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

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.