CMS Pub. 100-16, ch. mc86c16b, § 20.3.4

I-SNPs that serve residents of LTC facilities must own, operate, or have a contractual arrangement

with the LTC facility. The LTC facility must adhere to the I-SNP’s approved MOC. CMS requires

that the contract between the I-SNP and the LTC facility include the following:

1. Facilities in a chain organization must be contracted to adhere to the I-SNP MOC.

If the I-SNP’s contract is with a chain organization, the chain organization and the applicant

agree that the facilities listed will adhere to the approved I-SNP MOC.

2. Facilities must provide I-SNP clinical staff access to the I-SNP enrollees.

The contracted facility must agree to provide I-SNP clinical staff appropriate access to the I-SNP enrollees residing in the facility. The I-SNP clinical staff includes physicians, nurses,

nurse practitioners, and care coordinators, in accordance with the I-SNP protocols for

operation.

3. The I-SNP must provide protocols in accordance with the approved I-SNP MOC.

The I-SNP must agree to provide protocols to the facility for serving the I-SNP enrollees in

accordance with the approved I-SNP MOC. The I-SNP’s contract with the facility must

reference these protocols.

4. Delineation of services provided by the I-SNP staff and the LTC facility staff must be

specified.

The I-SNP staff and the facility staff must provide a delineation of the specific services to the

I-SNP enrollees, in accordance with the protocols and payment for the services provided by

the facility.

5. A training plan for LTC facility staff to understand the MOC must be included.

A training plan must be in place to ensure that LTC facility staff understands their

responsibilities in accordance with the approved I-SNP MOC, protocols, and contract. If the

training plan is a separate document, the contract should reference it.

6. Procedures must be developed and in place for facilities to maintain a list of credentialed

I-SNP clinical staff.

Procedures should ensure cooperation between the I-SNP and the facility in maintaining a list

of credentialed I-SNP clinical staff in accordance with the facility’s responsibilities under

Medicare conditions of participation.

7. A contract year for I-SNP must be specified.

The contract must include the full CMS contract cycle, which begins on January 1 and ends on

December 31. The I-SNP may also contract with additional LTC facilities throughout the

CMS contract cycle.

8. Grounds for early termination and a transition plan for I-SNP enrollees must be

specified.

The termination clause must clearly state any grounds for early termination of the contract

between the I-SNP and the LTC facility. The contract must include a clear plan for

transitioning the enrollee should the I-SNP’s contract with the LTC facility terminate.