(c)(2)(E) of the SocialSecurity Act \
approved waiver. Section 1915(c)(2)(E) of the Social Security Act \
requires states to annually provide CMS with information on the waiver's \
impact on the type, amount and cost of services provided under the state \
plan in addition to the health and welgare of recipients. Under the \
plan in addition to the health and welfare of recipients. Under the \
Privacy Act of 1974 any personally identifying information obatined will \
be kept private to the extent of the law."
}
</p>
<p>
{
"Accordint to the Paperwork Reduction Act of 1995, no persons are required to respond \
"According to the Paperwork Reduction Act of 1995, no persons are required to respond \
to a collection of information unless it displays a valid OMB control number. The valid OMB \
control number for this information colleciton is 0938-0272. The time required to complete \
control number for this information collection is 0938-0272. The time required to complete \
this information collection is estimated to average 44 hours per response, including the time to \
review instructions, search existing data resources, gather the data needed, and complete and \
review the information collection. If you have comments concerning the accuracy of the time \
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