Does your current Model of Care coincide with the new requirements?

The Centers for Medicare and Medicaid Services (CMS) revised the Model of Care (MOC) requirements, reducing core clinical and non-clinical elements from 11 to 4. Subsequently, the National Committee for Quality Assurance (NCQA) revised their scoring guidelines and methodology, based on this change.

What does this mean for health plans that are scheduled to resubmit applications for their MOC renewal in 2015?

Plans that are seeking to continue authorization to manage a Special Needs Plan (SNP) during the upcoming year must submit a MOC narrative to CMS as part of their SNP application by February each year. The SNP approval process itself focuses solely on the MOC requirements. Plan submissions are designed to go through Health Plan Management System (HPMS). As in previous years, the MOCs are reviewed and scored by NCQA, utilizing a scoring method designed with CMS. All of the elements and factors are scored on a scale of 0-4, with a minimum score of 70 percent required for a plan to pass.

For Medicare Advantage plans that need to modify their MOCs to accommodate the new core requirements, Gorman Health Group is ready and available to assist in that transition to help you reach a goal of obtaining higher MOC scores. We will guide your medical management staff to provide clear and concise responses to the multiple factors within each element, and also work with you to submit complete and detailed narrative responses to the following required elements:

 

1. Description of the SNP Population;

2. Care Coordination;

3. Provider Network; and

4. MOC Quality Measurement & Performance Improvement.

 

Insure you have a successful submission and approval process. Contact us today >>

 

Resources

The effective use of health information technology, or medical economics, can be one of the best assets for a health plan in controlling costs and service levels, especially when there may be an increase in plan membership. Learn important strategies for a plan’s medical management team. Read more >>

Save the Date for the Gorman Health Group 2015 Forum. Join us April 7-9, 2015 at the Gaylord National Resort and Convention Center in National Harbor, MD. Learn more about the event >>