1. SNP APPROVAL Model of Care Requirements Surveyor Training Brett Kay, Sandra Jones, Nidhi Dalwadi Mehta February 4 & 9, 2015

2. 2 SNP Approval MOC Requirements Surveyor Training for CY 2015 Purpose of Training SNP Approval MOC reviews – Provide brief overview of CMS’s 2016 SNP Approval application process – Project Timeline Provide a general understanding of main components of SNP Approval – Model of Care (MOC) Requirements (Elements 1-4) – Scoring Guidelines & Methodology – Surveyor FYI & Reminders

3. 3 SNP Approval MOC Requirements Surveyor Training for CY 2015 Objectives of Special Needs Plan/Medicare- Medicaid Plan (SNP/MMP) Model of Care Review Comply with statutory requirements of Affordable Care Act Ensure SNPs and MMPs have robust Models of Care Establish frequency for approval review cycle (1-3 years)

4. 4 SNP Approval MOC Requirements Surveyor Training for CY 2015 Project Time Line February 3 – Technical Assistance call prior to submission February 18 – SNP Applications submitted to CMS via HPMS April 20 – CMS issues Notice of Intent to Deny April 23 – TA call for Plans scoring <70% April 30 - SNP Cure Apps due in HPMS May 27 – CMS issues SNP Denial Notices June 1 - SNP bids due to CMS

5. 5 SNP Approval MOC Requirements Surveyor Training for CY 2015 SCORING GUIDELINES

6. 6 SNP Approval MOC Requirements Surveyor Training for CY 2015 Scoring will be similar to previous years Most elements composed of multiple factors MOC elements worth 0-4 points, based on # of factors met. Plans must provide a comprehensive description that provides “the what” & “the how” in response to each element & factor Total of 60 points (15 elements) converted to percentage scores – E.g., 50 points = 83.33% (2-year approval) Requires a minimum passing score of 70 percent How will NCQA Score the MOC?

7. 7 SNP Approval MOC Requirements Surveyor Training for CY 2015 Crosswalk to New Elements Old ElementsNew Elements MOC 1: SNP Population MOC 2: Care Coordination Care Transitions Protocol MOC 3: Provider Network MOC 4: Quality Measurement MOC 1: SNP-specific Population MOC 10: Vulnerable Populations MOC 3: Staff Structure/Care Management Roles MOC 4: Interdisciplinary Care Team MOC 7: Health Risk Assessment MOC 8: Individual Care Plan MOC 9: Communication Network MOC 5: Provider Network & Use of Clinical Practice Guidelines MOC 6: MOC Training MOC 2: Measurable Goals MOC 11: Outcome Measurement

8. 8 SNP Approval MOC Requirements Surveyor Training for CY 2015 MOC Scoring Implications Multi-year approval based on MOC scores --85 percent or higher = 3 years --75 percent to 84 percent = 2 years --70 percent to 74 percent = 1 year

9. 9 SNP Approval MOC Requirements Surveyor Training for CY 2015 SNPs must identify all of the H numbers that fall under the same MOC on the SNP MOC Matrix Upload document – While the MOC is the same – we want to see specificity on the target population at the local service area (PBP) level, not the national level. Make data and analysis relevant to specific populations in each service area –Expectation is for SNPs to submit a new MOC each renewal period with process updates and changes (e.g., changes to goals as a result of analysis of outcomes or process improvements), and not the same MOC previously approved –MOC will receive a new score Updates for this Review Period

10. 10 SNP Approval MOC Requirements Surveyor Training for CY 2015 Cure Opportunities SNPs that score >70% after initial review will not have an opportunity to cure. Their score will be final after the initial review. SNPs that score <70% after the initial review will have one cure opportunity. After that cure, regardless of the score, the plan will receive a one-year MOC approval status. Example: SNP A receives a score of 67% after initial review. Then, receives a score of 87% after cure 1. Even though a score of 87% provides a three-year approval, because the plan scored <70% initially, they are only eligible to receive a one-year approval.

11. 11 SNP Approval MOC Requirements Surveyor Training for CY 2015 Questions & Answers

12. Sandra Jones MOC 1: Description of SNP Population

13. 13 SNP Approval MOC Requirements Surveyor Training for CY 2015 Intent: Identify and describe the target population, including health and social factors, and unique characteristics of each SNP type Focus is on a description that: - Provides a foundation upon which the remaining measures build a complete continuum of care (e.g., end-of-life & special considerations) for current and potential members the plan intends to serve. - Includes specially tailored services for members considered “most vulnerable” (e.g. multiple hospital admissions or excessive spending on medications above set limits) MOC 1: Description of SNP Population

14. 14 SNP Approval MOC Requirements Surveyor Training for CY 2015 MOC 1 Element A: Overall SNP Population-Factor 1 Factor 1 MOC Description: Emphasis is on process and relevant resources used, not care coordination: – Member identification – Verification of eligibility – Tracking Process includes information on systems or data collection methodology used to identify and track eligible beneficiaries Description of the target population—must address specific population of SNP’s service area(s)

15. 15 SNP Approval MOC Requirements Surveyor Training for CY 2015 MOC 1 Element A: Overall SNP Population-Factor 2 Factor 2 There are separate requirements for social and medical/health factors; the focus is on social, cognitive and environmental factors: MOC description must also include – Social & environmental factors; living conditions – Cultural or linguistic challenges – Barriers to health care delivery – Caregiver concerns Potential factors that may interfere with provision of health care or services, caregiver considerations or other concerns.

16. 16 SNP Approval MOC Requirements Surveyor Training for CY 2015 MOC 1 Element A: Overall SNP Population-Factor 3 Factor 3 Focus is on medical/health/cognitive factors MOC description must also include – Current health status of members – Associated behavioral health issues – Comorbidities Disease characteristics that could impact present status

17. 17 SNP Approval MOC Requirements Surveyor Training for CY 2015 MOC 1 Element A: Overall SNP Population-Factor 4 Factor 4 Characteristics of population per SNP type – Includes limitations & barriers that affect overall health C- SNP – chronic conditions, incidence & prevalence D-SNP – define subtype (e.g., full, partial) as well as health conditions, including limitations & barriers I-SNP –Facility type; specialty providers & services; limitations & barriers

18. 18 SNP Approval MOC Requirements Surveyor Training for CY 2015 True/False The organization’s MOC should describe the needs of the target population that is specific to the locale or geographic area for each plan. Polling Question

19. 19 SNP Approval MOC Requirements Surveyor Training for CY 2015 Intent: Describe the most vulnerable beneficiaries and how their medical/social factors affect health outcomes and what services/resources the SNP provides to address these factors Focus: - Important to note that the focus is on population-level, not individual members - Simply put, what makes them “different from the general population”? MOC 1B: Most Vulnerable Beneficiaries

20. 20 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 1 Plan definition of “most vulnerable” and includes: – Robust & comprehensive description of members – Methodology used for identification (e.g., specify data collected from various resources, multiple admits/readmits, high pharmacy utilization, high risk stratification, specific diagnosis & subsequent treatment required) – Medical, psychosocial, cognitive or functional challenges – Any specially tailored services geared towards this population MOC 1 Element B: Most Vulnerable Beneficiaries-Factor 1

21. 21 SNP Approval MOC Requirements Surveyor Training for CY 2015 MOC includes a description of the most vulnerable members, specifically: Factor 2 Explain how certain characteristics (e.g., average age, gender, ethnicity, language barriers) affect health outcomes of the “most vulnerable:” – Demographic characteristics (e.g., average age, gender, ethnicity, language barriers, health literacy, socioeconomic status) MOC 1 Element B: Most Vulnerable Beneficiaries-Factor 2

22. 22 SNP Approval MOC Requirements Surveyor Training for CY 2015 MOC includes a description of the most vulnerable members specifically: Factor 3 Draw a correlation between demographic characteristics and clinical requirements: - Specify how the characteristics adversely affect health status & outcomes and the need for unique clinical intervention MOC 1 Element B: Most Vulnerable Beneficiaries- Factor 3

23. 23 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 4 Establish relationships with community partners – Describe the process for partnering with community providers to deliver needed services: Type of specialized resources and services How the SNP facilitates member/caregiver access How the SNP guarantees provision of continuity of eligible services MOC 1 Element B: Most Vulnerable Beneficiaries-Factor 4

24. 24 SNP Approval MOC Requirements Surveyor Training for CY 2015 True/False When an organization describes the demographic characteristics of its most vulnerable beneficiaries, the unique clinical interventions that address those needs do not have to correlate to the identified characteristics. Polling Question

25. 25 SNP Approval MOC Requirements Surveyor Training for CY 2015 Questions

26. MOC 2: Care Coordination Brett Kay

27. 27 SNP Approval MOC Requirements Surveyor Training for CY 2015 Intent: Describe admin/clinical staff roles and responsibilities – Focus: How care coordination (e.g. health care needs, preferences and sharing information across health care staff and facilities) occurs All elements must address the SNP’s care coordination activities in detail MOC 2: Element A: SNP Staff Structure

28. 28 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 1: Describe the administrative staff roles, responsibilities, and oversight functions. – Identify & describe employed or contracted staff that perform administrative functions: Enrollment and eligibility verification Claims processing Administrative oversight MOC 2: Element A: SNP Staff Structure

29. 29 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 2: Describe the clinical staff roles, responsibilities and oversight functions – Identify & describe employed or contracted staff that perform clinical functions including: Directing beneficiary care & education Care coordination Pharmacy consultation Behavioral health counseling Clinical oversight (e.g., describe how license/competency verification relates to specific population being served) MOC 2: Element A: SNP Staff Structure

30. 30 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 3: Coordination of responsibilities and job title – Describe how identified staff responsibilities coordinate with job title e.g. impact of staff changes: Title or position Levels of accountability MOC 2: Element A: SNP Staff Structure

31. 31 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 4: Contingency plan – Identify & describe contingency plans to ensure continuity of staff functions. MOC 2: Element A: SNP Staff Structure-Factor 4

32. 32 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 5: Initial & annual MOC training – Describe the process for conducting initial & annual MOC training Training content & strategies Employed & contracted staff* *Contracted staff do not include physicians or other providers MOC 2: Element A: SNP Staff Structure-Factor 5

33. 33 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 6: Maintaining training records Describe how the plan documents & maintains training records: – Process for documenting completion of required training; and – How/where the Plan maintains training records MOC 2: Element A: SNP Staff Structure-Factor 6

34. 34 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 7: Corrective actions: Describe the actions taken if staff do not complete required MOC training – Explain challenges to completing training for employed and contracted staff – Actions taken for missed or deficient training MOC 2: Element A: SNP Staff Structure-Factor 7

35. 35 SNP Approval MOC Requirements Surveyor Training for CY 2015 Polling Question When an organization describes its contingency plan(s) to avoid disruption, what types of information can be included? a)Disaster plans b)Remote/tele-work plans c)Technical issue plans d)Staff departure/turnover plans e)All of the above

36. 36 SNP Approval MOC Requirements Surveyor Training for CY 2015 Intent: Describe how the HRAT collects and uses data to assess medical, functional, cognitive, psychosocial and mental health needs of members. Focus: – How the HRAT is used to develop the ICP – Dissemination of information to ICT – Process for conducting the initial and annual assessments – Methodology used to review, analyze and stratify HRA results MOC 2: Element B: Health Risk Assessment Tool

37. 37 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 1: Describe the use and dissemination of HRAT information: Describe the data collected: – Medical – Functional – Cognitive – Psychosocial; and – Mental health needs of members Process for developing and updating the ICP in a timely basis MOC 2: Element B: Health Risk Assessment Tool- Factor 1

38. 38 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 2: Disseminating HRAT information Describe the process for sharing HRAT information with the ICT ICT use of HRAT information – Integration of results into the ICP Factor 3: Initial HRA & annual reassessment Describe the process including : – Timeframe for conducting (e.g. initial & annual) – Methodology (mailed, in-person, phone interview) – Contacting members not responding to mailings or calls MOC 2: Element B: Health Risk Assessment Tool-Factors 2 & 3

39. 39 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 4: Plan & rationale Describe the process used to review, analyze and stratify HRAT results – Detail stratification process – Communication of stratification results: ICT Provider network (e.g. specialty providers, allied or behavioral health practitioners) Members/caregivers; other SNP personnel as applicable – Explain how the SNP uses results to improve care coordination MOC 2: Element B: Health Risk Assessment Tool-Factor 4

40. 40 SNP Approval MOC Requirements Surveyor Training for CY 2015 Intent: Describe how the ICP is developed and communicated Focus – Describing the essential elements of the ICP – Detail the process for development/modification – Identify staff responsible – How updates to the ICP are: Documented Maintained; and Communicated. MOC 2: Element C: Individualized Care Plan (ICP)

41. 41 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 1: ICP essential components Description includes: – Member’s self management goals & objectives – Personal health care preferences – Services specifically tailored to beneficiary’s needs MOC 2: Element C: Individualized Care Plan (ICP)-Factor 1

42. 42 SNP Approval MOC Requirements Surveyor Training for CY 2015 Description includes: Factor 2: ICP development process & staff responsible – Process for ICP development – Details staff responsible e.g. role & functions, professional requirements and credentials Factor 3 – Personnel responsible for development of ICP, including involvement of member/caregiver MOC 2: Element C: Individualized Care Plan (ICP)-Factors 2 & 3

43. 43 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 4 – Process for determining the frequency for review & modification when changes occur Factor 5 – Communication of updates and modifications to the ICP MOC 2: Element C: Individualized Care Plan (ICP)-Factors 4 & 5

44. 44 SNP Approval MOC Requirements Surveyor Training for CY 2015 Polling Question True/False When the organization develops an ICP for each beneficiary to deliver appropriate care, it must ensure that the member and/or caregiver is involved in the creation of the ICP.

45. 45 SNP Approval MOC Requirements Surveyor Training for CY 2015 Intent: Describe the key components of the ICT Focus: – Key members of ICT – Roles/responsibilities – How the ICT contributes to improving beneficiary health status – Communications within the ICT MOC 2: Element D: Interdisciplinary Care Team (ICT)

46. 46 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 1: ICT membership Description includes: – How the SNP determines key members of ICT e.g., specialized expertise requirements – Process for facilitating participation of beneficiary/caregiver – Use of member HRAT results & ICP to identify ICT membership – Explain how ICT uses health care outcomes to evaluate established processes MOC 2: Element D: Interdisciplinary Care Team (ICT)-Factor 1

47. 47 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factors 2 & 3: ICT Roles & responsibilities Description includes: – Use of clinical managers, case managers & others to provide interdisciplinary care – How the SNP includes member/caregiver in the process – Provision of needed resources – How the SNP facilitates member/caregiver access to ICT members MOC 2: Element D: Interdisciplinary Care Team (ICT)-Factors 2 & 3

48. 48 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 4: Communication plan Description includes: – Evidence of an established communication plan – Process for maintaining effective and ongoing communication – Verification of communication e.g. ICT meeting minutes, ICP documentation – Communication with members identified with challenges e.g. hearing impairments, language barriers or cognitive deficiencies MOC 2: Element D: Interdisciplinary Care Team (ICT)-Factor 4

49. 49 SNP Approval MOC Requirements Surveyor Training for CY 2015 Intent: Describe the SNP’s processes to coordinate care transitions and facilitate timely communications across settings and providers. Focus: – Factor 1: The process for coordinating transitions – Factor 2: Personnel responsible for coordination efforts – Factor 3: Description of coordination between settings during a care transition – Factor 4: How beneficiaries have access to personal health information to facilitate communication with providers – Factor 5: Education provided to members/caregivers to manage conditions and avoid transitions – Factor 6: Process used to notify members/caregivers of staff assigned to support member through transitions MOC 2: Element E: Care Transition Protocols

50. 50 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 1: Process for coordinating transitions The description must specify: – Process & rationale used to connect members with appropriate providers Factor 2: Personnel responsible for coordination efforts – Identify & describe staff responsible for: Coordinating care transition process Ensuring follow-up services, e.g., scheduling appointments, needed resources MOC 2: Element E: Care Transition Protocols-Factors 1 & 2

51. 51 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 3: Applicable transitions Description of the steps staff managing transitions take before, during & after transitions Factor 4: Access to health information Process for facilitating member/caregiver access to health information necessary to communicate with providers in other healthcare settings or outside the network. MOC 2: Element E: Care Transition Protocols-Factors 3 & 4

52. 52 SNP Approval MOC Requirements Surveyor Training for CY 2015 Factor 5: Self-management activities Education provided to members/caregivers to manage conditions and avoid transitions – Signs & symptoms of worsening condition – How to respond to changes Factor 6: Notification of point of contact Process used to notify members/caregivers of staff assigned to support member through transitions MOC 2: Element E: Care Transition Protocols-Factors 5 & 6

53. 53 SNP Approval MOC Requirements Surveyor Training for CY 2015 Questions

54. SNP Approval Model of Care Training Elements 3 Nidhi Dalwadi Mehta

55. 55 SNP Approval MOC Training: Elements 3-4, January 2015 Element A: Specialized Expertise – Intent: demonstrate how the network is designed to address the needs of the SNP’s target population – Focus: Plan-level information for the provider network MOC 3: Provider Network-Element A

56. 56 SNP Approval MOC Training: Elements 3-4, January 2015 Factor 1: The specialized expertise in the provider network addresses the needs of the target population (MOC 1) Factor 2: Oversees the licensure and certification of providers Factor 3: Documentation of provider information Factor 4: Collaboration between the providers and ICT to provide necessary specialized services Element A: Specialized Expertise

57. 57 SNP Approval MOC Training: Elements 3-4, January 2015 True/False The specialized expertise in the provider network must address the needs of the SNPs target population identified in MOC 1. Polling Question

58. 58 SNP Approval MOC Training: Elements 3-4, January 2015 Element B: Use of Clinical Practice Guidelines (CPGs) and Care Transitions Protocols – Intent: Describe how the SNP ensures that beneficiaries receive appropriate, evidence-based care and services – Focus: Population-level decision making, not individual clinician level Identify challenges to using CPGs and protocols MOC 3: Provider Network

59. 59 SNP Approval MOC Training: Elements 3-4, January 2015 Factor 1: Monitoring how providers utilize CPG and nationally-recognized protocols appropriately Factor 2: Identify challenges where CPG and protocols need to be modified Factor 3: Decisions to modify CPGs and acted upon by the ICT Factor 4: Oversees the use of care transition protocols to maintain continuity of care Element B: Use of CPGs and Care Transition Protocols

60. 60 SNP Approval MOC Training: Elements 3-4, January 2015 Element C: Provider Network Training – Intent: describe how the SNP provides training for its provider network – Focus: How SNPs make training available to all network providers MOC 3: Provider Network-Element C

61. 61 SNP Approval MOC Training: Elements 3-4, January 2015 Factor 1: Initial and annual trainings for network and out- of-network providers seen by members on a routine basis Factor 2: Offering MOC trainings to all network providers Element C: MOC Training for the Provider Network-Factors 1 & 2

62. 62 SNP Approval MOC Training: Elements 3-4, January 2015 Factor 3: Challenges associated with completion of MOC trainings Factor 4: Actions taken when training is not complete Element C: MOC Training for the Provider Network-Factors 3 & 4

63. 63 SNP Approval MOC Training: Elements 3-4, January 2015 True/False A plan must show that all providers have received training on its MOC. Polling Question

64. 64 SNP Approval MOC Requirements Surveyor Training for CY 2015 Questions

65. SNP Approval Model of Care Training Elements 4 Nidhi Dalwadi Sandra Jones

66. 66 SNP Approval MOC Training: Elements 3-4, January 2015 Element A: Quality Performance Improvement Plan – Intent: Describe how the SNP conducts quality improvement related to its overall MOC – Highlights: Plan-level information focusing on goals that measure overall plan performance related to all aspects of the MOC MOC 4: MOC Quality Measurement & Performance Improvement

67. 67 SNP Approval MOC Training: Elements 3-4, January 2015 Factor 1: Overall quality improvement plan as it relates to the MOC and how the organization provides appropriate services to SNP beneficiaries, based on their unique needs Factor 2: Specific data sources used to continuously analyze, evaluate and report MOC quality performance Element A: MOC Quality Performance Improvement Plan-Factors 1 & 2

68. 68 SNP Approval MOC Training: Elements 3-4, January 2015 Factor 3: Key personnel involved with the internal quality performance process (e.g., Leadership, management groups, other SNP personnel and other stakeholders) Factor 4: SNP-specific goals and health outcomes objectives are integrated into the overall plan ( described in MOC 4, Element B ) Element A: MOC Quality Performance Improvement Plan-Factors 3 & 4

69. 69 SNP Approval MOC Training: Elements 3-4, January 2015 Element B: Measureable Goals – Intent: identify and define the measureable goals/health outcomes for the target population, and how the SNP determines if goals are being met – Highlights Plan-level measures and goals for the target population Focus is on health/clinical goals (e.g., controlling diabetes, mental health screening) MOC 4: MOC Quality Measurement & Performance Improvement-Element B

70. 70 SNP Approval MOC Training: Elements 3-4, January 2015 The organization must identify and define measureable goals and health outcomes for the MOC and: Factor 1: How they are utilized to improve the health care needs of SNP beneficiaries. Factor 2: Describe how health outcome measures evaluate the overall SNP population health outcomes at the plan level. Element B: Identify Goals and Health Outcome Measures-Factors 1 & 2

71. 71 SNP Approval MOC Training: Elements 3-4, January 2015 Factor 3: Describe how the SNP establishes methods to assess and track the MOCs impact on SNP beneficiaries’ health outcomes. Factor 4: Describe the processes and procedures the SNP will use to determine if health outcome goals are met. Factor 5: Describe the steps the SNP will take if goals are not met in the expected time frame. Element B: Track and Assess Goals

72. 72 SNP Approval MOC Training: Elements 3-4, January 2015 True/False Measureable goals from Element A and B can be the same as long as the plans provide details related to its unique target population. Polling Question

73. 73 SNP Approval MOC Training: Elements 3-4, January 2015 Element C: Measuring Patient Experience – Intent: describe how the SNP measures beneficiary satisfaction and responds to results – Focus Plans may use wide variety of patient experience/satisfaction surveys—CAHPS/HOS are acceptable, as are other alternatives Provide details of surveys and methodology for data collection MOC 4C: MOC Quality Measurement & Performance Improvement

74. 74 SNP Approval MOC Training: Elements 3-4, January 2015 The organization’s MOC must address the process for measuring SNP member satisfaction by: Factor 1: Describing the specific SNP survey used. Factor 2: Explaining the rationale for the selection of a specific tool. Factors 1 & 2: SNP Survey Utilization

75. 75 SNP Approval MOC Training: Elements 3-4, January 2015 Factor 3: Describe how results of patient experience surveys are integrated into the overall MOC performance improvement plan. Factor 4: Describe steps taken by the SNP to address issues identified in survey responses. Factors 3 & 4: Integration and Identification of Issues

76. 76 SNP Approval MOC Training: Elements 3-4, January 2015 Element D: Ongoing Performance Improvement Evaluation of the MOC – Intent: Describe how the SNP uses the results from its performance indicators/measures to support its ongoing quality improvement plan – Focus Include lessons learned and challenges in obtaining timely data. MOC 4 Element D: MOC Quality Measurement & Performance Improvement

77. 77 SNP Approval MOC Training: Elements 3-4, January 2015 Factor 1: How the organization will use the results of the quality performance indicators and measures to support ongoing improvement of the MOC. Factor 2: How the organization will use the results of the quality performance indicators and measures to continually assess and evaluate quality. Factors 1 & 2: Quality Performance Indicators and Measures

78. 78 SNP Approval MOC Training: Elements 3-4, January 2015 Factor 3: The organization’s ability for timely improvement of mechanisms for interpreting and responding to lessons learned through the MOC performance evaluation. Factor 4: How the performance improvement evaluation of the MOC will be documented and shared with key stakeholders. Factors 3 & 4: Lessons Learned and Key Stakeholders

79. 79 SNP Approval MOC Training: Elements 3-4, January 2015 Element E: Dissemination of SNP Quality Performance – Intent: describe how the SNP communicates its quality improvement plan/performance to stakeholders – Focus Detail who receives the information, how often they receive it, and what communication methods are used MOC 4 Element E: MOC Quality Measurement & Performance Improvement

80. 80 SNP Approval MOC Training: Elements 3-4, January 2015 The organization must address the process for communicating its quality improvement performance by: Describing how performance results and other pertinent information are shared with multiple stakeholders. Factor 1: Communication with Stakeholders

81. 81 SNP Approval MOC Training: Elements 3-4, January 2015 Factor 2: Stating the scheduled frequency of communications with stakeholders. Factor 3: Describing the methods for ad hoc communication with stakeholders. Factors 2 & 3: Frequency and Ad-hoc Communication

82. 82 SNP Approval MOC Training: Elements 3-4, January 2015 Identifying the individuals responsible for communicating performance updates in a timely manner. Factor 4: Responsible Individuals

83. 83 CMS – NCQA SNP Approval MOC Requirements Contract Year 2014 QUESTIONS

84. 84 CMS – NCQA SNP Approval MOC Requirements Contract Year 2015 SURVEYOR/EXECUTIVE REVIEWERS What you need to know

85. 85 CMS – NCQA SNP Approval MOC Requirements Contract Year 2015 Important to Know Surveyor Resources Online and/or in Resource Guide include: – Policies & Procedures – Review Checklist – Expense Forms – MOC Requirements & Scoring Guidelines – FAQs – Examples of submission responses Surveyor Assignments − Pre-assigned − Number assigned according to total plans submitting and FT/PT availability − Subject to change post submission − May vary during Cure #1

86. 86 CMS – NCQA SNP Approval MOC Requirements Contract Year 2015 Performing Reviews ISS User ID & Password required o Instructions --see screenshots o Retrieve MOC from Document Library o Score tools per Guidelines (make changes as necessary; no changes to Initial Review scores of “4” during Cure 1) o Remember to click “Save” and “Results” o Address questions to Sandra or Nidhi o Notify snpapproval@ncqa.org of any issues that may arise and upon completion of assignmentsnpapproval@ncqa.org

87. 87 SNP Approval MOC Requirements Surveyor Training for CY 2015 What to Expect Documentation – Ranges from minimal to significant – May not address all requirements; do not give full credit Examples – CMS no longer requires a case study or examples – Responses must include a detailed description of “the what” & “the how”

88. 88 SNP Approval MOC Requirements Surveyor Training for CY 2015 Textbox Language Surveyors and ERs: Please use clear & concise language as Plans will see the comments Keep comments brief; AND Provide enough detail for Plan to understand why it does not meet the requirements After Cure – if score changes to a 4, place comments in internal notes & include the following: “Documentation submitted during the Cure meets the requirements.” Do not use the following characters: ; &

89. 89 SNP Approval MOC Requirements Surveyor Training for CY 2015 Scoring Requirements Scoring Consistency – Assign same score for plans with tools from same Org w/same documentation

90. 90 SNP Approval MOC Requirements Surveyor Training for CY 2015 Questions

91. 91 SNP Approval MOC Requirements Surveyor Training for CY 2015 Additional Resources NCQA SNP Approval Webpage: http://www.ncqa.org/snpapprovalsurveyor SNP Approval mailbox snpapproval@ncqa.org Available resources: – CY 2015 MOC Scoring Guidelines – 2014 Surveyor Resource Guide (Updated with Examples) – Surveyor Checklist – Expense Report – FAQs – Conflict of Interest Form

92. 92 SNP Approval MOC Requirements Surveyor Training for CY 2015 Training & Education Surveyor Training (repeat) o February 9, 2015 1:00-3:00pm ET o Weekly Q&A Calls o March 5, 12, 19, & 26 Dial-In Information: 1-866-505-4013 (Confirmation Code): 370 852 5392# *When it asks if you are the leader you will do nothing and then you will be placed into the call. --SNP Technical Assistance Calls 3-4:30pm ET o April 23 Dial-In Information: 866-628-7188 Conference ID: 403 895 20

93. 93 SNP Approval MOC Requirements Surveyor Training for CY 2015 Training Surveyor Training – Repeat Monday, February 9, 2015 -- 1-3:00 pm ET WebEx Information: Dial-In Information: 1-866-505-4013 (Confirmation Code): 370 852 5392# *When it asks if you are the leader, wait for placement into the call. WebEx Information: Event address for attendees: https://ncqaevents.webex.com/ncqaevents Event password: Approval2015

94. 94 SNP Approval MOC Requirements Surveyor Training for CY 2015 Contacts Brett Kay Assistant Vice President, Recognition Operations 202-955-1722 kay@ncqa.org kay@ncqa.org Casandra Monroe Director, Accreditation Operations 202-955-5136 monroe@ncqa.org Sandra Jones Assistant Director, Accreditation Operations 202-955-5189 jones@ncqa.org

95. 95 SNP Approval MOC Requirements Surveyor Training for CY 2015 Contacts Nidhi Dalwadi Accreditation Manager 202-955- 3585 dalwadi@ncqa.org Delia Ponce Survey Management Analyst 202-955-1742 ponce@ncqa.org