Resources
General SNP Resources
-
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
-
Contains regulatory guidance unique to SNPs including plan eligibility, enrollment and D-SNP State Medicaid and I-SNP facility contract requirements, among other topics
-
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
-
Details CMS MOC requirements and NCQA MOC Scoring Guidelines
-
Be sure to read both sections 20.2.1 and 20.2.2
-
Critical resource for preparing MOCs for initial approval and renewal
-
-
​Current-year MOC trainings are often released in November ahead of the MOC filing deadline in February​
-
-
Current guidance on how to submit an off-cycle or "red-lined" MOC
-
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.
-
Current Part C and D Program Audit Protocols​
-
For the current SNP MOC/SNP Care Coordination (SNPCC) Audit Protocols, click on the zip file entitled: "Medicare_Part_C_and_D_Program_Audit_Protocols (CMS-10717)" and then open "SNPCCProtocol.pdf" and "SNPCCSupplementalQuestionnaire.pdf"
-
December 4th, 2018: CMS suspended Enrollment data collection in SNP-MOC Audit
-
Heavily revised CY 2022+ Protocols released in May 2021. CMS Training available at link.
Quality Measurement and Reporting
2024 Part C Reporting Specifications
-
Outlines annual reporting requirements related to the SNP Care Management (Health Risk Assessment Completion) Measure
-
Updated September 6, 2024​
-
2017-2018 QIP and CCIP Resource Guide
-
Describes SNP-specific Chronic Care Improvement Project (CCIP) requirement and documentation templates
-
Formal Quality Improvement Project (QIP) requirement has been eliminated
2024 Medicare Stars Technical Notes
-
Stars technical specifications document detailing numerator, denominator and benchmarks for each measure
-
Includes the 4 SNP-specific Star measures:
-
Part C Reporting: SNP Care Management​
-
HEDIS: Care of Older Adults
-
Functional Status Review (Display Measure)
-
Pain Assessment
-
Medication Review
-
-
Key SNP Regulations
Overall SNP Requirements
Quality Improvement SNP Requirements
Requirements for Dual Eligible SNPs
The above list is not comprehensive and provides only primary regulatory references. Subregulatory guidance is published by CMS on a continuous basis. Sign up for the HPMS listserv here.
Looking for additional information or have other questions? Email us at info@prizmhealthadvisory.com.