What is a Model of Care?

SNP Model of Care (MOCs) are considered a vital quality improvement tool and integral component for ensuring that the unique needs of each beneficiary enrolled in a SNP are identified and addressed. In 2010, the Patient Protection and Affordable Care Act (ACA) reinforced the importance of the MOC as a fundamental component of SNP quality improvement by requiring the National Committee for Quality Assurance (NCQA) to execute the review and approval of SNPs’ MOC based on standards and scoring criteria established by CMS.

NCQA assess MOCs from SNPS according to detailed CMS scoring guidelines. The MOC requirements comprise the following clinical and non-clinical standards:

  • Description of the SNP Population.
  • Care Coordination.
  • SNP Provider Network.
  • MOC Quality Measurement & Performance Improvement.

Each standard contains a number of elements that are comprised of individual factors SNPs are assessed against. For each element, SNPs get a score of 0-4 points depending on the number of factors it meets under the element.

A SNP is scored based on the percentage of points it receives out of the total possible points it could earn if it received the maximum of 4 points for each element. To relieve the burden of annual reporting, CMS implemented a multi-year approval process granted to those CMS that receive higher MOC scores. The approval categories are as follows:

  • 3-year Approval – score of 85% or higher.
  • 2-Year Approval – score of 75%-84%
  • 1-Year Approval – score 70%-74%

SNPs with an MOC score below 70% are consider “failing.” SNPs that receive a score below 70% under the initial review have an opportunity to resubmit their MOCs and achieve a score of 70% or greater. This one-time opportunity is called a Cure. Any plan that requires a Cure can only achieve a 1-Year Approval status regardless of their final score.