SNP Model of Care Approval Process

This section includes useful information about the National Committee for Quality Assurance (NCQA) special needs plan (SNP) approval process.

The Affordable Care Act (ACA) amended section 1859(f) of the Social Security Act to require that, starting in 2012, all SNPs be approved by NCQA based on standards developed by the Secretary. As provided under 42 CFR §§ 422.4(a)(iv), 422.101(f), and 422.152(g), the NCQA approval process is based on evaluation and approval of the SNP model of care (MOC), as per CMS guidance. SNPs may still need to meet other application-related requirements to operate. Click on “MA Application Information” below for more information about the MA application process, including SNP proposals.

CY 2012 NCQA SNP Approval Process

CMS developed standards and scoring criteria for each of the 11 clinical and non-clinical elements and corresponding factors for the MOC for CY 2012. CMS has also implemented a multi-year approval process that allows plans to be granted a longer approval period based on higher MOC scores. Click on the “CY 2012 SNP Model of Care Approval Information” link below for more information about the MOC approvals for each SNP operating in CY 2012. This file includes columns for each SNP with the following information - State, county, company name, plan name, plan and contract ID number, SNP type, SNP subtype, the length of time the approval has been granted for, and the approval start and end dates.

Marketing Guidance on Permitted Disclosure of NCQA SNP Approval Information

CMS has also issued guidance to MA organizations on the permitted disclosure of information regarding their NCQA SNP approval to current and prospective beneficiaries. Click on the link for “Permitted Disclosure of NCQA SNP Approval Information” below to access this marketing guidance.