Resources
General SNP Resources
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Offers a brief overview of SNPs including why and how they were created. More detail can be found by following links on the left of the page.
Medicare Managed Care Manual Chapter 16b - Special Needs Plans
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Contains regulatory guidance unique to SNPs including plan eligibility, enrollment and D-SNP State Medicaid and I-SNP facility contract requirements, among other topics
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Refer to Chapter 5 of the MMCM (below) for the SNP MOC requirements
SNP Model of Care
Medicare Managed Care Manual Chapter 5 -Quality Improvement
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Details CMS MOC requirements and NCQA MOC Scoring Guidelines
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Be sure to read both sections 20.2.1 and 20.2.2
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Critical resource for preparing MOCs for initial approval and renewal
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FAQs on how to submit an off-cycle or "red-lined" MOC
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As of January 2019, CMS will only accept off-cycle MOC submissions in HPMS for D-SNPs and I-SNPs from 6/1-11/30 each year. C-SNPs are no longer able to submit off-cycle MOCs.
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2017-2018 Part C and D Program Audit Protocols
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For the current SNP MOC Audit Protocols, click on the zip file entitled: "2017_Medicare_Parts_C_and_D_Program_Audit_Protocols_and_Data_Requests" and then open "Attachment_V_SNP_MOC"
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December 4th, 2018: CMS suspended Enrollment data collection in SNP-MOC Audit
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December 6th, 2019: Notice regarding proposed data collection for CMS Program Audits for 2021
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CMS form number CMS-10717
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December 27th, 2019: Notice regarding proposed changes to CMS Program Audits for 2020
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CMS form number CMS-10191
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Quality Measurement and Reporting
2020 Part C Reporting Specifications
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Outlines annual reporting requirements related to the SNP Care Management (Health Risk Assessment Completion) Measure
2017-2018 QIP and CCIP Resource Guide
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Describes SNP-specific Chronic Care Improvement Project (CCIP) requirement and documentation templates
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Formal Quality Improvement Project (QIP) requirement has been eliminated
2020 Medicare Stars Technical Notes
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Stars technical specifications document detailing numerator, denominator and benchmarks for each measure
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Includes the 4 SNP-specific Star measures:
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Part C Reporting: SNP Care Management
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HEDIS: Care of Older Adults
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Functional Status Review
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Pain Assessment
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Medication Review
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COVID-19 Guidance
Many changes to the Medicare Advantage program and Medicare FFS have been made to enable plans and providers to focus on patient care during the pandemic. The below list of changes is not comprehensive. Sign up for the HPMS listserv here.
CMS Program Audits
Benefit Flexibilities and Quality Improvement Program Changes
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Telehealth, mid-year benefit changes, Part D flexibilities
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HEDIS, CAHPS and HOS data collection and submissions suspended in 2020
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Changes to 2021 and 2022 Star ratings calculations
MOC Flexibility During Pandemic and Loss of SNP Status
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April 21, 2020: HPMS memo released with updates to March 10 guidance.
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"CMS will consider the special circumstances presented by the COVID-19 outbreak when conducting MOC monitoring or oversight activities."
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CMS will "exercise enforcement discretion" with respect to MA plans that choose to delay involuntary disenrollment of enrollees who are losing special needs status.
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Looking for additional information or have other questions? Email us at info@prizmhealthadvisory.com.