TotalCare (HMO D-SNP) Model of Care
What is the Model of Care (MOC)?
The Model of Care (MOC) is a health plan’s blueprint for providing members with comprehensive care coordination. It is a requirement from the Centers for Medicare and Medicaid Services (CMS) for all Medicare Advantage Special Needs Plans (SNPs). TotalCare (HMO D-SNP) providers are required to complete MOC training.
The MOC serves as:
- The plan’s contracted agreement to provide members with comprehensive coordination of their care needs and services.
- The roadmap for promoting quality health care, encompassing the plan’s care management policies and procedures and operational systems.
- A vital quality improvement tool that ensures the unique needs of each D-SNP member are identified and addressed.
The MOC reinforces the plan’s mission by helping members get the right health care, in the right setting, at the right time. The MOC guides effective care and coordination to improve:
- Quality.
- Accessibility.
- Affordability.
- Care integration across specialties and settings.
- Transitions of care.
- Use of preventive health services.
- Utilization and cost effectiveness.
- Member health status.
- Target Population.
- Care Coordination.
- Provider Network.
- Quality Measurement.
Each of these components contains detailed requirements that must be evaluated and submitted to State and Federal agencies for review.
Model of Care provider requirements
- Complete the Model of Care training. Model of Care training is required to be completed by all employed, contracted and temporary staff, including providers (in or out of network) routinely participating as part of the member’s interdisciplinary care team. This training occurs upon onboarding and annually thereafter.
- After completing the training, complete the attestation. The Alliance maintains training attestation records, per CMS regulation.
Questions?
Contact your Provider Relations Representative or call Provider Services at 831-430-5504.
Contact Provider Services
| General | 831-430-5504 |
| Claims Billing questions, claims status, general claims information |
831-430-5503 |
| Authorizations General authorization information or questions |
831-430-5506 |
| Authorization Status Checking the status of submitted authorizations |
831-430-5511 |
| Pharmacy Authorizations, general pharmacy information or questions |
831-430-5507 |
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