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.

The SNP Model of Care requires that all Medicare or Cal MediConnect 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 Promise created a standardized Health Risk Assessment (HRA) that evaluates the physical, psychosocial, cognitive, and functional needs of the Medicare or Cal MediConnect SNP member. Blue Shield Promise has contracted with a vendor to perform the telephonic HRA. All calls, whether successful or unsuccessful, are documented and reported to Blue Shield Promise.

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

This interactive module takes about 10 minutes to complete. Upon opening the course, you will be asked to fill out a registration form. Then, you must view each slide in the course to gain credit for completion.
2021 Cal MediConnect and Dual Eligible Special Needs Plan provider training (10 min)

If you cannot access the interactive module, or if you are submitting an attestation on behalf of a specialty group or clinic with multiple providers, please use the document below to view the course, and then complete the attestation form according to the instructions.
2021 Cal MediConnect and Dual-Eligible Special Needs Plan (PDF, 6.8 MB)
Attestation form (PDF, 64 KB)

Annual Dual Special Needs Plan Model of Care Evaluation

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. Annually, we check the quality of the care and service we make available to these members. We set goals and follow steps and actions to correct our process if we do not meet those goals.
Read the 2019 Dual Special Needs Plan Model of Care Evaluation (PDF, 64 KB)