Model of Care. (a) The MA Health Plan agrees to provide EOHHS on an annual basis its approved Model of Care (“MOC”) to ensure alignment with EOHHS expectations and care coordination of Medicaid benefits.
Model of Care. The ICO, in partnership with network providers, must implement an evidence-based model of care consistent with and the requirements set forth in this section and Section 2.6
Model of Care. All Participating Plans (in partnership with contracted providers) will be required to implement an evidence-based model of care (MOC) having explicit components consistent with the SNP Model of Care. California’s comprehensive care coordination requirements summarized in section IV will also apply and be outlined in the three-way contract. CMS’ MOC approval process is based on scoring each of the eleven clinical and non-clinical elements of the MOC. California included supplemental information in each of the eleven elements specific to integrated benefits and services under the demonstration. The supplemental information included care coordination, long-term services and supports, and behavioral health. CMS and California do not believe the supplemental information conflicts with the SNP Model of Care elements. The scoring methodology is divided
Model of Care. Under the Medicare Advantage program, a Special Needs Plan is required to have a model of care. All SNPs’ models of care must be approved by NCQA based on CMS standards and the requirements in 42 CFR §§ 422.4(a)(iv), 422.101(f), and 422.152(g). Prior to the next scheduled MOC submission for each MSHO SNP, CMS will give the State an opportunity to tailor the MOC elements, to reflect the MSHO requirements and processes, subject to CMS approval.
Model of Care. All MMPs (in partnership with contracted providers) will be required to implement an evidence-based Model of Care (MOC) meeting all CMS MOC standards for Special Needs Plans (SNP). CMS’ MMP MOC approval process is based on scoring each of the eleven clinical and non-clinical elements of the MOC. The scoring methodology is divided into three parts: (1) a standard; (2) elements; and (3) factors. These components of the MOC approval methodology are defined below:
A. Standard: The standard is defined as an MOC that has achieved a score of 70 percent or greater based on NCQA’s scoring methodology.
Model of Care. All CICOs (in partnership with contracted providers) will be required to implement an evidence-based model of care (MOC) having explicit components consistent with the Special Needs Plan Model of Care. CMS’ CICO MOC approval process will be based on scoring each of the thirteen clinical and non-clinical elements of the MOC (both CMS and State elements are included). The scoring methodology is divided into three parts: (1) a standard; (2) elements; and (3) factors. These components of the MOC approval methodology are defined below:
Model of Care. The Demonstration Plan, in partnership with network Providers, must implement an evidence-based model of care consistent with the requirements set forth in this section and Section 2.6.
Model of Care. A project has been set up to develop a new model of patient care which may include the classifications of Enrolled Nurses and/or Enrolled Nurses – Special Grade and any other classifications which may assist nurses in performing their professional duties.
Model of Care. The second model is the tiered model of care, which encourages collaboration between different types of obstetric providers. In this model, all deliveries take place at a centralized hospital, while outpatient services are provided at part-time clinics distributed throughout the area. Certified Nurse Midwives (CNM’s), provide care to low risk patients in decentralized clinics and assist in labor and delivery of low-risk patients. Obstetricians care for moderate risk patients, identified by the mid-level providers, in fewer, more centralized locations. They will then delivery complicated births and uncomplicated antepartum care. Finally, Maternal Fetal Medicine (MFMs) specialists see high-risk patients in one central location for pre-natal care and will deliver all high-risk patients. This model provides the option of a single flat-fee for comprehensive outpatient maternity care (including all labs, ultrasounds, monitoring, etc.). They also accept private insurance and Medicaid.
Model of Care. ANMF seek a commitment that a new model of care (which may include a hybrid Nursing Hours Per Patient Day/Ratio tool) will be implemented as a matter of urgency. The model should provide indirect care hours for the following: Associate Nurse Unit Managers, Nurse Unit Managers, Clinical Nurse Educators, Clinical Nurse Consultants, Clinical Nurse Specialists and Clinical Coordinators. Any recommended model which is adopted should apply to all areas within the THS. Further ANMF seek a model to compliment the agreed Birthrate Plus methodology which calculates staffing requirements for infant/neonates across maternity units. A date for introduction of agreed workload provisions to be included in the agreement.
