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Special Needs Plans Medicare and Medicaid Plans. CY 2015 Model of Care Submission Training. January 21, 2014 Susan Radke. Model of Care Submission. All Models of Care (MOC) are submitted via the Health Plan Management System (HPMS) Online Application User’s Manual SNP Upload Guide

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Special Needs Plans Medicare and Medicaid Plans


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    Presentation Transcript
    1. Special Needs PlansMedicare and Medicaid Plans CY 2015 Model of Care Submission Training January 21, 2014 Susan Radke

    2. Model of Care Submission • All Models of Care (MOC) are submitted via the Health Plan Management System (HPMS) • Online Application User’s Manual • SNP Upload Guide • MOC Upload Matrix Document (revised) • Follow the MOC Upload Matrix format to develop your MOC narrative for NCQA review • No appendices, attachments, or additional documentation needed • Be clear and concise

    3. Model of Care Submission How will I know if my MOC is due during the 2015 application submission timeframe? • All one-year MOC approvals are due to submit a MOC with the CY 2015 application • All service area expansion (SAE) applications require a MOC submission, which is due with the CY 2015 SAE application • HPMS will signal if a MOC submission is required

    4. Model of Care Submission Multi-year Approvals • Three year approval period If the MOC approval start date is January 1, 2012, the 3-year approval period is January 1, 2012 - December 31, 2014. The plan must submit a MOC by February 25, 2014.

    5. Model of Care Submission Multi-year Approvals • Two year approval period If the MOC start approval date is January 1, 2013, the 2-year approval period is January 1, 2013 - December 31, 2014. The plan must submit a MOC for review and approval by February25, 2014.

    6. Model of Care Submission • All MOC approvals and approval periods apply to the Contract Number/type/subtype and not to Plan Benefit Packages (PBPs) • Check HPMS to determine if your MOC submission is due for the CY 2015 application year via the following link: HPMS Home Page>Contract Management>Basic Contract Management>Select Contract Number>Submit Application Data The MOC Renewal Application information appears on the last screen

    7. Questions SNP MOC questions contact: SNP_Mail@cms.hhs.gov MMP MOC questions contact: MMCOcapsmodel@cms.hhs.gov