Training Attestations

In accordance with guidance from the Centers for Medicare & Medicaid Services (CMS), all Care Coordinators and member facing Support Staff who support the work of Care Coordinators (e.g., Case Aides, Community Health Workers, etc.) who serve Medica’s Dual-Eligible Special Needs Plan (D-SNP) members must complete annual Model of Care (MOC) training.  By completing this form, you are attesting that you reviewed and understand the Medica SNP MOC training.

Remember to click the "Submit" button at the bottom of the page to complete the attestation. 

You may review the MOC training at any time at the following link: https://www.medica.com/care-coordination/training 


If you have any questions related to the required Medica SNP Model of Care training or this form, please contact Courtney.Chupurdy@Medica.com 

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* 1. First Name

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* 2. Last Name

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* 3. Professional Credentials, if any (example: LSW, RN, etc)

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* 4. Name of Care System/County/Agency

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* 5. If not included above, type in name of Delegate Care System/County/Agency/Organization

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* 6. I attest to have viewed the entire Medica SNP Model of Care Training (type name to serve as signature)

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* 7. Date of Model of Care training completion

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* 8. By checking this box, I agree that the signature and information I have entered is accurate, and what I have entered above (#6) is the electronic representation of my signature  for the purpose of the Medica Model SNP of Care training.

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