2014 SNP Model of Care Review Process

New for 2014

CMS revised the Model of Care (MOC) requirements, reducing them from 11 to 4. Subsequently, NCQA revised the scoring guidelines and methodology based upon stakeholder comments submitted in response to Public Comment and CMS’ position. Plans seeking service area expansions, continued authorization to operate as a SNP or new SNP benefit packages for CY 2015 must submit an MOC narrative as part of the SNP Approval application to CMS by February 25, 2014 to CMS via HPMS.

Background

The Affordable Care Act (ACA) amended section 1859(f) of the Social Security Act to require that, starting in 2012, all SNPs be approved by NCQA based on standards developed by the Secretary. As provided under 42 CFR §§ 422.4(a) (iv), 422.101(f), and 422.152(g), the NCQA approval process is based on evaluation and approval of the SNP Model of Care (MOC), as per CMS guidance. 

Specifically, the ACA requires that all SNPs, new, existing or those seeking to expand service areas, be approved by NCQA effective beginning January 1, 2012. For 2013 and subsequent years, only new SNPs or those seeking service area expansions are required to submit an application for SNP approval to CMS. The NCQA SNP approval process is a separate and distinct process from that of the Structure and Process (S&P) measures evaluation. The SNP approval process focuses solely on the MOC requirements. The MOCs are submitted to CMS via HPMS, then reviewed and scored by NCQA based on scoring guidelines developed with CMS.

Requirements

Scoring of the MOC includes evaluation of the following clinical and non-clinical elements by NCQA surveyors: 

  1. Description of the SNP Population
  2. Care Coordination
  3. Provider Network
  4. MOC Quality Measurement & Performance Improvement

For more information on the SNP Approval Application requirements and process, please go to the following Web site: COMING SOON

Scoring

As in previous years, the elements noted may contain one or more factors, which NCQA scores on a scale of 0-4. SNPs must provide detailed responses to all elements and factors. A minimum score of seventy (70) percent is considered passing. To relieve the burden of annual reporting, CMS implemented a multi-year approval process granted to those plans that receive higher MOC scores.

The elements noted may contain one or more factors, which NCQA scores on a scale of 0-4. SNPs must provide in depth and detailed responses to all elements and factors. A minimum score of seventy (70) percent is considered passing. To relieve the burden of annual reporting, CMS implemented a multi-year approval process granted to those plans that receive higher MOC scores.

Multi-year SNP Approval time-periods are as follows:

  • Three (3) years = Eighty-five (85) percent or higher
  • Two (2) years = Seventy-five (75) percent to eighty-four (84) percent range
  • One (1) year = Seventy (70) percent to seventy-four (74) percent range

Timeline

Click on the Timeline link to view CY 2015 dates.

* For more information on trainings and technical assistance calls, please refer to the SNP Approval Training Sessions link above.

SNP and S&P Assessment

Learn more about NCQA's SNP and S&P Assessment.