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SNP Approval Model of Care TrainingElements 3 - 4
Sandra Jones, NCQA
TK Oseni, NCQA
Alana Casciello, NCQA
Brett Kay, NCQA
Daniel Lehman, CMS
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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
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Objectives
of SNP Approval Trainings
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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)
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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
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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
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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
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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
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Provider Network
MOC 3
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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
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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
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• 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
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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
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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
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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
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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
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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
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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
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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
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Quality Measurement & Performance Improvement MOC 4
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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
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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
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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
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1.
2.
3.
4.
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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
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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
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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
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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
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MOC 4 Element C: Measuring Patient Experience of Care
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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
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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
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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
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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
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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
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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
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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
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HPMS Review –How to UploadDaniel Lehman, CMS
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HPMS Review: Contract Management Tab
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HPMS Review: Models of Care
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HPMS Review: Select MOC to Upload
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HPMS Review: Select File for Upload
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HPMS Review: File Upload Confirmation
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HPMS Review: Submission Renewal
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HPMS Review: MOC Detailed Report
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Initial and Cure Submissions
Submission Format
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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
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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
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Training and Resources
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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
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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
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Get in touch
Training recordings and slides:
Please visit the NCQA SNPApproval
Website at: snpmoc.ncqa.org
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https://dpap.lmi.org/https://dmao.lmi.org/
Thank you