On May 9, 2022, CMS issued new requirements for third-party organizations (TPMOs) with an effective date of June 28, 2022 and an applicable date of January 1, 2023. CMS interpreted the applicability date to apply to marketing for the January 1, 2023 date (AEP).
The requirements are:
1. The definition of TPMOs was defined in CFR Section 42 § 422.2260 and § 423.2260 as organizations and individuals, including independent agents and brokers, who are compensated to perform lead generation, marketing sales, and enrollment related functions as a part of the chain of enrollment. TPMOs may be a first tier, downstream or related entity (FDR), but can also be entities that are not FDRs but provide services to an MA plan or an MA plan’s FDR.
This definition was refined to include independent agentsand brokers due to CMS’ growing concerns about the activities of TPMOs and the increase in the number of alleged complaints about these organizations misleading beneficiaries about advertised benefits.
2. TPMOs must use the standardized disclaimer codified in CFR 42 § 422.2267(e)(41) and §423.2267(e)(41). The disclaimer required states: ‘‘We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.’’ This disclaimer would be required on any marketing materials and websites stated verbally or in writing.
3. CFR Section 42 § 422.2274(g) and § 423.2274(g) includes the requirement that all agents would be required to record and store all calls associated with enrollments of Medicare Advantage and PDP. At this time, this requirement includes all agents and would be applicable to new and existing customers. The rule references marketing calls, which is interpreted by CMS includes enrollments. The only enrollments that do not need to be recorded are those that are actually face-to-face. However, if an agent walks a consumer through an online enrollment (even while sitting in the home), it must be recorded. Storage would be required for 10 years.
PSM has solutions currently and will make additional information available as soon as possible, however all agents should make preparations for recording and storage of all calls (inbound and outbound).
More details to come as we receive more updates and guidance.