Model of Care
The Centers for Medicare & Medicaid Services (CMS) requires all Special Needs Plans (SNP) to have a Model of Care (MOC).
The MOC includes:
- Care coordination and care management for all Horizon NJ TotalCare (HMO D-SNP) members
- An Individualized Care Plan (ICP) based on member assessment and member feedback
- An interdisciplinary care team (IDT) that reviews the member’s Plan of Care and provides input in a collaborative way
- A member’s IDT consist of:
- Member/caregiver
- Medical Director
- Primary Care Provider
- FIDE-SNP Care Manager
- Behavioral Health Care Manager
- Pharmacist
- MLTSS Representative
- Quality Representative
- Physical therapy/occupational therapy
- Dental Representative
- A member’s IDT consist of:
Individualized Care Plan (ICP)
ICPs are:
- Created for each Horizon NJ TotalCare (HMO D-SNP) member using the Health Risk Assessment Tool and other data
- Coordinated with the member/caregiver
- Culturally appropriate
- Easy to understand
- Updated when a member’s status changes
- Shared with PCP and member
The member’s Care Manager will:
- Develop goals with the member/caregiver
- Coordinate care for members including doctor appointments, transportation, home care, prescription refills and durable medical equipment
For more information, contact Care Management at 1-888-621-5894 option 2.