Every Special Needs Plan (SNP) must have a Model of Care (MOC). This requirement is found under section 1859(f)(7) of the Social Security Act. In essence, a MOC provides the groundwork under which a SNP will meet the needs of each of its enrollees. The MOC can be viewed as an integral part of the overall quality improvement toolbox to ensure that each member’s unique needs are identified and addressed. This is done by the plan’s care management practices. It is through this MOC that the bricks are laid for encouraging SNP quality, care management, and care coordination processes.

Attesting to MOC training is a yearly CMS obligation for both contracted providers and those providers that are non-contracted yet who provide care to enrollees on a regular basis. An example of such a provider would be a non-contracted nephrologist who is treating an enrollee for kidney disease but because of their contractual ties to a provider group may not be able to contract with other health plans.