Miscellaneous
It is the reigning standard of care for SNP programs and approved by CMS.
What is the Model of Care?
HealthTel/Revel
What is the name of the vendor that is contracted to complete initial and annual RSAs?
Circulation, Nutrition, Skin, Vision and Urinary Function
What are the Problems mapped to the POC when Diabetes is selected on an RSA?
A dual eligible plan (Medicare & Medicaid)
What is a DSNP?
This must occur within 30 days of RSA completion/POC creation/program enrollment
What is ICP communication/sharing?
Annual Special Needs Plan Training & Annual Measurable Goals Training
What are the mandatory training courses for individuals working with Special Needs Plans?
It must be completed within 90 days of enrollment to a health plan
What is an Initial RSA?
My daily blood sugars will be within a desired target range for me as indicated by my hemoglobin A1c results during the next 12 months
What is one of the goals that is mapped when diabetes is selected on the RSA
A special plan for those with chronic or disabling conditions
What is a CSNP?
Mailing or verbal sharing/communication
What are approved methods of ICP sharing?
100%
What is the CMS compliance target for SNP programs?
It must be completed within 365 days of the previous one.
What is an Annual RSA?
Specific, Measurable, Attainable, Relevant, Time-bound
What are SMART Goals?
Heart Failure, CAD, COPD, ESRD, Diabetes
What are some qualifying conditions for C-SNP plan eligibility?
It is where we document creation and revision of the Individualized Care Plan (ICP).
What is the POC Member Review window in the POC Summary tab?
Qfiniti
Where can we find individual SNPMOC audit results?
If the current HRA/RSA is at least 10 months old
When does the case manager complete the next annual RSA?
Must be InFocus, have at least one specific LTG, and must remain open/be worked for the life of the case.
What are issues/concerns identified in the most recent RSA?
Nurse Case Manager, Health Care Advocate , and Clinical Administrative Coordinator.
What are required credentials found in ICUE?
This type of ICP sharing must occur on the date of member contact.
What is verbal sharing of the ICP?
DSNP and CSNP
What are the 2 types of Special Needs Programs that we serve?
Case Management/Disease Management, M&R and Diabetic Health Navigator
What is the Department that is selected on the RSA?
This happens at least every 30 days or per program guidelines.
What is the required frequency to review and revise the Plan of Care?
It is a daily operational report used by frontline staff to assist with ensuring SNP MOC compliance. and is our primary resource/tool for ensuring cases with exceptions are brought into compliance for SNP MOC metrics.
What is the daily SNP MOC Compliance Report?
With Program enrollment, with the completion of an RSA, with a transition of care, with a change in member condition, and when requested by the member.
When are we required to share the ICP with the member and provider? (ICP Sharing Triggers).