Key dates for Model of Care reviews for Contract Year 2023.
Understand the process for determining MOC scores.
Clarification to HRA Requirements*
CMS and NCQA received a few questions regarding HRA policies and reporting practices based on MOC training sessions 1 & 2 on November 30, 2021. MA organizations offering Special Needs Plans (SNPs) must conduct initial and annual HRAs of individuals’ physical, psychosocial, and functional needs, using a comprehensive risk assessment tool that CMS may review during oversight activities [see Social Security Act, § 1859(f)(5)(A)(ii)(I) and 42 CFR § 422.101(f)(1)(i)].
In addition, Medicare Advantage Special Needs Plans (SNPs) are required under 42 CFR 422.152(g)(2)(iv) to submit health risk assessment (HRA) completion data as a part of CMS Part C Plan Reporting process. CMS provides further guidance to plans in the Part C Plan Reporting Technical Specifications found here: https://www.cms.gov/files/document/cy2021-part-c-technical-specifications.pdf. As noted in the Tech Specs, only completed HRAs that comprise direct beneficiary and/or caregiver input will be considered valid for purposes of fulfilling the Part C reporting requirements. This means, for example, that HRAs completed only using claims and/or other administrative data would not be acceptable for the purposes of meeting the Part C reporting requirements. SNPs should take this into consideration when reviewing their MOC HRA processes and incorporate appropriate enrollee refusal or “unable to reach” policies into their MOC HRA policies.
*Corrections to statements during trainings regarding the HRA requirements were deleted in the recordings and notification placed on the SNP MOC website as well as noted here within the Scoring Guidelines.
SNP Model of Care Off-cycle Revisions FAQs and Clarifications
Training Log In information is now available.
Training Slides are now available and Recordings will be coming soon.
For technical inquiries about the Model of Care Requirements, please contact the DPAP portal mailbox at https://dpap.lmi.org.