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SNP Approval Model of Care Training · 2021. 1. 11. · TK Oseni, NCQA Alana Casciello, NCQA Brett...

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1 SNP Approval Model of Care Training Elements 3 - 4 Sandra Jones, NCQA TK Oseni, NCQA Alana Casciello, NCQA Brett Kay, NCQA Daniel Lehman, CMS
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  • 1

    SNP Approval Model of Care TrainingElements 3 - 4

    Sandra Jones, NCQA

    TK Oseni, NCQA

    Alana Casciello, NCQA

    Brett Kay, NCQA

    Daniel Lehman, CMS

  • 2

    ORIGINS OF THE SNP MODEL OF CARE

    (MOC)

    MOC ELEMENTS - OVERVIEW

    SCORING THE MOC

    PROJECT TIMELINE

    REMINDERS

    MOC 3 & 4

    Q & A

    HPMS REVIEW

    HOW TO SUBMIT

    HIGHLIGHT TRAININGS

    IDENTIFY CONTACTS & RESOURCES

    Agenda

    Agenda

  • 3

    Objectives

    of SNP Approval Trainings

    3

  • Compliance

    Comply with

    statutory

    requirements of

    ACA

    Defines Health

    Care Delivery

    Ensure SNPs

    have a robust

    Model of Care

    Approval

    Periods

    Establish frequency

    for approval review

    cycle (1-3 years)

    4

    Origins of the ACA - Model of Care Review

  • Model of Care Elements

    MOC 1 MOC 2 MOC 3 MOC 4

    Care

    Coordination

    Provider

    Network

    Quality

    MeasurementTarget

    Population

    5

    QA

  • Scoring the MOCThe methodology behind the process

    MOC elements worth 0-4

    points,

    based on # of factors met

    Total of 60 points (15

    elements) converted to

    percentage scores E.g., 50

    points = 83.33% or a 2-year

    approval:

    • 85%+ --3-year

    approval• 75-84%--2-year

    approval

    • 70-74%--1-year

    approval.

    • Plans scoring

  • Model of Care Trainings

    January 5 MOC 1-2

    January 7 MOC 3-4

    3-4:30pm ET

    January 2021

    Results Uploaded &

    April 19 - NOIDs distributed

    Cure TA Call

    April 20 3-4:00 pm EST

    April - 29

    Cure Submission by 8:00pm EST

    April

    Pre-Submission

    Technical Assistance (TA) Call

    January 12

    2-3:00 pm ET

    January continued

    May

    May 10 - Cure Results Uploaded

    May 26 - CMS issues Approvals/Denials

    Submission Day

    February 17 by 8:00pm EST

    NCQA reviews MOC’s

    February - March

    Final Bids due to CMS

    June 7June

    SNP Approval Timeline

    7

  • Reminders for this Review PeriodImportant information you need to know

    ▪ MOC must address the regulatory language in specific

    elements

    ▪ Looking for process details and descriptions

    ▪ Must address the Who, What, Where and How

    ▪ Provide oversight where applicable

    ▪ Reviewers will score your MOC narrative based on the CY 2022

    Guidelines

    Specific regulations are highlighted within the elements and we will

    emphasize each as we walk through applicable elements/factors

    General process statements are not acceptable and will be scored

    down

    8

  • Keep in Mind

    SNPs must identify all H-numbers that follow similar processes under a

    single MOC on the Matrix Upload document.

    You must describe the Target population in your service area

    ▪ Data and analysis must be relevant to specific population in each service area (not as described in national statistics or general language that covers your organization’s overall population.)

    ▪ Expectation is for SNPs to submit a new MOC each renewal period with

    process updates and changes (e.g., changes to goals as a result of

    analysis of outcomes or process improvements), and not the same MOC

    previously approved

    ▪ An opportunity to think through and improve processes

    ▪ Address all requirements in the elements and factors

    ▪ Check the explanation for clarification

    ▪ MOC’s will be reviewed and scored based upon current assessment of

    the requirements

    9

  • 10

    Provider Network

    MOC 3

    10

  • Regulations at 42 CFR§422.152(g)(2)(vi) require

    SNPs to demonstrate that the provider network has

    specialized clinical expertise in delivery of care to

    beneficiaries

    CMS Regulation—MOC 3 Element ASNP networks must have clinical expertise

    11

  • 12

    MOC 3A: Specialized Expertise

    Intent: Demonstrate how the network is designed to address the needs of the SNP’s target population

    Focus:

    Describe plan-level information on the network providers who see SNP beneficiaries

    • Contracted to provide health care services to SNP beneficiaries

    • Detail how and why these providers are appropriate

    • Include relevant facilities and providers necessary to address the needs of the target population

    • Identify and describe oversight for all network provider types

  • MOC 3 Element A: Specialized ExpertiseFactor-level details

    1. How providers with specialized expertise correspond to the target population identified in MOC 1

    2. How the SNP oversees provider network facilities and that its providers are competent and have active licenses

    3. How the SNP documents, updates and maintains accurate providerinformation

    4. How providers collaborate with the ICT and contribute to a beneficiary’s ICP to provide necessary specialized services

    13

  • • Correlate the provider network to the specific target population

    • Describe oversight for providers and facilities to ensure appropriate licensure

    • Process for updating and maintaining provider information

    • Describe the collaborative process with the ICT to provide needed services to beneficiaries

    14

    Takeaway Points MOC 3A: Provider Network

  • Regulations at 42 CFR §422.101 (f)(2)(iii)-(v);42 CFR§422.152(g)(2)(ix) require SNPs to demonstrate the use of CPGs and CTPs.

    CMS REGULATION—MOC 3 ELEMENT B

    SNPS USE OF CLINICAL PRACTICE GUIDELINES AND

    CARE TRANSITION PROTOCOLS

    15

  • 16

    MOC 3B: Use of Clinical Practice Guidelines and Care TransitionsIntent: Describe how the SNP ensures that beneficiaries receive appropriate, evidence-based care and services

    Focus: Population-level decision making, not at the individual provider level

    • Identify challenges to using CPGs and protocols

    • The SNP must demonstrate the use of CPGs and CTPs

    o How providers utilize the appropriate CPGs

    o Process for instances when CPGs may not be appropriate

    o What oversight is provided for the use of CTPs, how oversight is provided, who provides it

    16

  • MOC 3 Element B: Use of Clinical Practice Guidelines and Care Transition Protocols

    DescribeDescribe how SNP providers maintain continuity of care using the CTPs outlined in MOC 4, Element E

    DetailDetail how decisions to modify CPGs or recognized protocols are made, incorporated into the ICP, communicated and acted on by the ICT

    IdentifyIdentify challenges where the use of CPGs and protocols need to be modified or are inappropriate for specific vulnerable SNP beneficiaries

    ExplainExplain the process for monitoring how providers utilize CPGs and nationally recognized protocols appropriate to each SNP’s target population

    Factor Factor-level details

    17

  • Iden

    Collaborate with ICTMonitor appropriate

    utilization of CPGs

    .

    Takeaway Points: MOC 3B CPGs and Transitions

    Continuity of careIdentify challenges to

    using CPGs

    Process for

    modifying guidelines

    18

  • Intent: Describe how the SNP provides training for its provider network

    Focus:

    • How do SNPs make training available to all network providers?

    • The SNP conducts MOC training for its network of providers:

    o How are initial and annual training conducted for in-network and out-of-network providers?

    o How is training tracked?

    o What actions are taken when training is incomplete?

    MOC 3 Element C: Provider Network TrainingProvider Network Training on the MOC

    19

  • MOC 3 Element C: Provider Network TrainingFactor-level details

    REQUIRE INITIAL AND ANNUAL

    TRAINING FOR IN-NETWORK AND OUT-

    OF-NETWORK PROVIDERS

    ROUTINELY SEEN BY BENEFICIARIES

    DOCUMENT EVIDENCE THAT THE

    ORGANIZATION MAKES AVAILABLE AND OFFERS MOC

    TRAINING FOR NETWORK

    PROVIDERS

    EXPLAIN CHALLENGES

    ASSOCIATED WITH COMPLETION OF MOC TRAINING

    ACTIONS TAKEN WHEN THE

    REQUIRED MOC TRAINING IS

    DEFICIENT OR HAS NOT BEEN

    COMPLETED

    20

  • 21

    Takeaway Points—MOC 3C:Provider Training

    Describe challenges associated with provider completion of training

    Describe actions taken for deficient or incomplete trainings

    Process for required initial and annual training

    Document evidence of training

    availability

  • Questions

    22

  • 23

    Quality Measurement & Performance Improvement MOC 4

    23

  • CMS Regulation: MOC 4: MOC Quality Measurement and Performance improvement

    Regulations at 42 CFR §422.152(g) require all SNPs to conduct a quality improvement program that measures the effectiveness of their MOC

    24

  • Intent: Describe how the SNP conducts quality improvement related to its overall MOC

    Focus:

    • Plan-level information focusing on goals that measure overall planperformance related to all aspects of the MOC

    • Measurement of quality and performance can lead to increased organizational effectiveness and efficiency

    o Quality improvement goals for the MOC

    o Must detail benchmarks or goals

    MOC 4 Element A: Quality PerformanceImprovement Plan

    25

  • MOC 4A: MOC Quality Measurement and Performance Improvement

    Factor-level detailsFactor

    Describe the overall quality improvement plan and how the organization delivers or provides for appropriate services to SNP beneficiaries, based on their unique needs

    Describe

    Describe the specific data sources and performance and outcomes measures used to continuously analyze, evaluate and report MOC quality performanceDescribe

    Describe how leadership, management groups, other SNP personnel and stakeholders are involved with the internal quality performance processDescribe

    Describe how SNP-specific measurable goals and health outcome objectives are integrated into the overall performance plan, as described in MOC 4, Element BDescribe

    26

    1.

    2.

    3.

    4.

  • 27

    MOC 4A Takeaway Points

    Quality Measurement andPerformance Improvement

    • Include data sources and outcome measures

    • Describe key personnel involved

    • Plan for goals not met

    • Remeasure

    • Don’t forget to include goals and benchmarks with timeframes

    27

  • Intent: Identify and define the measureable goals/healthoutcomes for the target population, and how the SNPdetermines if goals are being met

    Focus:

    • Plan-level measures and goals for the target population

    • Health/clinical goals (e.g., controlling diabetes, improvingmental health screening access)

    • The goal of performance improvement and quality measurement is to improve the SNP's ability to deliver high-quality services and benefits

    • Health outcomes, accessibility and clinical goals related to population health

    MOC 4 Element B: Measureable Goals andHealth Outcomes for the MOC

    28

  • MOC 4 Element B: Measureable Goals and Health Outcomes for the MOCFactor-level details

    DescribeDescribe the steps the SNP will take if goals are not met in the expected time frame

    DescribeDescribe the processes and procedures the SNP will use to determine if health outcome goals are met

    DescribeDescribe how the SNP establishes methods to assess and track the MOC's impact on SNP beneficiaries’ health outcomes

    IdentifyIdentify specific beneficiary health outcome measures used to measure overall SNP population health outcomes at the plan level

    Identify and defineIdentify and define the measurable goals and health outcomes used to improve the health care needs of SNP beneficiaries

    29

    1.

    2.

    3.

    4.

    5.

  • Detail Detail A

    Identify measures to improve overall plan health

    outcomes

    Identify and define goals and desired outcomes to improve

    individual health

    Takeaway Points: MOC 4B Measurable Goalsand Outcomes

    Detail your process with time frames

    Actions taken when goals are not met

    Assess impact

    30

  • MOC 4 Element C: Measuring Patient Experience of Care

    31

    Analysis of member satisfaction

    Intent: Describe how the SNP measures beneficiary satisfaction and responds to results

    Focus:

    • Plans may use a wide variety of patient experience/satisfaction surveys—CAHPS/HOS are acceptable, as are other alternatives

    • Provide details of surveys and methodology for data collection

  • 1. Describe the specific SNP survey used

    2. Explain the rationale for selection of a specific tool

    3. Describe how results of patient experience surveys are integrated into the overall MOC performance improvement plan

    4. Describe steps taken by the SNP to address issues identified in survey responses

    MOC 4 Element C: Measuring Patient Experienceof Care

    Factor-level details

    32

  • Integrateresults into the

    overall MOC performance improvement

    plan

    Takeaway Points: MOC 4C SNP Member Satisfaction

    Describe the process for

    identifying issues to address from survey results

    Describe how results will be integrated into the

    overall MOC performance

    improvement plan

    33

  • 34

    MOC 4 Element D: MOC Ongoing Performance Improvement Evaluation of the MOC

    Intent: Describe how the SNP uses

    the results from its performance

    indicators/measures to support its

    ongoing quality improvement plan

    Focus

    • Include lessons learned and challenges in obtaining timely

    data

  • MOC 4 Element D: MOC Ongoing PerformanceImprovement Evaluation of the MOC

    35

    Factor-level details

    1. How the organization will use the results of quality performanceindicators and measures to support ongoing improvement of the MOC

    2. How the organization will use the results of quality performanceindicators and measures to continuously assess and evaluate quality

    3. The organization’s ability for timely improvement of mechanisms forinterpreting and responding to lessons learned through the MOCperformance evaluation

    4. How the performance improvement evaluation of the MOC will bedocumented and shared with key stakeholders

  • 36

    Takeaway Points—MOC 4D: Ongoing Performance Improvement MOC Evaluation

    Mechanism for interpreting and responding to lessons learned

    Process for documenting and sharing results with key stakeholders

    How results will be used to support ongoing improvements

    to the MOC

    Indicators and measures to continuously assess and evaluate quality

  • Intent: Describe how the SNP communicates its quality improvement plan/performance to stakeholders

    Focus

    • Detail who receives the information, how often they receive it and thecommunication methods used

    MOC 4 Element E: Dissemination of SNPQuality Performance

    37

  • 1. Describe how performance results and other pertinent information isshared with multiple stakeholders

    2. State the scheduled frequency of communications with stakeholders

    3. Describe the methods for ad hoc communication with stakeholders

    4. Identify the individuals responsible for communicating performance updates in a timely manner

    MOC 4 Element E: Dissemination of SNP Quality PerformanceFactor-level detail

    38

  • 39

    Takeaway Points—MOC 4E:Dissemination of SNP Quality Performance Related to MOCPlan Personnel and Staff

    • Plan Leadership

    • Communications via weekly reports

    • Interdisciplinary Care Committee—Quarterly

    • Corporate Quality Improvement Committee—Monthly (Quarterly ICC reports)

    • Board Reports—Quarterly

    Regulatory Agencies

    Communications via “Weekly Reports”:

    • Member newsletters—Quarterly

    • Member health statements—Biannually

    • Summary of Benefits—Annual

    Quality Improvement Projects and Chronic Care Improvement Program—Annual

    Provider Networks:

    • Provider newsletters—Quarterly

    • Provider manuals—Annual

    • SNP Model of Care training—Annual

    39

  • 4040

  • 41

    HPMS Review –How to UploadDaniel Lehman, CMS

    41

  • HPMS Review: Contract Management Tab

    42

    42

  • HPMS Review: Models of Care

    43

    43

  • HPMS Review: Select MOC to Upload

    44

    44

  • HPMS Review: Select File for Upload

    45

    45

  • HPMS Review: File Upload Confirmation

    46

    46

  • HPMS Review: Submission Renewal

    47

    47

  • HPMS Review: MOC Detailed Report

    48

    48

  • 49

    49

  • 50

    Initial and Cure Submissions

    Submission Format

    50

  • Submission Instructions

    What? SNPs submit2 documents:

    • MOC narrative

    • Matrix

    Where?

    Upload via HPMS by

    the date and time

    provided

    How?

    • May include supporting

    documentation as an

    appendix

    • May reference

    supporting

    documentation in the

    text

    Using Links*

    • Ensure that all links

    are operational

    o Check before

    submission

    *Nonfunctioning links or embedded documents may prevent reviewers from seeing your document and

    may result in decreased scores assessed without an opportunity to Cure

    51

  • Technical Assistance for Cure for Plans scoring less than 70%

    Previousinstructions apply!

    What?

    • Must include MOC

    and Matrix

    Where?

    Upload via HPMS by

    the date and time

    provided

    How?

    • Must redline changes

    o Strikethrough text that is no

    longer applicable and replace

    in colored font

    • Address all factor

    requirements

    • May reference documents

    in appendix

    • Check links

    52

  • 53

    Training and Resources

    53

  • Training & EducationSessions focus on MOC Requirements & Technical Assistance

    MOC Elements 1 & 2

    1 training

    January 5, 2021;

    2:00-4:00 pm ET

    MOC Elements 3 & 4

    1 training

    January 7, 2021

    2:00-4:00 pm ET

    Pre-Submission Technical Assistance(TA) Call: January 12;

    2-3:00pm ET

    Cure TA Call: April 20, 3-4:00 pm ET for SNP’s that scored 69%

    and below

    Slides are available on the NCQA SNP Approval website:

    (snpmoc.ncqa.org). Recordings from trainings will post within

    one week of the training call.

  • Make this a simple process for you and the reviewer. Ensure that you address the requirements of all elements and factors.

    THE SNP TEAM

    55

  • For technical inquires related to the MOC program plan

    requirements or regulation issues, please contact CMS

    at: https://dpap.lmi.org. In the subject line enter: SNP

    MOC Inquiry

    SNP application inquiries via the CMS SNP mailbox:

    type https://dmao.lmi.org ; then select the SNP mailbox.

    Subject line: SNP Application Inquiry

    56

    Get in touch

    Training recordings and slides:

    Please visit the NCQA SNPApproval

    Website at: snpmoc.ncqa.org

    56

    https://dpap.lmi.org/https://dmao.lmi.org/

  • Thank you


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