Special Needs Plan Learning Path

This SNP Learning Path series does NOT replace the SNP Model of Care and Final Rule trainings that are required annually by a health plan.

Activity description

A Special Needs Plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care; it limits enrollment to special needs individuals. The Centers for Medicare and Medicaid Services (CMS) have identified certain populations as having special needs that require enhanced or specialized standards of health care. These individuals have various social determinants of health (SDOH) such as low income, transportation and housing needs and social isolation. They may also have mental or behavioral health diagnoses, multiple chronic conditions, or they may be receiving long-term services. CMS has certain requirements and compliance standards that must be adhered to by the health plan and any organizations delegated for SNP activities. The goal of this learning path is to create an understanding of CMS requirements and standards as they apply to SNP; provide key principles to care managing vulnerable populations at higher risk for adverse health events, including members of a Dual Special Needs Plan (DSNP); explain the importance of Care Transition Protocols (CTP); and review how to fulfill member needs across the continuum of care through a Complex Case Management (CCM) team.

Provided by
This activity is provided by OptumHealth Education and Optum Care.

Commercial support
No commercial support was received for this activity.

Hardware/Software Requirements
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Target Audience

This activity is designed to meet the educational needs of physicians, PAs, nurses, nurse practitioners, case managers, social workers and other health care professionals (HCPs) who have an interest in SNPs.

Learning Objectives

At the end of this educational activity, participants should be able to:

  • Define the categories of SNPs.
  • Discuss key principles to care managing vulnerable populations at higher risk for adverse health events.
  • Explain the importance of following the required elements for Health Risk Assessments (HRA), Individualized Care Plans (ICP), the use of Interdisciplinary Care Teams (ICT) and managing patients across Transitions of Care (TOC).
  • Determine how to manage member needs across the continuum of care.

Additional Information

Activity summary
Available credit: 
  • 4.00 AMA
  • 4.00 ANCC
  • 4.00 Attendance
  • 4.00 CCMC - General
  • 4.00 ASWB
Activity opens: 
11/20/2020
Activity expires: 
12/31/2023

Faculty
Lolly Bilous, MSN, RN, CCM
Training Consultant 
Clinical Adherence and Remediation
Clinical Consistency and Safety
Clinical Performance
Optum Care

Kris Blair, MBA, BSN, RN 
Associate Director 
Clinical Adherence and Remediation Team
Clinical Consistency and Safety
Clinical Performance 
Optum Care

Amy Holdren, BSN, RN, CCM
Senior Clinical Program Consultant
Clinical Consistency and Safety
Clinical Performance 
Optum Care

Lauri McCoy, MSN, RN
Clinical Program Consultant Sr
Clinical Consistency and Safety
Clinical Performance 
Optum Care

Valerie Ventura, MSN, RN
Vice President
Clinical Adherence and Remediation
Clinical Consistency and Safety
Clinical Performance 
Optum Care

Planners
Sarah Chart, RN
Vice President
OptumHealth Education

Rebecca Gleason, RN, CCM
Activity Manager
OptumHealth Education

Kevin Heath, MD, MHL, FACP
Medical Director
Clinical Performance 
Optum Care

Disclosures of relevant financial relationships
In accordance with the ACCME Standards for Commercial SupportSM, OptumHealth Education (OHE) requires all those involved in the development of activity content to disclose their relevant financial relationships. An individual has a relevant financial relationship if such person (or his/her spouse/partner) has a financial relationship in any amount occurring in the last 12 months with a commercial interest. OHE ensures that the content is independent of commercial bias.

The activity faculty or planners have no financial relationships to disclose.

Method for calculating CE credit
CE credit was calculated by the complexity of content.

Accreditation Statement
Joint LogoIn support of improving patient care, this activity has been planned and implemented by OptumHealth Education and Optum Care. OptumHealth Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE) and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Credit Designation Statements

Nurses
The participant will be awarded up to 4.00 contact hours of credit for attendance and completion of supplemental materials.

Nurse practitioners
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts credit from organizations accredited by the ACCME and ANCC.

Physicians
OptumHealth Education designates this enduring activity for a maximum of 4.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

PAs
The American Academy of Physician Assistants (AAPA) accepts credit from organizations accredited by the ACCME.

Social workers
ACE logoAs a Jointly Accredited Organization, OptumHealth Education is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. OptumHealth Education maintains responsibility for this course. Social workers completing this course receive 4.00 continuing education credits.

Case managers
The Commission for Case Manager Certification has approved this program for a maximum of 4.00 clock hours for Certified Case Managers (CCM).

Attendance
A certificate of attendance will be provided to learners upon completion of activity requirements, enabling participants to register with licensing boards or associations that have not been pre-approved for credits. To apply for credit types not listed above, participants should use the procedure established by the specific organization with which they wish to obtain credit.

Available Credit

  • 4.00 AMA
  • 4.00 ANCC
  • 4.00 Attendance
  • 4.00 CCMC - General
  • 4.00 ASWB
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This SNP Learning Path series does NOT replace the SNP Model of Care and Final Rule trainings that are required annually by a health plan.