Laura Zwolinski: Greetings, and welcome to the first of four Special Needs Plans Model of Care trainings for Contract Year 2027.

Laura Zwolinski: Today, we will concentrate our review on MOC1, the description of the overall SNP population.

Laura Zwolinski: We are excited to review the requirements for MOC1 with you, and to point out the key changes made for contract year 2027.

Laura Zwolinski: Next slide.

Laura Zwolinski: This slide includes the NCQA team members supporting the SNP model of care review and approval effort, and we'll all introduce ourselves briefly.

Laura Zwolinski: My name is Laura Zwalinski, I am a director in NCQA's Quality Solutions Group, and I currently serve as NCQA's Task Lead for all activities and processes related to SNP Model of Care Reviews. Again, welcome everyone, and I will go ahead and pass it over to my colleague Sri, to introduce herself to the group.

Shree Patel: Thank you, Laura. My name is Sri Patel. I'm a healthcare analyst at NCQA and serve as a content analyst on the SNP project. I will pass it over to my colleague, Madeline, to introduce herself.

Madeline Vancott: Thank you, Sri! My name is Madeline Van Cott. I am a healthcare analyst at NCQA, and I serve as lead analyst on the SNP project. And now, I'll pass it over to my colleague, Alan.

Alan Hoffman (NCQA): Hello, I am Alan Huffman, NCQA's Vice President for Federal Services. I am responsible for NCQA's overall performance for work we perform for federal agencies. We are pleased to be able to provide this training resource.

Laura Zwolinski: Thank you, Alan. Next slide, please.

Laura Zwolinski: We also wanted to take a moment to introduce our colleagues at the Centers for Medicare and Medicaid Services, or CMS.

Laura Zwolinski: Daniel Lehman serves as the Contracting Officer's representative for the SNP Model of Care Review and Approval work. He is part of the Medicare Drug and Health Plan Contract Administration Group, or MCAG.

Laura Zwolinski: and the Division of Policy Analysis and Planning, or DPAP.

Laura Zwolinski: Emily Moore is a health insurance specialist at CMS, and also supports both MCAG and DPAP.

Laura Zwolinski: On behalf of the NCQA and CMS teams, we welcome you to this year's virtual training sessions, and we thank you in advance for your time and attention.

Laura Zwolinski: Next slide.

Laura Zwolinski: In terms of the agenda for today's session, we've just completed our welcome and introductions. During the remainder of our time together, we will review some housekeeping items and general updates for Contract Year 2027.

Laura Zwolinski: We'll also review the background and origins of the SNP model of care to include a high-level overview of the MOC elements.

Laura Zwolinski: We'll cover the timeline for contract year 2027, and also explain how scoring is assigned.

Laura Zwolinski: We'll then segue into detailed presentations on the two elements that comprise MOC1.

Laura Zwolinski: Then, we'll provide information and details regarding the technical assistance calls hosted by CMS and NCQA.

Laura Zwolinski: As a reminder, as we go through the slides, please pause where necessary and take note of or write down any questions that you might have, so that when we do hold the contract year 2027 technical assistance calls.

Laura Zwolinski: You have your questions primed and ready.

Laura Zwolinski: Lastly, we will cover the post-training survey.

Laura Zwolinski: Next slide.

Laura Zwolinski: So we'll now move into our housekeeping items. First, we'd like to share a little about the SNP Model of Care training format for contract year 2027.

Laura Zwolinski: This year, we recorded four separate training sessions. Each one is specific to one of the four MOC standards. That is, there are trainings specific to MOC1,

Laura Zwolinski: MOC2, MOC3, and MOC4.

Laura Zwolinski: All four of these recordings are available on NCQA's SNP approval website.

Laura Zwolinski: We strongly encourage you to watch all four of these trainings.

Laura Zwolinski: NCQA and CMS will continue to hold two pre-submission technical assistance, or TA, calls to create a form in which plans can pose questions live.

Laura Zwolinski: The first of these sessions will take place from 2 to 4 p.m. Eastern Standard Time on March 19th, 2026,

Laura Zwolinski: And the second will take place from 2 to 4 p.m. Eastern Time on April 16th.

Laura Zwolinski: These calls will be recorded and made available to plans via the SNP approval website.

Laura Zwolinski: As questions arise during the MOC1 training session.

Laura Zwolinski: or any of the other three training sessions, please document your questions so that they are ready for you to ask during the TA calls.

Laura Zwolinski: Lastly, we'd like to collect planned feedback on our training sessions so that we can continue to improve them.

Laura Zwolinski: At the end of the slide deck for this training session, there will be a link that directs to an online evaluation survey.

Laura Zwolinski: We kindly request and encourage plans to provide feedback via this link to support our improvement activities.

Laura Zwolinski: And we'll revisit the survey at the end of today's session.

Laura Zwolinski: Next slide.

Laura Zwolinski: We want to draw your attention to this slide to emphasize some of the high-level changes made for contract year 2027.

Laura Zwolinski: First and foremost, we want to underscore that there have been changes made to element and factor requirements.

Laura Zwolinski: These changes reflect the revised Model of Care Matrix for contract year 2027,

Laura Zwolinski: Which CMS released in January of 2026.

Laura Zwolinski: The contract year 2027 SNP model of care scoring guidelines were updated to align with this revised MOC matrix and include substantial changes and revisions.

Laura Zwolinski: To make sure that you understand the revisions and the corresponding changes that you'll need to address in your Model of Care documentation, we strongly encourage you to thoroughly review this year's Model of Care Matrix and scoring guidelines, as well as to listen carefully to all four training recordings.

Laura Zwolinski: We also encourage you to attend the TA calls being held in March and April.

Laura Zwolinski: Lastly, given that there have been some substantial shifts in the requirements and the ordering of factors, please make sure that the model of care that you submit for contract year 2027 reflects the element and factor order included in the contract year 2027 scoring guidelines.

Laura Zwolinski: This supports a more efficient review process and ensures that your document aligns with the most current guidance.

Laura Zwolinski: We thank you in advance for your continued efforts to support and improve the model of care review process.

Laura Zwolinski: Next slide.

Laura Zwolinski: We're now going to move into an overview of the special symbols used in today's training slides.

Laura Zwolinski: Please note that, throughout the slide deck, new requirements for contract year 2027 are demarcated with a red star bullet point.

Laura Zwolinski: Items that were clarified for contract year 2027 are denoted by an exclamation point bullet.

Laura Zwolinski: We will emphasize these items throughout the four training sessions.

Laura Zwolinski: In addition, we'd like to note that we have included regulations within the explanations in the contract year 2027 scoring guidelines.

Laura Zwolinski: When applicable, we will be sure to emphasize these regulations as we review specific elements and their related factors.

Laura Zwolinski: Next slide.

Laura Zwolinski: We now want to specifically touch on the most recent version of the SNP Model of Care scoring guidelines, as we'd like to provide some context around how changes made over the prior year's guidelines are called out in this year's version of the document.

Laura Zwolinski: Substantive changes and clarifications made to the Contract Year 2027 scoring guidelines are noted in the summary of Changes section towards the beginning of the description of each element.

Laura Zwolinski: The Summary of Changes section includes the significant changes or clarifications made for the three most recent versions of the scoring guidelines. For this year, this includes changes made for contract years 2027, 2026, and 2025.

Laura Zwolinski: Any updates made for the current version of the guidelines are specifically labeled as Contract Year 2027 Updates in the Summary of Changes section of each element.

Laura Zwolinski: Changes made in contract years 2026 or 2025 that still stand are not labeled with the year.

Laura Zwolinski: Again, please be sure to carefully review the contract year 2027 Model of Care Matrix.

Laura Zwolinski: Scoring guidelines, current regulations, and the training slides and recordings carefully, so that you understand the updates, additions, and reordering of responses that you need to make in your model of care to align with new or updated requirements.

Laura Zwolinski: Next slide.

Laura Zwolinski: We also want to remind everyone about NCQA's SNP approval website, which is located at the web address included on this slide, or snipmoc.ncu.org.

Laura Zwolinski: Please note that the contract year 2027 SNP Model of Care Scoring Guidelines are currently posted to this website.

Laura Zwolinski: Along with the model of care matrix, and all training recordings and associated slide decks.

Laura Zwolinski: This is also where you can access login information and details for the upcoming TA calls, and where the recordings from those calls will be posted.

Laura Zwolinski: Next slide.

Laura Zwolinski: This slide includes information related to technical assistance.

Laura Zwolinski: As mentioned on the previous slide, you can access training recordings as well as training slides and other resources on the NCQA SNP approval website.

Laura Zwolinski: We've included the direct links to the CY2027 matrix and scoring guidelines on this slide.

Laura Zwolinski: We recommend that you review all training materials prior to submitting any inquiries.

Laura Zwolinski: For inquiries related to model of care requirements or regulation questions, please contact CMS at the address included in the middle column of this slide, and enter SNP MOC inquiry in the subject line.

Laura Zwolinski: Please submit SNP application inquiries via the CMS SNP mailbox.

Laura Zwolinski: Type the address included in the right column of the slide, and then select the SNP mailbox. Once you do this, enter SNP application inquiry in the subject line.

Laura Zwolinski: This concludes the housekeeping and general update section of today's training. Next slide.

Laura Zwolinski: We're now going to shift our attention to some background information on the SNP model of care.

Laura Zwolinski: An overview of the timeline for Contractor 2027,

Laura Zwolinski: And touch on some key reminders for this year.

Laura Zwolinski: Next slide.

Laura Zwolinski: To summarize the objectives of the STIP Model of Care Review.

Laura Zwolinski: They are to ensure compliance with the Affordable Care Act, or ACA, requirements.

Laura Zwolinski: Provide oversight for the implementation of a robust model of care for all SNPs.

Laura Zwolinski: And finally, to review, monitor, and track approvals according to the requirements.

Laura Zwolinski: Please keep in mind that while ISNPs and DSNPs may earn up to a 3-year approval period.

Laura Zwolinski: CSNPs are required to submit a model of care for review annually.

Laura Zwolinski: Next slide.

Laura Zwolinski: This slide provides an overview of the four model of care standards.

Laura Zwolinski: Each standard is comprised of multiple elements.

Laura Zwolinski: MOC1 focuses on the target population.

Laura Zwolinski: This requires a detailed description of your plan's target population to include both the general and most vulnerable enrollees.

Laura Zwolinski: MOC2 focuses on care coordination, And this standard covers the spectrum from staff structure, health risk assessments and stratification.

Laura Zwolinski: Face-to-face encounters, individualized care plan development and planning.

Laura Zwolinski: Interdisciplinary care team creation and participation, and transitions of care.

Laura Zwolinski: For MOC3, the focus is on the provider network.

Laura Zwolinski: Please keep in mind that this includes the facilities and practitioners necessary to address the needs of the SNP target population.

Laura Zwolinski: Lastly, MOC4 addresses quality measurement processes, monitoring, improvement, tracking, and communication, which are all essential to a plan successfully meeting enrollee needs.

Laura Zwolinski: Next slide.

Laura Zwolinski: This slide provides an overview of the contract year 2027 SNP Model of Care Approval Timeline.

Laura Zwolinski: Please note that the timeline has shifted compared to prior years.

Laura Zwolinski: At this point, we've posted the model of care matrix and scoring guidelines, as well as recorded and posted the model of care trainings for MOC standards 1 through 4.

Laura Zwolinski: As previously mentioned, NCQA and CMS will host two pre-submission technical assistance calls. The first will be held on Thursday, March 19th, 2026, and the second will be held on Thursday, April 16th.

Laura Zwolinski: Contract year 2027 SNP Model of Care submissions are due via HPMS on Friday, May 29th, 2026, no later than 8 p.m. Eastern Standard Time.

Laura Zwolinski: NCQA will download and review the submissions, and subsequently enter scores into HPMS by the end of July.

Laura Zwolinski: This submission timeline change aligns the CMS model of care submission process with the Medicare Advantage statutory bid submission deadline and state Medicaid agency contracting processes.

Laura Zwolinski: Beginning this year and moving forward, the model of care submission deadline will move to the Friday before the first Monday in June, which is the day final bids are due to CMS. In 2026, final bids are due on Monday, June 1st.

Laura Zwolinski: NCQA will upload scores to HPMS by the end of July.

Laura Zwolinski: Then on Monday, August 3rd, CMS will distribute Notice of Intent to Deny Letters, or NOIDs.

Laura Zwolinski: Noids are sent to plans that score less than 50% on any one or more elements, or that score less than 70% overall.

Laura Zwolinski: These SNPs are required to address deficiencies during a designated period called the cure.

Laura Zwolinski: A TA call with instructions for how to cure documentation will be held on Tuesday, August 4th.

Laura Zwolinski: And all CURE submissions are due in HPMS by 8pm Eastern Standard Time on Thursday, August 13th.

Laura Zwolinski: Following the CURE review period, CMS will issue approvals and denials on September 1st.

Laura Zwolinski: Next slide.

Laura Zwolinski: So this slide includes a few reminders for this review period.

Laura Zwolinski: We strongly advise NIPS to give thoughtful consideration to your model of care documentation.

Laura Zwolinski: Each submission offers an opportunity to think through and improve processes.

Laura Zwolinski: SNP submitting renewal models of care should include any planned substantive changes in your annual submission.

Laura Zwolinski: The expectation is for SNPs to submit a new model of care each renewal period to capture process updates and changes.

Laura Zwolinski: Please be sure to address all of the requirements specified for each element and factor, as noted in the model of care matrix and in the contract year.

Laura Zwolinski: SNP Model of Care Scoring Guidelines. Reviewers will score model of care narratives based on this version of the scoring guidelines.

Laura Zwolinski: NCQA is looking for descriptions that include specific process details. Where applicable, responses should also describe associated oversight activities.

Laura Zwolinski: And to the extent possible, responses should address the who, what, where, when, and how in the process description.

Laura Zwolinski: Again, we are looking for detailed descriptions, and so to that end, we do want to emphasize that general process statements are not acceptable and will be scored down.

Laura Zwolinski: As an important reminder, due to the volume of changes made to the model of care matrix and scoring guidelines this year, which includes some shifting of factors, please make sure that you update the structure of your model of care documentation

Laura Zwolinski: To align with the order of elements and factors as presented and specified in the contract year 2027 scoring guidelines.

Laura Zwolinski: This will support more efficient reviews, and we do thank you in advance for your partnership and collaboration in supporting these changes.

Laura Zwolinski: Also, be sure that you do not include any protected health information or personally identifiable information in the model of care narrative.

Laura Zwolinski: We are clarifying this point for contract year 2027, given some experiences during the contract year 2026 review period.

Laura Zwolinski: Lastly, please only upload two documents to HPMS for NCQA's review.

Laura Zwolinski: The model of care narrative, and the associated matrix, which serves as a table of contents.

Laura Zwolinski: NCQA staff only download the Model of Care narrative and the matrix for review. We do not download any other documents.

Laura Zwolinski: Given this, all information to address requirements that are relevant to our review, for instance, your organizational chart or training slides, must be included within the model of care narrative document itself, and cannot be submitted as a standalone document.

Laura Zwolinski: Next slide.

Laura Zwolinski: We now like to review the SNP model of care scoring methodology.

Laura Zwolinski: Models of care will continue to be scored on a scale of 0 to 4 points for each element.

Laura Zwolinski: Factors within elements are assigned a certain number of points, depending on the count of factors within the element.

Laura Zwolinski: These points are then summed to an overall element score between 0 and 4.

Laura Zwolinski: We do want to call out one particular thing that has changed for contract year 2027.

Laura Zwolinski: And that is that there are now 15 instead of 16 elements.

Laura Zwolinski: Given this, the maximum score a SNP can receive is 60 points versus the previous 64 points.

Laura Zwolinski: Once summed, point totals are converted to a percentage, which correlates to a particular approval period.

Laura Zwolinski: This is true for ISNPs and DSNPs only, as CSNPs are required to submit a model of care annually.

Laura Zwolinski: For ISNPs and DSNPs, a percentage score of 85% or greater equates to a 3-year approval period.

Laura Zwolinski: A percentage score between 75 and 84% equates to a 2-year approval period.

Laura Zwolinski: And a percentage score between 70% and 74% equates to a 1-year approval period.

Laura Zwolinski: Please note that plans are required to meet two minimum scoring thresholds to obtain approval for implementation.

Laura Zwolinski: First, SNPs must obtain a minimum benchmark threshold score of 50% for each element.

Laura Zwolinski: This is regardless of the final overall score assessed.

Laura Zwolinski: And second, SNPs must obtain an overall score of at least 70%.

Laura Zwolinski: If either of these scoring requirements are not met during the initial review period, your organization will need to submit a revised model of care narrative during what we refer to as the cure period.

Laura Zwolinski: The cure period is a one-time opportunity for SNPs to address the identified deficiencies and to meet the minimum scoring requirements.

Laura Zwolinski: Plans required to cure their documentation will only receive a one-year approval period, regardless of final score.

Laura Zwolinski: At this time, we'd also like to take an opportunity to briefly differentiate between the Model of Care Review and the CMS SNP audit.

Laura Zwolinski: Please note that the model of care review process aims to ensure that plans incorporate all required elements into the model of care narrative according to the regulations, while the CMS SNP audit evaluates the implementation of the model of care and plan performance for care coordination and related tasks.

Laura Zwolinski: The areas of focus for the Model of Care Review and CMS SNP audits may seem similar, however, these are two separate activities. For the audit, plans are required to meet all of the requirements outlined

Laura Zwolinski: in the MA regulations for SNPs, regardless of what's been included or described in the approved model of care.

Laura Zwolinski: Next slide.

Laura Zwolinski: Now that we've covered the timeline and key reminders, we're going to turn our attention to a detailed review of MOC1, which is a description of the overall SNP population.

Laura Zwolinski: So with that, I'll turn things over to Sri to present the first element in MOC1.

Laura Zwolinski: Next slide.

Shree Patel: Thank you, Laura. We'll start off with a review of the first element for today's training. MOC 1 Element A, which pertains to the overall SNP population and most vulnerable enrollees. To note up front, wide-scale changes were made to this element for contract year 2027.

Next slide, please.

Shree Patel: Please note that there are substantive changes made to MOC1A for both content and the reordering of factors, and therefore the star distinction will be used throughout the next few slides.

Shree Patel: At a high level, this element now requires a description of both the general and most vulnerable SNP populations, whereas previously, this element focused solely on the general SNP population.

Shree Patel: MOC1, Element A, aims to detail the SNP's general and most vulnerable population enrollees it serves, if it is a renewal plan, or if the population it intends to serve, if it is a new plan applying for the first time.

Shree Patel: Who are the enrollees in your general population? Who are your sickest and most vulnerable enrollees, and what sets them apart from the general SNP population? What demographic, health, and social factors, as well as disparities, represent these populations? And lastly, how does the SNP plan

Shree Patel: To meet both needs of these populations.

Shree Patel: The important thing to remember is that this element in particular sets the stage for all other components of your organization's model of care, because your target population is what you are building all services, processes, and benefits around.

Shree Patel: This element is the foundation upon which subsequent elements build to create a complete continuum of care, and we cannot stress the importance of this element enough.

Shree Patel: We want to make sure that this element is fully fleshed out in your model of care so that you have a thorough and complete description of your target population. Next slide.

Shree Patel: There are four factors for MOC1 element A. We'll review factor-level details and key information for each factor across the next few slides.

Shree Patel: The new Factor 1 will require that a plan identify the specific SNP type for which the MOC was submitted.

Shree Patel: The MOC must include the specific SNP type of CSNP, ISNP, or DSNP. For example, a CSNP should indicate that it is a CSNP renewal plan that focuses on cardiovascular disease.

Shree Patel: An ISNP must identify the setting in which their enrollees reside, such as skilled nursing facility, community, or other residential or institutional settings. For example, the plan must also specify whether they are a facility-based, institutional equivalent, or hybrid iSNP.

Shree Patel: DSNIT must indicate the intended level of integration they are seeking. Fully integrated, highly integrated, or coordination only.

Shree Patel: DSNPs only must describe the eligibility categories and criteria for the DSNP.

Shree Patel: For example, the plan is seeking to become a highly integrated dual-eligible

Shree Patel: hide with a qualified Medicare beneficiary QMV-only criteria.

Shree Patel: Also new for this year, plans must specifically indicate whether the MOC is an initial or renewal submission.

Shree Patel: Plans should address all of these items clearly for the factor intent to be met.

Shree Patel: Factor 2 now focuses on the health status of both the general population and the most vulnerable population. As a part of this factor, a clear distinction between two demographics must be made.

Shree Patel: Do not provide demographic information for the most vulnerable population that is identical to the demographic information provided to the general population.

Shree Patel: The plan must detail population demographics, including, but not limited to, average age, sex, ethnicity, language, education level, and socioeconomic status.

Shree Patel: All information provided must be specific to your target audience. Please be aware that plans and operations for 2 years must use their own data for both the general and most vulnerable populations.

Shree Patel: New plans or plans without enrollees may use enrollee information from other product lines or compile details from the intended plan service area as background context only.

Shree Patel: As an example of the intended target population.

Shree Patel: In each of these scenarios, some national and or regional data for background context is okay to include. However, you need to make sure that you are providing information about the

Shree Patel: the target population of the SNPs in your service area, and that you identify the rationale for using the proxy data provided in terms of how it relates to the target population.

Shree Patel: Any SNP-specific data used to describe the membership must be recent, within the last 3 years, to ensure that it is still relevant.

Shree Patel: That is, data older than 2022 should not be used to describe the current SNP target population. If outdated data is included to describe the general and or most vulnerable populations, the intent of the factor is not considered met, and the factor will be scored down.

Shree Patel: Along the same vein, please be sure to identify and specify the sources and dates for all planned data.

Shree Patel: Please remember that there are a variety of components in this factor that must be addressed to receive credit. Next slide, please.

Shree Patel: For Factor III, the MOC must describe the target population's specific health characteristics for both the general and most vulnerable populations, including a description of the current health status of its SNP enrollees and a review of relevant diseases and comorbidities.

Shree Patel: The SNP must indicate the incidence and prevalence of major diseases and chronic conditions that potentially affect or challenge health and well-being.

Shree Patel: Additionally, the MOC must address social, cognitive, environmental factors, and living conditions associated with the SNP population you serve or intend to serve.

Shree Patel: Please note that SNPs renewing their contracts after 2 years of operation must provide their own historical data instead of other local, national, or proxy data.

Shree Patel: That is, following 2 years out of operation, we expect renewing plans to submit SNP-specific data rather than proxy data.

Shree Patel: That said, new plans or plans without enrollees may use enrollee information from other product lines or compile details from the intended plan service area as an example of the intended target population.

Shree Patel: In each of these scenarios, the plan must identify the rationale for using the proxy data provided in terms of how it relates to the target population.

Shree Patel: And again, all membership data must be current and cannot be from earlier than 2022.

Shree Patel: Data sources must be labeled.

Shree Patel: Finally, for Factor 4, plans must describe conditions and or other factors impacting their enrollees and the actions taken to address these needs.

Shree Patel: Again, please note for contract year 2027, membership data prior to 2022 cannot be used.

Shree Patel: Next slide, please.

Shree Patel: This slide provides an example of how to address MOC1, Element A, Factor 2. Plans may use a variety of methods to document, communicate, and display the detailed demographic information required for Factor 2.

Shree Patel: The most common is a table that identifies each service area in the target population. For instance, county or state, and includes a demographic breakdown of age, sex, ethnicity, language spoken, and education within each of these areas.

Shree Patel: Please ensure that both the general population and most vulnerable demographic details are included for each service area that the SNP covers, as shown here. This is the level of detail we are looking for in terms of demographic data.

Shree Patel: Please be sure that all information presented is specific to the population served, and that it is provided for all service areas. That is, if there are only 3 service areas covered by a particular SNP, the SNP must provide demographic details for each one.

Shree Patel: If data for any one service area is missing, the factor will be scored down.

Shree Patel: For example, if a plan enrollees are located in Ohio, Indiana, and Kentucky, but demographic information is provided for only Ohio and Indiana, but not Kentucky, the factor will be scored down.

Shree Patel: We also want to emphasize here that we expect plans to provide the same level of detail for both the general and most vulnerable populations.

Shree Patel: To reiterate, if you are a SNP renewing your contract year after year 2 of operation, you must include historical SNP-specific data instead of other local, national, or proxy data.

Shree Patel: Please be sure to note the relevant data sources and year as well, which is done here beneath the slide.

Shree Patel: Some plans opt to include a detailed narrative of demographic information rather than a table. This is also an acceptable approach. However, we still expect to see the same level of detail if the information is provided in a narrative form.

Shree Patel: Lastly, on this slide, we wanted to share that MOC1 elements A and B were some of the most frequently failed elements last year. That is, not meeting these elements were a common reason plans were required to cure.

Shree Patel: Given this, we really want to emphasize the need for plans to follow the guidance we are providing when preparing documentation for these elements, particularly given the changes and additions that were made to these elements for contract year 2027.

Shree Patel: Next slide, please.

Shree Patel: Again, we want to make sure plans understand the expectations surrounding any data provided for the target population. The key takeaway here is that plans really need to make sure that the information they provide is specific to the target population served by the SNP in their respective service areas.

Shree Patel: In addition, as previously mentioned, please only provide recent data from within the past 3 years, so there is some level of assurance that the data is relevant to the current target population.

Shree Patel: To reiterate, using data older than 2022 will not be considered as meeting the intent of this factor.

Shree Patel: While national statistics provide some idea of chronic diseases and comorbidities that certain populations face, the

Shree Patel: The SNP's response must speak specifically to the target population for the intended service area. To stress again, if you are a SNP renewing your contract after year 2 of operation, you must provide SNP-specific data as opposed to local, national, or other proxy data.

Shree Patel: Conversely, new plans or plans without enrollees may use enrollee information from other product lines to compile details from the intended plan service area, as an example of the intended target population.

Shree Patel: In these cases, the plan must note that they are a new plan, or one without any enrollees, and must also identify the rationale for using proxy data by drawing a correlation to the SNP's target population.

Shree Patel: That is, if a plan is using regional statistics, it cannot earn credit in the absence of identifying why the statistics are representative of its intended target population. The plan will not receive credit if the rationale

Shree Patel: Just… justifies how the… just…

Shree Patel: The plan will not receive credit if a rationale that justifies how the proxy data applies to the target population is not included.

Shree Patel: We have emphasized these points during prior trainings, however, we do still receive data that is not specific to eSNP or outdated statistics in some models of care.

Shree Patel: Please remember that we need to understand what your specific target population looks like using current data. Next slide, please.

Shree Patel: We would like to provide some information and guidance specific to corporate entities that submit multiple models of care narratives for review across contract number, SNP type, and detail. While procedural parallels may exist across these corporate submissions, it is imperative that the plan provides

Shree Patel: information specific and customized to the SNP's target population, service area, vulnerable members, and SNP type for each model of care submitted.

Shree Patel: This is particularly important for MOC 1A. There are also additional elements that require customization based on the SNP submission. For instance, MOC 4B.

Shree Patel: We also want to stress that plans should not submit the exact same document by SNP detail for corporate entity submissions without customizing information for that specific population.

Shree Patel: The model of care submitted for a unique combination of the contract number, SNP type, and SNP detail must appropriately provide enrollee details for that particular SNP submission.

Shree Patel: If enrollee data for other corporate submissions is also included in the model of care that is being reviewed, the SNP must clearly identify the data specific to the submission being reviewed.

Shree Patel: Furthermore, as an additional example, a model of care narrative should not be identical between a CSNP submission for diabetes and a CSNP submission for cardiovascular disease.

Shree Patel: The verbiage should be customized to be specific for that population and their needs. Please note that reviewers are checking

Shree Patel: data across different submissions. If data in MOC 1A are identical for the general and most vulnerable populations in different submissions and no rationale is provided, these elements will be scored down. Next slide, please.

Shree Patel: This slide presents a table of summary of changes listed in the CY2027 scoring guidelines for MOC1A.

Shree Patel: First, we wanted to note an overall shift in focus for this element. The most vulnerable population demographic is now merged into MOC1A. Previously, this was found in MOC1B.

Shree Patel: All factors for this element must now include

Shree Patel: The most vulnerable populations, in addition to the general population.

Shree Patel: For Factor 1, prior Factor 1, which pertained to determining

Shree Patel: Tracking and verifying eligibility was deleted and replaced with New Factor 1, which is about identifying SNP type and submission type.

Shree Patel: The demographic data for the general population was shifted from Factor III up to new factor 2.

Shree Patel: Health status and health disparities was moved to the new Factor III.

Shree Patel: Factor 4 was expanded to describe conditions and or other factors impacting their enrollees and the actions taken to address these needs.

Shree Patel: Next slide, please.

Shree Patel: That brings us to the end of MOC 1A. I want to recap some of the main takeaways from this element. In terms of dues.

Shree Patel: Please be sure to refer to the matrix, the regulations, and the model of care scoring guidelines. It is important you review the explanations associated with each factor in the scoring guidelines closely, as they provide clarification and detail each item that needs to be addressed to meet the factor.

Shree Patel: We strongly recommend that you read through all the explanations carefully as you prepare your model of care documentation. This is a general best practice for all elements and factors.

Shree Patel: Please clearly label the elements and factors with your model of care documentation. In addition, please be sure that factor responses are presented in the order specific

Shree Patel: And specified in the scoring guidelines.

Shree Patel: Also, if a complete response for a particular factor depends on information that is included elsewhere in the document, please cross-reference the other information. For example, include language such as, please refer to MOC2

Shree Patel: Element B, Factor 1, for additional details. This is helpful guidance to keep in mind as you more… as…

Shree Patel: The more clearly you label and identify information relevant to each factor.

Shree Patel: The easier it is for reviewers to evaluate.

Shree Patel: To address changes.

Shree Patel: made this year, please be sure to include information for both the general and most vulnerable populations for factors 2, 3, and 4. Finally, please be sure to provide demographic detail data

Shree Patel: detailed, specific to your SNP population using data no older than 2022.

Shree Patel: Don't forget that SNP's renewing contracts after 2 years of operations must provide SNP-specific enrollee data as opposed to proxy data. And again, using data from a similar plan that already exists and is operational is permitted only if you are a brand new SNP,

Shree Patel: and have no historical information on your target population. However, please clearly note this in your MOC documentation.

Shree Patel: In terms of don'ts, please don't forget to address all items included in each factor's explanation to ensure you provide a complete response.

Shree Patel: Do not rely on national statistics or use data older than 2022 to meet requirements. Remember, we are looking for specific and current information related to your target population.

Shree Patel: Do not forget to include both the general and most vulnerable population data for factors 2, 3, and 4.

Shree Patel: Finally, don't forget to reference the data sources and years for data used in MOC 1A. That concludes our review of MOC 1A, and with that, I'll hand it back over to Laura to begin our review of MOC 1B. Next slide, please.

Laura Zwolinski: Thank you, Sri. We'll now turn our attention to MOC 1 Element B, which describes services for the most vulnerable enrollees.

Laura Zwolinski: Next slide.

Laura Zwolinski: Medicare Advantage organizations offering SNPs must coordinate the delivery of specialized benefits and services that meet the needs of the most vulnerable enrollees, including frail and disabled beneficiaries and beneficiaries near the end of life.

Laura Zwolinski: The intent of MLC 1 Element B focuses specifically on the process implemented by plans to identify their most vulnerable enrollees and the specially tailored services and benefits provided to these enrollees.

Laura Zwolinski: In addition to the established community partnerships that provide, facilitate, or assist those enrollees in identifying and accessing these support services.

Laura Zwolinski: The information that plants provide for this element must be specific to the most vulnerable population.

Laura Zwolinski: For this element, we ask that you clearly define the methodology used to identify the most vulnerable population, and describe the special services and benefits provided to these enrollees.

Laura Zwolinski: The narrative should address how the SNP helps enrollees overcome the challenges of navigating the healthcare system.

Laura Zwolinski: Going beyond the services and support provided to the general SMIT population.

Laura Zwolinski: The response also requires a description of the community partnerships that support the most vulnerable enrollees, and an explanation of any challenges associated with establishing these partnerships.

Laura Zwolinski: Please note that substantive changes have been made to the content of this element and its component factors for contract year 2027.

Laura Zwolinski: This is in addition to the order in which factors are presented in the scoring guidelines.

Laura Zwolinski: Given this, please be sure to review the changes and new requirements for this element carefully, and to organize your model of care so that responses are presented in the specified order, and address the correct factor requirements.

Laura Zwolinski: Next slide, please.

Laura Zwolinski: So let's go ahead and discuss this element in more detail at the factor level.

Laura Zwolinski: For Factor 1, the SNP must describe the internal process or methodology used to identify the most vulnerable SNP enrollees.

Laura Zwolinski: For example, the plan might use data collected on multiple hospital admissions within a specified time frame.

Laura Zwolinski: High pharmacy utilization, specific diagnoses, or documented medical, psychosocial, cognitive, or functional challenges.

Laura Zwolinski: It is suggested that plans determine what makes the SNP enrollees higher risk by looking at the presence of comorbidities.

Laura Zwolinski: Service utilization, demographics, as well as other relevant factors.

Laura Zwolinski: The model of care must detail the specific criteria used to determine whether an enrollee is considered part of the most vulnerable population.

Laura Zwolinski: Plans should avoid general statements and share the specific criteria used to identify the most vulnerable members.

Laura Zwolinski: We will provide an example of this on an upcoming slide.

Laura Zwolinski: The plan must differentiate between the most vulnerable enrollees and the general population who have lower risk stratification scores and are less resource intensive.

Laura Zwolinski: For Factor 2,

Laura Zwolinski: The SNP must describe the specially tailored care management practices used to support enrollees who are considered especially vulnerable.

Laura Zwolinski: SNPs must detail the additional benefits, specially tailored services, and resources offered to provide care to these most vulnerable enrollees above those available to the general SNP members.

Laura Zwolinski: For example, enrollees of a DSNP who are bedridden may face barriers accessing care. Therefore, the SNP provides in-home visits and covers additional telehealth services as a supplemental benefit.

Laura Zwolinski: We are not looking for an exhausted list of resources available to all enrollees, but rather those additional services provided to the most vulnerable enrollees.

Laura Zwolinski: SNPs must also address how they will meet the needs of these vulnerable enrollees throughout the full continuum of care, including end-of-life considerations.

Laura Zwolinski: Please note that this is a new factor for contract year 2027. In past years, this factor focused on the provision of demographic characteristics.

Laura Zwolinski: for the most vulnerable population. As Sri shared earlier in today's training, this information should now be included under MOC 1 Element A, Factor 2.

Laura Zwolinski: That said, plans may have included some information related to this new factor under Factor 3 of this element in prior years.

Laura Zwolinski: Next slide.

Laura Zwolinski: For Factor 3, SNPs must describe their established partnerships with community organizations that provide, facilitate, or assist in identifying resources for the most vulnerable enrollees and their caregivers.

Laura Zwolinski: Plans must also describe how the SNP collaborates with its partners to facilitate access to community services, deliver needed services, and maintain continuity of services for the most vulnerable enrollees and their caregivers.

Laura Zwolinski: Plans should also describe how they support and or maintain these partnerships.

Laura Zwolinski: Plans must also include a list of current community partnerships specific to the SNP service area and the associated services they provide to the most vulnerable enrollees.

Laura Zwolinski: These services should be specific to the service area. That is, we expect some level of customization across different submissions from the same corporate plan.

Laura Zwolinski: Please note that while last year we allowed plans to earn credit related to established partnerships if they described the system they use to house research identifying access resources.

Laura Zwolinski: However, this approach is no longer, sufficient to earn credit for this year. Plans must include a list of current partnerships for contract year 2027.

Laura Zwolinski: We also wanted to note that in prior years, plans may have included some of the information required to meet this factor under Factors 3 and or 4.

Laura Zwolinski: For Factor 4, SNPs must explain any challenges associated with the establishment

Laura Zwolinski: Of partnerships with community organizations that impact the ability to connect enrollees to specific community services.

Laura Zwolinski: This response must also include a description of the strategies and solutions the SNP uses to mitigate these strategies.

Laura Zwolinski: Please note that this factor is new for contract year 2027.

Laura Zwolinski: Next slide.

Laura Zwolinski: This slide provides an example of the specific criteria used to identify the most vulnerable members under Factor 1 of this element.

Laura Zwolinski: As you can see in this example, the health plan provided a number of specific characteristics and criteria used to determine the most vulnerable population.

Laura Zwolinski: We have bolded these criteria, which include characteristics such as four or more chronic medical or behavioral conditions.

Laura Zwolinski: Frequent trips to the ER, specifically 3 or more in a year.

Laura Zwolinski: Complex medication regimens, specifically more than 8 prescriptions.

Laura Zwolinski: Limitations in at least 3 ADLs, and less than a high school education.

Laura Zwolinski: In addition, the plan notes that this population also includes any enrollees experiencing homelessness, as well as any enrollees diagnosed with end-stage renal disease.

Laura Zwolinski: Again, please be sure that you define the inclusion criteria specifically. That is, you can see here that the plan indicated more than 8 prescriptions, rather than just high prescription usage. We are looking for this level of detail and specificity in your response.

Laura Zwolinski: Next slide, please.

Laura Zwolinski: This is an example of the do's and don'ts for presenting information on established partnerships for Factor III.

Laura Zwolinski: SNPs must include a list of current community partners and the services they provide to their most vulnerable enrollees.

Laura Zwolinski: The information on this slide is not a comprehensive list of services that we expect to see, and it is really just meant as an example, in this case, to illustrate the level of detail that we are looking for.

Laura Zwolinski: The column on the left meets the intent of the factor because it provides a description of the resource.

Laura Zwolinski: The column on the right does not meet the intent of the factor, as it is too general and provides no description.

Laura Zwolinski: When providing information for Factor III,

Laura Zwolinski: Be specific in detailing the services available among your community partners, and how those services are relevant to the needs of your most vulnerable enrollees. Again, the expectation is for SNPs to include resources specific to the most vulnerable population in their service area.

Laura Zwolinski: We also expect the list of services to vary for geographically diverse SNPs under the same corporate group.

Laura Zwolinski: Next slide.

Laura Zwolinski: This slide presents a table of the summary of changes listed in the contract year 2027 scoring guidelines for MOC1 Element B.

Laura Zwolinski: First, we want to emphasize the overall shift in focus for this element. Previously, this was a description of the most vulnerable population itself. It is now a review of the services provided to the most vulnerable enrollees.

Laura Zwolinski: Given this, there are some significant changes in the information required to successfully meet some of the factors for this element.

Laura Zwolinski: For Factor 1, the focus on the identification process for the most vulnerable population remains the same.

Laura Zwolinski: In prior years, we stressed that plans must define the process and specific inclusion criteria used to identify the most vulnerable population.

Laura Zwolinski: This requirement still stands, however, please note that the description of the most vulnerable population in terms of house status and conditions has been moved to MOC1 Element A.

Laura Zwolinski: For Factor 2, plans must now describe the specially tailored services and care management practices used to support the most vulnerable population.

Laura Zwolinski: This is a change implemented for Contractor 2027, both in terms of expansion of the requested information, as well as placement within the element. In prior years, plans may have included some of this information under Factor 3 of this element.

Laura Zwolinski: For contract year 2027, a new Factor IV has been added in which plans need to explain challenges associated with establishing community partners, as well as describe their mitigation strategies and solutions.

Laura Zwolinski: Next slide.

Laura Zwolinski: This slide summarizes the do's and don'ts specific to MOC 1 Element B.

Laura Zwolinski: For the dues, for Factor 1, be sure to identify the specific

Laura Zwolinski: Criteria used to identify the most vulnerable population.

Laura Zwolinski: For Factor 2, make sure that you describe the additional benefits, specially tailored services, and resources offered to the most vulnerable enrollees.

Laura Zwolinski: Above and beyond those provided to enrollees in the general population.

Laura Zwolinski: For Factor 3, be sure to include a list of current community partnerships and describe services provided to the most vulnerable enrollees. This must be a descriptive list. An overview of the plan system to house, research, identify, and access resources is not sufficient.

Laura Zwolinski: For Factor 4, new this year, make sure that you explain the challenges associated with establishing community partners, in addition to describing the strategies and solutions used to mitigate these challenges.

Laura Zwolinski: Please don't forget to tailor your responses to the new and clarified requirements for this element.

Laura Zwolinski: In addition, please ensure that your responses are included within the appropriate factor heading and presented in the order specified in this year's scoring guidelines.

Laura Zwolinski: And that takes us to the end of our review of MOC1. So with that, I will turn things back over to Sri. Next slide, please.

Shree Patel: Thank you, Laura. We'll now review some training and education items. Next slide, please.

Shree Patel: To review what was shared at the beginning of the presentation, this slide provides information on the training and education sessions scheduled for plans for contract year 2027.

Shree Patel: Training recordings for all four recorded training sessions are now posted to the SNP approval website at snipmoc.ncqa.org underneath the resources section. In addition, the training slides are also posted to the site.

Shree Patel: NCQA and CMS will hold two technical assistance calls to allow ample time for plans to ask questions in a live forum.

Shree Patel: The first of these sessions will take place from 2 to 4 p.m. Eastern Standard Time on March 19, 2026, and the second will take place from 2 to 4 Eastern Standard Time on April 16, 2026. The TA calls will be recorded and available to plans.

Shree Patel: Finally, the CURE TA call is scheduled from 2 to 4 p.m. Eastern Standard Time on August 4th, 2026. Plans that score less than 50% on one or more elements, or those that score less than 70% overall, will be required to CURE and should attend this session. Next slide, please.

Shree Patel: As mentioned earlier today, we have included a short post-training survey to collect your comments and feedback regarding this training session.

Shree Patel: Please click on the link embedded in the slide deck posted to the SNP approval website to access this survey. Please note that the survey will request feedback on the training for MOC 1 specifically.

Shree Patel: We will use any survey results received to continue to improve future training sessions, and we thank you in advance for taking the time to complete the survey.

Shree Patel: We'll also plan to review any common questions we receive on particular elements or factors during the pre-submission TA calls. We value your feedback and look forward to making meaningful updates based on your comments in the future. Next slide, please.

Shree Patel: Thank you for your time and attention during the MOC1 training on the overall SNP population and vulnerable enrollees. This concludes the training session.