Laura Zwolinski: Hello and welcome! This is the fourth and final installment of the Special Needs Plan's Model of Care Training Sessions for Contract Year 2027. Laura Zwolinski: Today, we are focusing on MOC4, which covers quality measurement and performance improvement as it relates to the MOC. Laura Zwolinski: We look forward to reviewing the MOC4 requirements with you, as well as calling out key changes made to the MOC4 elements and factors this year. Laura Zwolinski: My name is Laura Zielinski, I am the NCQA Task Lead for SNP Model of Care Review Activities, and I am joined here today by my colleagues Sri Patel and Madeline Vankott. Laura Zwolinski: Next slide, please. Laura Zwolinski: Today's training session will include a housekeeping refresher of important topics reviewed during prior trainings that we think are helpful to reiterate. Laura Zwolinski: We'll then move into a detailed review of the four elements included in MOC4 and their factors. Laura Zwolinski: We'll also review some important reminders and touch on some details related to initial and cure model of care submissions. Laura Zwolinski: After that, we'll recap some training information and remind plans about the post-training survey that is available for you to provide feedback to us. Laura Zwolinski: Next slide. Laura Zwolinski: We're going to start off by reviewing some housekeeping items. We understand that we reviewed these items during previous trainings, but believe that this is helpful contextual information for plans or attendees who do not watch the trainings in order. Laura Zwolinski: Please feel free to fast-forward through this information if you've already listened to it. Laura Zwolinski: In terms of the training format for Contract Year 2027, we pre-recorded four separate training sessions. Each one is specific to one of the four MOC standards. Laura Zwolinski: All four of these recordings are currently available on NCQA SNP Approval website. Laura Zwolinski: We strongly encourage you to watch all four of the training recordings. Laura Zwolinski: NCQA and CMS will continue to hold two pre-submission technical assistance calls to create a form in which plans can ask 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, and the second will take place from 2 to 4 p.m. Eastern Standard 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 for you during today's session on MOC4, 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 you to an online evaluation survey. Laura Zwolinski: We'd like to encourage plans to share your feedback and questions with us. 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, which CMS released in January 2026. Laura Zwolinski: The contract year 2027 SNP model of care scoring guidelines were updated to align with this revised Model of Care matrix and include substantial changes and revisions. Laura Zwolinski: To make sure that you understand the revisions and the corresponding changes that you need to address in your model of care documentation. Laura Zwolinski: 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. 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. Laura Zwolinski: 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 improve the model of care review process. Laura Zwolinski: Next slide. Laura Zwolinski: Please note that throughout the slide deck, new requirements for contract year 2027 are indicated by 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 today's training session. 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'd like to note a few things about changes included in the contract year 2027 SNP Model of Care Scoring Guidelines. Laura Zwolinski: Substantive changes and clarifications made to the 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 have been specifically labeled as a Contract Year 2027 update. Laura Zwolinski: However, those 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, and current regulations, and also review 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 want to take a moment to remind plans that the contract year 2027 scoring guidelines are currently posted to NCQA's SNP approval website. Laura Zwolinski: The Model of Care Matrix and all training recordings and associated slide decks are also posted here. Laura Zwolinski: In addition, this is where you can access login information and details for the upcoming technical assistance calls, and where the recordings from those calls will be posted. 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. Laura Zwolinski: 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 29, 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. Laura Zwolinski: In 2026, final bids are due to CMS on Monday, June 1st. Laura Zwolinski: NCQA will upload scores to HPMS by the end of July. Then, on Monday, August 3rd, CMS will distribute Notice of Intent to Deny Letters, or NOIDs. NOIDs are sent to plans that score less than 50% on any one or more elements. Laura Zwolinski: 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, and all CURE submissions are due in HPMS by 8 p.m. 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: This line includes information related to technical assistance. Laura Zwolinski: 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 contract year 2027 matrix and scoring guidelines on this slide. Laura Zwolinski: Before submitting any inquiries, we recommend that you first review these trading materials. 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. Type the address included in the right column of this slide, and then select the SNP mailbox. Once you do this, enter SNP application inquiry in the subject line. Laura Zwolinski: And that concludes the housekeeping and general updates section of today's training. Laura Zwolinski: Next slide. Laura Zwolinski: Let's go ahead and dive into our review of MOC4. Laura Zwolinski: Before we begin, I want to pause here to note that for contract year 2027, Laura Zwolinski: MOC4 now includes a total of 4 elements instead of 5. Laura Zwolinski: This is because the prior element MOC4D, Ongoing Performance Improvement Evaluation of the Model of Care, was deleted since these requirements were already captured under MOC 4A, Model of Care Quality Performance Improvement Plan. Next slide. Laura Zwolinski: The first element we'll look at is MOC4 Element A, which is about the plan's quality performance improvement process and plan. Next slide. Laura Zwolinski: All SNPs must implement a quality improvement program that evaluates the effectiveness of the model of care. Laura Zwolinski: It must provide for the collection, analysis, and reporting of data that measure health outcomes and indices of quality for the target SNP population. Laura Zwolinski: Specific requirements and details related to the improvement plan are included in the regulation language. We encourage you to familiarize yourself with these details. Laura Zwolinski: Next slide. Laura Zwolinski: The objective of MOC4 Element A is to describe the overall quality performance improvement plan and how it ensures that appropriate services are delivered to SNP enrollees. Laura Zwolinski: It gets at how your plan is addressing the key elements necessary for overall improvement, and how you are measuring the degree of improvement. Laura Zwolinski: Moreover, it improves the SNP's ability to deliver high-quality services and benefits. Laura Zwolinski: We are looking for details about your data-driven improvement processes, as well as who is involved. Laura Zwolinski: We also want to know how you integrate goals into the plan, and the process you use to evaluate whether or not they have been achieved. Laura Zwolinski: Please note that the number of factors for this element increased from 4 to 5 this year. Laura Zwolinski: Next slide, please. Laura Zwolinski: So now we'll review the requirements for each factor. Laura Zwolinski: For Factor 1, the SNP must describe the overall quality improvement plan and address how it determines whether the overall model of care structure effectively accommodates the specific needs of SNP enrollees through the delivery of appropriate services. Laura Zwolinski: Please note that, at a minimum, the Quality Performance Improvement Plan must address the SNPPS process for improving access to and coordination of care. Laura Zwolinski: Member and provider satisfaction, and program effectiveness. Laura Zwolinski: As previously noted in the overview of the regulations, this process must be data-driven. Laura Zwolinski: Factor 2 requires the SNP to describe its process for continuous collection, analysis, evaluation, and reporting of quality performance data to support ongoing improvement of the model of care. Laura Zwolinski: Please note that this response must specify the frequency of these activities. Laura Zwolinski: For Factor 3, describe how the SNP leadership team and other key SNP personnel and stakeholders participate in and support internal quality performance processes. Laura Zwolinski: Be sure to identify the personnel involved, their role in analyzing quality performance information, and their decision-making authority. Laura Zwolinski: Next slide, please. Laura Zwolinski: For Factor 4, plans need to describe how the goals established for the overall model of care performance and enrollee health outcomes are integrated into the overall performance improvement plan. Laura Zwolinski: You also need to detail the process used to determine if goals and outcomes are met or not met. Laura Zwolinski: Please note that, this year, the specific details of these goals and outcomes will need to be outlined later on in MOC 4 Element B. Laura Zwolinski: Given this, please note that this factor focuses on a description of the processes rather than on the determination of whether specific goals or outcomes were actually achieved. Again, that level of detail is now required in MOC4 Element B. Laura Zwolinski: Please be aware that the response you provide related to assessing whether goals and outcomes are met or not met must include a discussion of how benchmarks and timeframes for measurement are used. Laura Zwolinski: You must also specify the remeasurement process and frequency for cases in which goals or outcomes may not be achieved. Laura Zwolinski: Lastly, we wanted to note the addition of a new factor to this element for contract year 2027. Laura Zwolinski: This new Factor V requires that SNPs describe the process they use to systematically identify enrollees that have received no-covered Medicare services during a defined time period. Laura Zwolinski: The response must provide information on the actions taken by the SNP, Laura Zwolinski: To identify and connect with these enrollees. Laura Zwolinski: The purpose of this new factor is for plans to identify members who have received no services so that the SNP can implement processes to encourage these members to obtain primary and preventive care services that may be warranted for their individual health status. Laura Zwolinski: Next slide. Laura Zwolinski: This slide presents a table of the summary of changes for this element for contract year 2027. Laura Zwolinski: First, as previously noted, Factor 4 focuses on a description of the processes to determine whether goals or outcomes are met. Laura Zwolinski: Rather than on whether specific goals or outcomes were achieved. Those specifics are now addressed in MOC 4 Element B. Laura Zwolinski: Again, Factor V is a new addition for this year. It requires the process SNPs use to determine enrollees that have not yet received any covered Medicare services, and what the plan does to connect with these members to encourage them to seek services related to their health status. Laura Zwolinski: Next slide. Laura Zwolinski: Lastly, here are some key points to remember as you prepare your model of care for this element. Laura Zwolinski: Do make sure that you define key personnel and their involvement in the performance improvement plan for Factor III. Laura Zwolinski: For Factor 4, be sure that you describe both the process used to integrate goals into the improvement plan, and to determine if goals are met or not met. Laura Zwolinski: Also, make sure that you don't forget to specify the remeasurement process for when goals are not met. Laura Zwolinski: Including the use of benchmarks and timeframes for Factor 4. Laura Zwolinski: Also, don't forget to address new Factor 5 regarding the identification of enrollees that haven't received any covered Medicare services. Laura Zwolinski: Next slide, please. Laura Zwolinski: We're now going to talk about MOC 4 Element B, which is all about measurable goals related to model of care performance and enrollee health outcomes. Laura Zwolinski: Next slide. Laura Zwolinski: Regulations require that NCQA assess whether goals from the previously approved model of care have been met. Laura Zwolinski: To support this evaluation, plans must provide relevant information about the model of care's goals, as well as data, that is, results, pertaining to the fulfillment of the previous model of care goals. Laura Zwolinski: Initial models of care must include information on the model of care goals for review and approval. over. Lastly, the plan must detail how it will achieve or revise goals that were not met in the new model of care. Laura Zwolinski: Next slide. Laura Zwolinski: The intent of MOC4 Element B is to define the SNP's measurable goals used to evaluate overall model of care performance and the health outcomes measures used to assess the health of the SNP population. Laura Zwolinski: This focuses on the population overall, and not on individual enrollees. In all, goals must be at the plan or SNP level. Laura Zwolinski: This element also requires that SNPs determine if prior goals were met or not met. Laura Zwolinski: That is, your plan must assess your current level of performance. Laura Zwolinski: For those goals not met, SNPs need to describe the actions taken to change or modify the goals. Laura Zwolinski: In terms of changes made to this element for contract year 2027, Laura Zwolinski: We want to note that the number of factors was reduced from 5 to 4. Laura Zwolinski: Other changes were also made, so please be sure that your responses include the required information. Laura Zwolinski: And are presented in the order specified in the scoring guidelines. Next slide. Laura Zwolinski: This year, Factor 1 focuses specifically on overall model of care performance goals for the new model of care. Laura Zwolinski: SNPs must identify in detail the specific, measurable goals it will use to assess overall model of care performance. Laura Zwolinski: Please keep in mind that all goals must be measurable and specific. Laura Zwolinski: SNPs must provide relevant information on how they will achieve these goals, and include specific data sources, benchmarks, and the timeframes and frequencies used to measure, evaluate, and achieve them. Laura Zwolinski: Please use a table, bullet points, or other means to identify your overall model of care performance goals. Laura Zwolinski: Some examples of overall model of care performance goals are listed on the slide here, and they may include improving access and affordability for the SNP population. Laura Zwolinski: Improving care coordination and appropriate delivery of services through direct alignment Laura Zwolinski: with the HRA, ICP, and ICT. Laura Zwolinski: And simply stated, direct alignment means that services delivered to SNP enrollees are based upon their health assessments. Laura Zwolinski: We want to emphasize here that SNPs are required to include a goal for each of these three items, HRA, ICP, and ICT completion, to meet this factor, and all three of these goals must be set to 100%. Laura Zwolinski: Enhancing care transitions across providers and healthcare settings is also an example of overall model of care performance goals. Laura Zwolinski: Please note that no goals should be listed as TBD or to be determined. Laura Zwolinski: This does not meet the requirements for this factor. Laura Zwolinski: Again, these goals are specific to the new model of care, or the one you are submitting for approval. Laura Zwolinski: Next slide, please. Laura Zwolinski: Factor 2 focuses specifically on enrollee health outcomes goals for the new model of care. Laura Zwolinski: SNPs must identify in detail the specific health outcome goals it will use to evaluate the health of the SNP population. Laura Zwolinski: These goals should be informed by the healthcare needs of your target population. Similar to the last factor, all goals must be measurable and specific. Laura Zwolinski: Again, beyond the goals themselves, SNPs must include specific data sources, benchmarks, and the timeframes and frequencies used to measure, evaluate, and achieve the specified goals. Laura Zwolinski: Please use a table, bullet points, or other means to identify your health outcomes goals. Laura Zwolinski: We've listed examples of some enrollee health outcomes goals on this slide. Laura Zwolinski: The first group represents goals ensuring appropriate utilization of services for chronic conditions, such as improving hemoglobin A1C rate levels in enrollees with diabetes, improving medication adherence, and lowering all-cause readmissions. Laura Zwolinski: The second group represents goals for ensuring appropriate utilization of preventive health services, such as improving breast, colorectal, and depression screening rates, and improving vaccination rates. Again, make sure that you do not list any goals as TBT. Laura Zwolinski: Also, to reiterate, these goals are specific to the new model of care being submitted for approval. Laura Zwolinski: Next slide. Laura Zwolinski: For Factor 3, the ST must explain how overall model of care performance goals and enrollee health outcomes Laura Zwolinski: Measure goals are communicated through the SNP and to stakeholders. Please note that this is a new requirement for contract year 2027. Laura Zwolinski: This factor also requires a description of the methods used to assess and track how its overall quality program, including the goals and specific measures it uses, affect the health outcomes of its enrollees. Laura Zwolinski: This may include the data collected. Laura Zwolinski: How it is collected and analyzed, and how often it is collected and analyzed. Laura Zwolinski: Next slide. Laura Zwolinski: The requirements for Factor IV vary depending on whether your organization is submitting a renewal model of care or an initial model of care. Laura Zwolinski: And we'll walk through the requirements for renewal models of care first. Laura Zwolinski: For this factor, renewal models of care must include a determination of whether each goal from the previous model of care was met or not met. Laura Zwolinski: They must also provide data and results for each goal. Laura Zwolinski: Please be advised that all goal and results information should be presented at the SNP level, rather than for a combination of multiple plans. We want to clarify that, this year, the overarching process the plan uses to determine if goals were met or not met Laura Zwolinski: is required under the previous element we discussed, MOC4 Element A, Factor 4. We are emphasizing that this factor requires specific data, results, and the goal determinations themselves. Laura Zwolinski: If there is a specific reason that your plan has limited data and results for goals, please specify the rationale for the limited data in your response. Laura Zwolinski: In general, we expect renewal plans to include results and data for your goals. Laura Zwolinski: An instance in which a renewal plan might have limited data is if it just began operations in January 2026, and so would only have a few months of data by the submission deadline. Laura Zwolinski: Again, make sure to specify this in your response. Laura Zwolinski: Please note that renewal models of care must also include a description of the specific actions they will take. Laura Zwolinski: To achieve or modify unmet goals in the next model of care. Laura Zwolinski: This includes a description of the remeasurement and analysis process. Laura Zwolinski: Moving on to initial plans. Laura Zwolinski: Since initial plans are not yet in operation, they will not have any data related to goals, or be able to determine whether goals have been met. Laura Zwolinski: For this factor, if you are an initial submission, please clearly indicate this in your response, and note that this is the reason that you do not have any data or results to report. Laura Zwolinski: Beyond this, initial plans need to describe the general process they will use when the SNP determines that a goal is not met. Laura Zwolinski: Including the remeasurement and analysis process for unmet goals. Laura Zwolinski: Please note that this year's Factor 4 is largely a combination of last year's Factors 4 and 5, so plans may have included some of the information required for this factor under Factor 5 previously. Laura Zwolinski: Next slide, please Laura Zwolinski: This slide is an example to illustrate how plans can address the requirements specified for overall model of care performance goals for Factor I and Factor 4. Laura Zwolinski: The first five columns shaded in blue present the information required for Factor 1, in which the plan needs to identify and detail the specific measurable goals it will use to measure overall performance in the new model of care being submitted for approval. Laura Zwolinski: To meet Factor 1, the table provides a description of each goal, the quantified goal itself. Laura Zwolinski: The current benchmark, the data sources used to collect information required to analyze goal performance. Laura Zwolinski: And specifies the measurement frequency. Laura Zwolinski: The specific goals in this example include access and affordability goals, in addition to HRA, ICP, and ICT completion goals. Laura Zwolinski: Please note that this is not an exhaustive list of goals, and the goals for your plan likely include additional performance goals, such as care transition or member satisfaction goals. Laura Zwolinski: I also want to draw your attention to the three required care coordination goals for HRA, ICP, and ICT. Laura Zwolinski: You can see that they are all included here, and that the current goal is set to 100%. Laura Zwolinski: This level of detail is required for both renewal and initial plans to meet Factor 1. Laura Zwolinski: For renewal plans to meet the requirements related to overall model of care performance goals for Factor 4, Laura Zwolinski: Which requires the plan to specify whether the goals of the previously approved model of care were met or not met. Laura Zwolinski: The last three columns of the table, shaded in red here, have been included to provide the quantified gold results. Laura Zwolinski: A designation of whether the goal was met or not met. Laura Zwolinski: And when and how frequently the goal will be remeasured. Laura Zwolinski: To meet Factor 4 in relation to the overall model of care performance goals, plans would need to include information that captures all the column topics in this table. Laura Zwolinski: Please note that beyond the table itself, renewal plans would also need to provide an action plan for goals not met, and also address how goals will be revised and remeasured. Laura Zwolinski: We recommend that plans use a table to provide information for these factors. However, a narrative approach is acceptable if the necessary details are included. Laura Zwolinski: We also want to point out that this table assumes identical goals for the previously approved. Laura Zwolinski: model of care and the new model of care. And this is really for ease of illustration purposes only. Your model of care will likely have different goal targets, or even different goals, for the new goals in factor 1, and the previously approved goals in factor 4, based on your performance evaluation of those goals. Laura Zwolinski: Please note that the same holds true for health outcome measure goals, which are required under Factor 2. Laura Zwolinski: Factor 2 should provide the level of detail for the new Model of Care's health outcome measure goals as provided in the first 5 columns of this table. Laura Zwolinski: Renewal plans must also report the prior model of care's health outcomes, goals, results, and determinations under Factor 4, which would require the information captured across all columns of this table. Laura Zwolinski: Next slide, please. Laura Zwolinski: We want to pause here to note that, in the past. Laura Zwolinski: MOC4 elements A and B caused some confusion for plans. Laura Zwolinski: This year, we aim to clarify some of this confusion by making MOC4 Element A specific to the Quality Improvement Plan itself. Laura Zwolinski: And the processes used to support it. Laura Zwolinski: MOC4 Element B is now specific to the goals themselves, including their outcomes. That said, we would like to review a few questions we commonly receive related to MOC4 Element B to provide some clarification. Laura Zwolinski: And we'll start with a question related to Factor 1. Laura Zwolinski: The question is, if we set the HRA completion goal to 100%, can we include enrollees who refused and those unable to be contacted when determining the completion rate? Laura Zwolinski: And the answer is no. The completion rate should only include those enrollees with a completed HRA. Laura Zwolinski: While the HRA goal must be set to 100%, Laura Zwolinski: CMS understands that some enrollees will not complete an HRA, either because they are unable to reach, or because they refuse. Given this, plans will not be penalized if they do not meet the 100% goal. Laura Zwolinski: The same holds true for the ICP and ICT completion goals. Laura Zwolinski: Next slide. Laura Zwolinski: This question relates to the goals presented in the new model of care submission. Laura Zwolinski: This information is captured in factors 1 and 2. Laura Zwolinski: The question is, do plans need to keep all previous model of care goal targets and outcome measures for the current model of care submission, or can they modify them as needed? Laura Zwolinski: And the answer is no, SNPs do not need to retain all goals from their previously approved model of care. Plans should modify previous goals as needed to meet the needs of their population and to effectuate improvement. Laura Zwolinski: Please note that Factors 1 and 2 should present the goals of the new model of care submission and incorporate any changes that you needed to make based on the outcomes of the goals in your previously approved model of care. Laura Zwolinski: Data, results, and a determination of whether your previous model of care goals were met or not met should be included under Factor 4. This is where plans describe changes to previously established goals and actions taken if they were not met. Laura Zwolinski: Next slide, please. Laura Zwolinski: This question has to do with Factor 4. The question is, for MOC 4 Element B, are plans only required to indicate whether goals are met or not met, rather than provide the actual quantified results? Laura Zwolinski: And the answer is, beyond providing a determination of whether each goal and health outcome measure was met or not met. Laura Zwolinski: Plans must also include the associated data and results for each goal. Laura Zwolinski: In addition, for goals not met, plans need to outline a specific action plan to support improvement. Laura Zwolinski: If, for some reason, your plan does not have data or results to provide for your goals, please detail the rationale as to why you do not have this information. Laura Zwolinski: For instance, please be specific in denoting if your plan is an initial plan or a renewal plan that just became operational. Laura Zwolinski: Next slide. Laura Zwolinski: This question has to do with Factor 4, and the question is, given that our plan has an effective start date of January 1st, 2026, Laura Zwolinski: We will not have sufficient data to report outcome measures related to the achievement of goals for the contract year 2027 model of care submission. Laura Zwolinski: Is it acceptable to note in the model of care that we have insufficient data available to measure goal achievement? Laura Zwolinski: And the answer is, while this submission is technically a renewal submission, the plan indicates that it does not have sufficient data to report on the goals previously specified in its initial submission. Laura Zwolinski: If no outcome data are available because the SNP has just become operational, the plan must clearly indicate this in its model of care response. Laura Zwolinski: We also want to clarify here that initial submissions should indicate that they do not have data available because they are an initial model of care. Laura Zwolinski: For all other submissions, the expectation is that result data is provided for each goal. Laura Zwolinski: Next slide, please. Laura Zwolinski: This slide summarizes the changes made to MOC 4 Element B for Contract Year 2027. Laura Zwolinski: We revised Factor 1 to focus on the overall model of care performance goals specifically, and Factor 2 to focus on enrolling health outcome goals specifically. Laura Zwolinski: Please note that the goals presented here should be those for the new Model of Care submission. Laura Zwolinski: For Factor 3, we newly specified that, as part of the response, SNPs must address how performance goals are communicated throughout the SNP and to stakeholders. Laura Zwolinski: Factor 4 was updated to specify that plans must indicate whether goals of the previously approved model of care were met or not met. Laura Zwolinski: This includes the provision of associated data and results, and plans must describe the action steps for goals not met. Laura Zwolinski: Lastly, we wanted to know that last year's factors 4 and 5 were combined into this year's factor 4. Laura Zwolinski: Next slide. Laura Zwolinski: Some key factors to remember for MOC4 Element B include, for Factor 1, make sure that you include separate care coordination goals for the HRA, ICP, and ICT, and that all of these goals are set to 100%. Laura Zwolinski: For Factors 1 and 2, don't forget to include target goals for the new model of care, along with relevant data sources, benchmarks, and associated timeframes for measurement. Laura Zwolinski: You'll need to provide this information for both overall model of care performance goals and health outcome measure goals. Laura Zwolinski: And new this year, be sure to include how goals are communicated throughout the SNP and to stakeholders in your response to Factor 3. Laura Zwolinski: For Factor 4, be sure that you designate whether each goal of the previously approved model of care submission was met or not met. Laura Zwolinski: Alongside supporting results and data. And don't forget to detail specific action plans for goals not met. Laura Zwolinski: And that completes our review of this element. With that, I will hand it over to Sri for the next two elements. Next slide, please. Shree Patel: Thank you, Laura. Next up, we are going to review MOC4 Element C, which involves measuring SNP enrollees' experiences of care. Shree Patel: Next slide, please. Shree Patel: The intent of MOC 4C requires that plans detail how they measured the patient experience of care, or what sometimes is known as the SNP Member or Enrollee Satisfaction Survey. Shree Patel: For this element, plans are required to describe the types of surveys they use to assess SNP member experience, as well as provide a description of the survey administration methodology used. Shree Patel: This description must include the rationale for the selection, and use of specific survey or surveys, and how member survey results are subsequently integrated into the plan's overall performance improvement plan. Shree Patel: We do understand that there are numerous ways through which plans can measure patient experience. Shree Patel: To this end, plans may use a wide array of patient experience or satisfaction surveys, and neither CMS nor NCQA is prescriptive in requiring the use of any specific survey instruments. The key is that plans must provide detailed information on the survey and the administration process. Shree Patel: Plans will also demonstrate how enrollee feedback is analyzed, and then incorporated into the plan's performance improvement efforts, as well as how issues are addressed from survey results. Shree Patel: Please note that this year, some factors were shifted and or expanded for this element. Next slide, please. Shree Patel: There are four factors for MOC4C. Please pay attention to the factor shifts across this element for contract year 2027. Shree Patel: For Factor 1, plans must describe the specific survey or surveys used to measure and assess SNP enrollee experience. The instrument must measure overall plan satisfaction, and not simply case management activity. Shree Patel: Enrollee feedback collected by the survey or surveys must include information about the overall SNP program or program staff. Shree Patel: That is, for instance, the ICT or case managers, the usefulness of the information provided by the plan to the enrollee or caregivers, and the member's ability to adhere to recommendations. Shree Patel: Member feedback may be obtained through member experience surveys or by conducting focus groups. Regardless of approach, the sample should be representative of enrollees through the plan. Shree Patel: Again, if more than one survey is used, the plan must describe each one. If this is not done, the factor will be scored down. Further, plans must provide the rationale for why a particular survey or set of surveys were selected to measure enrollee satisfaction. Shree Patel: If multiple surveys are used, please be sure to provide a rationale for each of the surveys. If this is not done, again, the factor will be scored down. Please note the rationale for the survey that was previously under Factor 2 and now has been moved up to Factor 1 for CY2027. Shree Patel: For Factor 2, although many of these items were not new requirements for CY2027, they are new to Factor II and are labeled as such. For this factor, we are looking for you to provide details on survey administration methodology. Shree Patel: The description of the survey administration methodology should address the survey mode or modes used. For instance, is it conducted through mail or phone, to contact enrollees, as well as how many outreach attempts are made to collect feedback. Shree Patel: Plans must describe how they solicit feedback from a broad sample of members, and not just those members who contact the plan to share feedback. Shree Patel: In addition, please be mindful to specify the survey sample size. Shree Patel: Plans commonly omit this information from their documentation. If you do not provide a sample size for each survey used, you will be scored down on this factor. If you are a new plan, you can provide an estimate of the sample size you intend to use. Next slide, please. Shree Patel: For Factor 3, plans must describe how they analyze the feedback and how the results are gathered through the enrollee experience survey to identify key themes and issues. Shree Patel: The MOC should explain how the results of the SNP enrollee satisfaction surveys are integrated into the overall MOC performance improvement plan. Shree Patel: Please note, in addition for CY2027 requires plans to describe how results are used to implement new programs that target areas for improvement. Shree Patel: For Factor 4, plans must describe the process used to address issues identified in response to SNP enrollee experience survey results. Further, please include the specific steps taken to address issues identified in the survey responses. Shree Patel: Next slide. Shree Patel: This slide presents a table of summary of changes listed in the Contract Year 2027 scoring guidelines for MOC4 Element C. First, we combined Prior Factor 1 with Prior Factor 2. Shree Patel: A new Factor 2 was added regarding methodology and sample size, which included some language that was previously under Factor 3. Shree Patel: For Factor 3, plans will now be required to describe how results are used to implement new programs that target areas for improvement. Shree Patel: Lastly, for this year's version of Factor 4, it now focuses on the process the SNP uses to address any issues identified through survey responses. Shree Patel: Next slide. Shree Patel: Please keep the do's and don'ts included on this slide in mind when preparing your documentation for this element. Shree Patel: In terms of dues for this element, for Factor 1, please tell us why you selected this particular survey or surveys you are using. Shree Patel: For Factor 2, include the methodology, example modes, attempts, frequency, used to administer each enrollee satisfaction survey identified in Factor 1. For Factor 3, Shree Patel: Please be sure to describe the process for incorporating survey findings into the overall improvement plan and how those results are used to implement new programs. Shree Patel: And for Factor 4, make sure to detail the process, including specific steps that will be taken to address these findings. Shree Patel: For the don'ts, please don't forget to include details on sample size for Factor II. Shree Patel: This is required for both initial and renewal plans. Please note that initial plans may provide a sample size estimate for each survey used. However, renewal plans are expected to provide the actual sample size. Shree Patel: Please don't forget to tailor responses to the new and or clarified requirements across the element. Shree Patel: Please don't forget to ensure responses are included with the appropriate factor and presented in the order specified in the contract year 2027 scoring guidelines. That concludes this element. Next slide, please. Shree Patel: We will now review MOC2D, dissemination of MOC quality performance results. Please note that MOC 4D is a new element and title for contract year 2027, and focuses on the dissemination of MOC quality performance results. Next slide. Shree Patel: Again, please note that last year's MOC4 Element D was deleted, which shifted this element up from MOC4 Element E to Element D this year. The intent of this element is for SNPs to detail how quality performance and results are documented and shared with key stakeholders. Shree Patel: For this element, SNPs should explain who the stakeholders are, the frequency of distribution, and how it is distributed, and who is responsible for overseeing the distribution process. Lastly, they should indicate how performance improvement results are documented and maintained. Next slide, please. Shree Patel: To reiterate, previously much of this information was included under last year's MOC4 Element E dissemination of SNP quality performance related to the MOC. Shree Patel: Now, onto the factor level details. Shree Patel: Factor 1 requires plans to describe how quality performance results are routinely shared with stakeholders. Shree Patel: Please ensure that the stakeholders are also identified. This includes, but are not limited to, SNP leadership teams, SNP board of directors, SNP personnel, staff, provider networks, SNP enrollees, and caregivers, etc. Shree Patel: For Factor 2, indicate the frequency and methods of these communications and your timeframes for these distributions. For Factor 3, identify the staff responsible for communicating performance updates in a timely manner, as well as the individual who oversees the task. Shree Patel: Please note that this information was previously under Factor 4 of MOC 4 Element E last year. Shree Patel: New for CY 2027, Factor 4 requires plans to describe how performance improvement results and updates will be documented. Next slide. Shree Patel: This slide presents a table of summary of changes listed in the Contract Year 2027 scoring guidelines for MOC4 Element D. Shree Patel: First, as previously noted, previous Element D ongoing performance improvement evaluation of the MOC was removed for CY2027. Therefore, previous Element E dissemination of MOC quality and performance results was shifted to new Element D. Shree Patel: For Factor 3, we removed prior Factor 3, which required a description of ad hoc communications. Lastly, for this year's version of Factor 4, it now focuses on the SNP's use to document performance improvement updates and results. Next slide. Shree Patel: As a recap for MOC4 Element D, it is important to clearly define how results are shared, note who the results are shared with, provide a frequency for communication of performance, identify plan leadership. Shree Patel: responsible for this process. And finally, describe how performance improvement results and updates will be documented. Shree Patel: As a reminder, do not forget to tailor responses to the new factors across the element, and ensure responses are included within the appropriate factor and presented in the order specified in the contract year 2027 scoring guidelines. Shree Patel: And that concludes MOC4 Element D, which is the last element in MOC4. Next slide, please. Shree Patel: Now, I'll review some important reminders. Next slide. Shree Patel: We strongly advise SNPs to give thoughtful consideration to your MOC documentation. Each submission offers an opportunity to think through and improve processes. Shree Patel: SNF submitting renewal models of care should include any substantive changes in your annual submission. Shree Patel: The expectation is for SNPs to submit a new model of care each renewal period to capture process updates and changes. Shree Patel: Please be sure to address all of the requirements specified for each element and factor as noted in the MOC matrix and in the contract year 2027 SNP Model of Care Scoring Guidelines. Shree Patel: Reviewers will score model of care narratives based on this version of the scoring guidelines. NCQA is looking for descriptions that include specific process details. Where applicable, responses should be descriptive and associated with oversight activities. Shree Patel: To the extent possible, responses should address the who, what, where, and when, and how in the process description. Shree Patel: Again, we are looking for detailed descriptions. Shree Patel: To that end, we also want to emphasize that general process statements are not acceptable and will be scored down. Shree Patel: As an important reminder, due to the volume of changes made in the MOC 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 to align with the order of elements and factors Shree Patel: As presented and specified in the contract year 2027 scoring guidelines. Shree Patel: This will support more efficient reviews, and we thank you in advance for your partnership and collaboration in supporting these changes and improving the MOC process. Shree Patel: Also, please be sure you do not include any PHI or PII in your model of care narrative. We are clarifying this point for contract year 2027, given experiences during the contract year 2026 review period. Shree Patel: Lastly, please only upload two documents to HPMS for NCQA's review, the model of care narrative and the associated matrix. Shree Patel: NCQA staff will only download the MOC narrative and matrix for review. We do not download any other documents. Given this, all information to address requirements that are relevant for our review, for instance, your organization chart. Shree Patel: or training slides must be included within the model of care document itself, and cannot be submitted as a standalone document. Shree Patel: Next slide. Shree Patel: Further data and analysis must be relevant to the specific population in each service area, not as described in national statistics or general language that covers your organization's overall population. Shree Patel: The expectation is for SNPs to submit a new model of care each renewal period to capture process updates and changes which are not the same as previously approved model of care. Shree Patel: Each submission offers an opportunity to think through and improve processes. Next slide. Shree Patel: We will now shift into a review of initial and cure submission process, and we'll provide guidance and key reminders on these topics. Next slide, please. Shree Patel: This slide provides instructions to keep in mind as you prepare and submit your contract year 2027 submissions this May. Shree Patel: Please note that all submissions are due by 8pm Eastern Standard Time on Friday, May 29th, 2026. Shree Patel: Documents must be uploaded via HPMS by this deadline. Please make sure you upload two documents and two documents only to HPMS, the model of care narrative itself and the associated matrix. Shree Patel: Please be advised that NCQA staff downloads the MOC and Matrix documents only. We do not download or review any other documents or attachments. Shree Patel: Given this, please verify that any information or documents relevant to our review, for instance, your organization chart, staff or provider trainings, or summary documents, are embedded directly into the appropriate location of the model of care, or are included as appendices at the end of the document. Shree Patel: We provided a file naming convention for your use for your matrix and model of care documents on this slide. We urge you to follow this format Shree Patel: which is the contract number, followed by the plan name and the SNP type. Shree Patel: And finally, whether the document is a model of care or the matrix. We also ask that you include all corporate affiliate H numbers that share a similar model of care in the matrix or in the introductory section of your model of care narrative. This supports consistency in reviewing. Shree Patel: In terms of format, beyond what we've already noted, please make sure to verify that responses you provide in your model of care are presented in the order specified in the CY2027 scoring guidelines, and that they capture all recurrent requirements. Shree Patel: This supports a more efficient review process and ensures that your document aligns with the most current guidance. We thank you in advance for your continued efforts to improve the model of care review process. Shree Patel: Please verify that any and all links that you include are operational, as non-functional links may prevent reviewers from seeing specific information and result in a decrease in scores assessed. Lastly, please do not include any PHI or PII within the MOC. Next slide. Shree Patel: Please note that any plans that do not score at least 50% on every element, or that score less than 70% overall, will be required to submit revised documentation to address deficiencies during what we call the cure. Shree Patel: Plants will be notified if they need to cure during the receipt of a Notice of Intent to Deny Notice, or NOID, on August 3rd. CURE submissions must be uploaded via HPMS by 8 p.m. Eastern Standard Time on Thursday, August 13th, 2026. Shree Patel: Plants must upload an updated version of the model of care and matrix to HVMS. Shree Patel: Do not submit any other documents. Shree Patel: Please note that all other instructions presented on the previous slide for initial submissions also apply to CURE submissions. However, there are some specific formatting instructions that need to be Shree Patel: done following the CURE submission. All language changes over the initial submission that are included in the CURE submissions must be clearly identified. Shree Patel: This means that language that was removed can either be marked in a strikethrough text or deleted in track changes mode. Additional language should be added in red font or through track changes. Shree Patel: This process helps reviewers and NCQA staff to see the revisions and or additional edits clearly. Shree Patel: Shree Patel: Please note that you can only include revisions for factors that were scored as not met following the initial review period. That said, please make sure that your CURE documentation addresses all factor requirements to support a successful outcome. Next slide, please. Shree Patel: We are now going to go over some training reminders. Next slide. Shree Patel: To review what was shared at the beginning of this 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 under the Resources section. Shree Patel: 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. The first of these sessions will take place from 2 to 4 p.m. Eastern Standard Time on March 19, 2026. Shree Patel: And the second will take place from 2 to 4 p.m. Eastern Standard Time on April 16th, 2026. The TA calls will be recorded and available to plans. Finally, the CURE TA call is scheduled from 2 to 4 p.m. Eastern Standard Time on August 4th, 2026. Shree Patel: Plans that score less than 50% on one or more elements, or those that score less than 70% overall, are required to cure and should attend the session. Next slide, please. Shree Patel: We've included a short post-training survey to collect your comments and feedback regarding this training session. Please click on the link embedded in the slide deck posted to the SNP approval website to access this survey. Please note that this survey will request feedback on the training for MOC4 specifically. Shree Patel: We are using any survey results received to continue to improve future training sessions, and we thank you kindly in advance for taking the time to complete the survey. We'll also plan to review any common questions we receive on particular elements or factors during the pre-submission TA calls. Next slide, please. Shree Patel: Thank you for your time and attention during the MOC4 training on quality measurement and performance improvement. This is the last of our training recordings. Again, we thank you and look forward to this year's MOC review session. This concludes the training session.