US · guidance
CMS Pub. 100-16, ch. mc86c16b, § 30.2
Model of Care Approval
As provided under section 1859(f)(7) of the Act, every SNP must have an NCQA-approved MOC.
The MOC provides the basic framework under which the SNP will meet the needs of each of its
enrollees. The MOC is a vital quality improvement tool and integral component for ensuring that the
unique needs of each enrollee are identified by the SNP and addressed through the plan’s care
management practices. The MOC provides the foundation for promoting SNP quality, care
management, and care coordination processes. Please note that detailed information regarding the
SNP MOC elements and scoring criteria are located in chapter 5 of the MMCM.
The statute gives the Secretary the authority to establish standards for the MOC approval process.
The NCQA MOC approval process scores each of the clinical and non-clinical elements of the MOC.
SNPs are approved for one, two, or three year periods.
SNPs that have a failing score (less than 70 percent) for their initial MOC submission will have one
cure opportunity to achieve a passing score (greater than 70 percent). Regardless of the score
following that cure opportunity (provided the score is at least 70 percent), those SNPs will receive a
one-year approval. Table 4 below summarizes the MOC review and cure process.
Table 4: Overview of MOC Review and Cure Processes
Score for Initial
MOC
Submission (%)
Cure
Options
Post 1st Cure Final Approval Status
85% to 100% No cure
options
N/A 3-year approval
75% to 84% No cure
options
N/A 2-year approval
70% to 74% No cure
options
N/A 1-year approval
69% or below One cure
option
70% or higher 1-year approval
69% or below One cure
option
69% or below No approval
This policy provides added incentive for SNPs to develop and submit comprehensive and carefully
considered MOCs for initial NCQA approval and rewards those SNPs that have demonstrated ability
to develop quality MOCs.
History
(Rev. 123, Issued: 08-19-16, Effective: 08-19-16, Implementation: 08-19-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
b3f70f49ef930525d9e6cae3ad6a0d8b66872af63bacd0c60329e9af0b42f246
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