Additional Quality Improvement Program Requirements for Special

20.2 - Additional Quality Improvement Program Requirements for Special Needs Plans (SNPs) (Rev. 117, Issued: 08-08-14, Effective: 08-08-14, Implementation: 08-08-14) Section 1856(f)(7) of the Patient Protection and Affordable Care Act stipulates that all MAO’s offering Special Needs Plans (SNPs) must submit an evidence-based Model of Care (MOC) to CMS for NCQA evaluation and approval in accordance with CMS guidance. As provided at 42 CFR §422.101(f) and §422.152(g), SNPs must develop and implement a MOC that provides the structure for care management processes and systems that will enable the health plan to provide coordinated care for special needs individuals. An MAO must develop separate MOCs to meet the needs of the targeted population for each SNP type it offers. All SNPs must submit the MOC Matrix Upload Document, as well as the MOC narrative, in HPMS during the MA/SNP application timeframe. Refer to Section 40.1 and 40.2 of Chapter 16b of the Medicare Managed Care Manual titled, “Special Needs Plans” for additional information regarding the application and MOC approval requirements. The MOC was re- organized and revised to promote clarity and enhance the focus on care coordination, care transition, care needs and activities. All SNPs that must submit a MOC will be required to use the revised MOC structure for the first time as part of the CY 2015 application cycle. The MOC narrative must include the following four elements: 1. Description of the SNP Population; 2. Care Coordination; 3. SNP Provider Network; and 4. MOC Quality Measurement & Performance Improvement Section 20.2.2 below provides a detailed description of each of these elements.