This guide explains the Model of Care (MOC), its significance for Special Needs Plans (SNPs), and how you, as a provider, can access payer-specific MOC documents. Understanding and adhering to these guidelines ensures compliance with CMS requirements and optimal care for your clients.
What are Special Needs Plans (SNPs)?
Medicare Advantage plans offer Special Needs Plans (SNPs) tailored to specific populations. These include:
- C-SNPs (Chronic Condition SNPs): For patients with chronic conditions like diabetes or heart failure.
- D-SNPs (Dual-Eligible SNPs): For patients eligible for both Medicare and Medicaid benefits.
- I-SNPs (Institutional SNPs): For patients residing in long-term care facilities.
Each SNP is governed by a CMS-approved MOC to ensure coordinated, high-quality care tailored to the specific needs of SNP members.
What is the Model of Care (MOC)?
The Model of Care (MOC) serves as a comprehensive care framework for SNP members, focusing on:
- Developing individualized care plans.
- Ensuring a multidisciplinary approach to care coordination.
- Conducting regular provider training to meet CMS requirements.
Provider training requirement
MOC documents include details on provider training, as required by CMS:
- Describe how the SNP conducts initial and annual MOC training for its employed and contracted staff, which may include, but not be limited to, printed instructional materials, face-to-face training, web-based instruction, and audio/video-conferencing.
Rula is considered “contracted staff”, and participates in MOC training by sharing these documents with our provider community.
Accessing MOC documents
Below is a list of MOC documents from different Medicare Advantage plans for your review and reference (note: documents will be added over time as Rula expands into Medicare Advantage):
Additional resources
- Medicare Advantage at Rula: Understand Rula's Medicare Advantage participation and compliance requirements.