CMS Pub. 100-16, ch. 5, § 20.2

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.