SNF Training, SNP Model of Care Training, and Medicare Marketing Guidelines
In accordance with Centers for Medicare and Medicaid Services (CMS) regulations, Medicare Advantage organizations (MAOs) are required to establish, implement and ensure that all first-tier, downstream and related entities (FDRs) have taken and reviewed the following trainings and educational materials:
- SNF Training – Jimmo v. Sebelius Settlement
CMS recently issued a requirement related to the settlement of the 2013 Jimmo v. Sebelius class action lawsuit. The settlement addresses the delivery of skilled nursing services to Medicare beneficiaries and applies to nursing facilities, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met).
All Medicare providers are required to review this training in order to ensure that services are provided and coverage determinations are adjudicated accurately and appropriately in accordance with existing Medicare policy.
- Model of Care Initial and Annual Training
The Centers for Medicare and Medicaid Services (CMS) requires Medicare Advantage organizations (MAOs) to provide initial and annual Model of Care training for Special Needs Plans (SNP) and those participating in Medicare Medicaid Plans (MMP or Cal MediConnect). In accordance with the regulations, Health Net has developed the SNP/MMP Model of Care training. This requirement is applicable to SNP/MMP providers only.
CMS requires that SNP/MMP providers and appropriate staff (those involved in the provision of SNP/MMP services) complete the Model of Care training each year by December 31. The training can be provided in a variety of modalities, such as printed, face-to-face, or online Web-based formats. SNP/MMP providers do not have to submit confirmation of training upon completion; however, providers are subject to audit by CMS and Health Net to demonstrate that the training was provided to appropriate staff. Therefore, providers must maintain training records, which may consist of a mailing list, fax list, sign-in sheet, or other formats. You can use the Model of Care training that Health Net has provided here to fulfill this requirement. Remember to provide Model of Care training to new hires in addition to annually for existing staff.
- Medicare Marketing Guidelines
The Centers for Medicare and Medicaid Services (CMS) Medicare Managed Care Manual provides specific guidance regarding marketing communications to Medicare-eligible members by health plans and their participating providers. Health Net participating providers are required to comply with applicable Medicare laws and regulations, and Health Net policies and procedures when creating or distributing marketing materials.
The Health Net policies and procedures for submitting marketing materials is available on Health Net’s provider website in the Health Net Provider Library under Operations Manuals > Compliance and Regulations > CMS Provider Marketing Guidelines. For additional questions regarding Medicare marketing materials submission, or to submit Medicare marketing materials for approval, contact the Health Net Medicare Marketing Department by email at:
For updated and additional information regarding CMS Medicare marketing guidelines, refer to the CMS website at: