SNP Structure and Process for Public Comment 2

SNP Structure & Process Measures for Public Comment 1 SNP 1: Complex Case Management The organization coordinates services for members with complex conditions and helps them access needed resources. Intent The organization helps members with multiple or complex conditions to obtain access to care and services and coordinates their care Element A: Identifying Members for Case Management Final--Not For CommentThe organization uses the following data sources to analyze the health status of members. 1. Claim or encounter data 2. Hospital discharge data 3. Pharmacy data 4. Laboratory results 5. Data collected through the Utilization Management process, if applicable. 100% 80% 50% 20% 0% Scoring The The The The The organization organization organization organization organization meets 4 meets 3 meets 2 meets 1 factor meets 0 factors factors factors factors Data source Documented process, ReportsScope of SNP benefit package review Look-back For Initial Surveys: NCQA looks for evidence of completion of the required activities period during the 3 months prior to the survey date. Explanation The organization implements case management for members. Case management is the coordination of care and services provided to members to facilitate appropriate delivery of care and services. It involves comprehensive assessment of the member’s condition; determination of available benefits and resources; and development and implementation of a case ...