Dual Special Needs Plan Model of Care

The Centers for Medicare & Medicaid Services (CMS) issued final regulations on the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). As part of this regulation, the Special Needs Plan Model of Care (SNP) required implementation by January 1, 2010.

A Dual Special Needs Plan Model of Care (D-SNP MOC) describes how we provide healthcare services to our low-income senior (65+) members and members who have special needs. Our purpose is to provide them with access to care that is reliable, convenient, and accessible.

The SNP Model of Care requires that all Medicare SNP members receive an initial Health Risk Assessment (HRA) within 90 days of enrollment, and that an Individualized Care Plan (ICP) be created for each member. The ICP will be developed and shared with the member, the primary care physician (PCP), and any other parties involved in managing the member's care, such as IPA case managers or social workers. The purpose is to encourage the early identification of the member's health status and allow coordinated care to improve their overall health.

Health Risk Assessment process

Blue Shield of California created a standardized Health Risk Assessment (HRA) that evaluates the physical, psychosocial, cognitive, and functional needs of the Medicare SNP member. All calls, whether successful or unsuccessful, are documented and reported within the Blue Shield of California Care Management system.

Individualized Care Plan process

An Individualized Care Plan is generated according to the patient's answers on the HRA. The Care Plan is comprised of problems, interventions, and goals. Interventions are targeted to address the associated problems, resulting in the formation of either a short-term or long-term goal.

The member and the PCP receive a cover letter explaining the HRA process and the Individualized Care Plan. The PCP also receives a summary of the member's HRA responses.

Provider training

The Model of Care training requirement applies to providers who facilitate and/or provide care to Blue Shield members enrolled in Blue Shield’s Medicare Dual Special Needs Plans (D-SNPs).

This interactive course takes about 10 minutes to complete. Click the attestation link at the end to gain credit for completion. You will receive a confirmation email for your records.
  2024 Dual-Eligible Special Needs Plan provider training (10 min)

If you cannot access the interactive course, or if you are attesting on behalf of a specialty group or clinic with multiple providers, download the course PDF and complete the appropriate attestation form below.
  2024 Dual-Eligible Special Needs Plan provider training (PDF, 1.7 MB)

  2024 Course attestation for individuals and groups of up to 20 practitioners

  2024 Large Group attestation for groups of 20+ practitioners (PDF, 20 KB)

If you have questions about the Model of Care provider training requirement, refer to the FAQ below.

  2024 Model of Care FAQ (PDF, 145 KB)
 

Annual Dual Special Needs Plan Model of Care Evaluation

Annually, we check the quality of the care and service we make available to our Dual  Special Needs Plan members. We set goals and follow steps and actions to correct our process if we do not meet those goals. For more information on how we performed on meeting goals and corrective actions, please refer to the annual evaluation below.

  Read the 2023 Dual Special Needs Plan Model of Care Evaluation (PDF, 155 KB)