Medicare Special Needs Plans 2022

NOTE: The information below applies to ambulatory care providers.

A Special Needs Plan (SNP) is a Medicare Advantage Plan designed to provide targeted care to certain vulnerable groups of Medicare beneficiaries. Medicare SNPs limit membership to people with specific diseases or characteristics and tailor their benefits, provider choices, and drug formularies to best meet the special needs of the groups they serve. There are three categories of SNP plans:

1) Dual-Eligible SNPs (D-SNP) enroll beneficiaries who are eligible for both Medicare and Medicaid
2) Chronic Condition SNPs (C-SNP) enroll beneficiaries with certain chronic or disabling conditions
3) Institutional SNPs (I-SNP) enroll beneficiaries who are expected to reside at least 90 days in a long-term care facility

CMS requires SNP contractors, such as Amerigroup, Molina, and UnitedHealthcare, to make “Model of Care” (MOC) training available to all network providers. The MOC represents the contractor’s plan for delivering coordinated care and case management to its SNP members. Below is a brief summary of these three SNP contractors’ models of care, with links to their slide deck or training program.

You may have already received this MOC information directly from these plans, along with a request for you to attest that the materials were reviewed. While you should review the materials, you do not need to sign the attestation. A single attestation will be submitted on behalf of all Valley Medical Group members.

Notification about a patient’s participation in the program and any additional program information or documentation will be provided to you by the patient or the SNP plans. If you have questions or would like additional information, please contact Kris Atkisson, Manager of Value Based Initiatives, at Kris_Atkisson@Valleymed.org, or Hiroshi Nakano, MBA, VP of Value Based Initiatives, at Hiroshi_Nakano@Valleymed.org.

Molina Model of Care Program
Molina MOC 2022 Training Presentation

What is the Molina Model of Care (MOC) Program? The Molina MOC provides the basic framework to deliver integrated care management to its dual-eligible special needs members.

What responsibilities do providers have as part of the Molina MOC Program?

• Actively communicate with Molina Case Managers, Interdisciplinary Care Team (ICT) participants, Molina members, and their caregivers
• Accept invitations to attend member’s ICT meetings whenever possible
• Collaborate with Molina Case Managers on the ICP
• Assist with outreach attempts to engage members in the CM program

Amerigroup Model of Care Program
Amerigroup MOC 2019 Training Presentation

What is the Amerigroup Model of Care (MOC) Program? The Amerigroup MOC outlines specific goals and objectives for its targeted SNP populations, including:

• Plan of care feedback and consensus
• Clinical coordination for the member and accessing member information on the portal
• Participation in the Interdisciplinary Care Team (ICT)
• Appropriate communication with the member’s family or legal representative
• Timely submission of documentation
• How to obtain additional information or resources

UnitedHealthcare (UHC) Model of Care Program
UHC MOC Training Resources

What is the UnitedHealthcare (UHC) Model of Care (MOC) Program? The UHC MOC describes the structure, processes and care management systems that provide coordinated care to members with special needs.

Once you have accessed the UHC MOC website through the link above, click on the Menu tab to view all of the UHC MOC training materials.