SNP ‘Models of Care’ Changes Could Mean Mounds of New Paperwork

By James Gutman - January 3, 2014 Sometimes it’s not good to be “Special.” That seems to be one of the takeaways from the proposed National Committee for Quality Assurance (NCQA) changes, as disseminated by CMS, in the Models of Care (MOC) requirements covering Medical Advantage Special Needs Plans (SNPs). The well-intentioned draft document would do some things the SNP Alliance trade group likes, such as reorganizing the requirements into fewer “domains” than currently mandated and having all the care management-related functions put under a single domain. But the changes also would dramatically increase documentation and reporting requirements for both SNPs and their providers, and that has already financially squeezed SNPs very worried. The MOC requirements stem from an Affordable Care Act provision mandating that all new and existing SNPs be approved by NCQA beginning Jan. 1, 2013. NCQA does all the reviewing and scoring of plans on the MOC based on guidelines developed by CMS, which did not make changes to the requirements for 2013. But CMS is proposing a plethora of changes for 2014 that would become part of SNPs’ applications for 2015 due next month. Among other things, those changes seemingly would create the need to develop complex care plans for every SNP beneficiary, even though 85% of SNP enrollees are Medicare-Medicaid dual eligibles, who are impoverished but often don’t need more health care than “periodic assessments,” says SNP Alliance Co-Chair Valerie Wilbur. The changes also would impose major new training requirements for SNPs’ provider networks, she says, that could drive providers away from participation in SNPs, especially since the providers’ compensation for SNP patients isn’t high to begin with. And there would be a host of new quality measurement and administrative reporting requirements, some of which involve “a lot of duplication” and one of which is “just additional busywork,” she asserts. Neither Wilbur nor other SNP experts queried by AIS take issue with the need for strict standards to ensure SNPs meet the needs of their beneficiaries, all of whom are substantially disadvantaged in some way. But they are hoping that the final new MOC requirements, which they expect to be unveiled at a joint NCQA-CMS conference in Baltimore Jan. 13, will back off new mandates that they fear will drain more of their already-sparse resources and time. What do you think will happen? Where do you draw the line between making sure SNP beneficiaries get the extra attention they need and imposing so many requirements that it may not be feasible to provide that care? What would be the impact of these changes on SNP star ratings? How can SNPs avoid being so “Special” that they are loved to death? http://aishealth.com/blog/medicare-advantage-and-part-d/snp-models-care-changes-could-mean-mounds-new-paperwork?utm_source=Real%20Magnet&utm_medium=Email&utm_campaign=29287992