The CMS Final Rule 2023 was announced in May 2022 and requires all Medicare and Medicaid marketing calls to be recorded and stored for at least 10 years.
Call Recording Requirements
The language is important here as CMS has confirmed it interprets “enrollment” as “marketing.” The call recording requirement applies to all healthcare agents who enroll beneficiaries in new plans. Healthcare agents and brokers will be required to record all “marketing” calls with beneficiaries in their entirety, including the enrollment process. This rule applies to both new and existing clients. The call recordings must then be stored in a HIPAA compliant manner for at least 10 years.
CMS considers a “marketing” call anything that falls under the “Chain of Enrollment,” which is defined as any events from the point when a beneficiary is made aware of an MA/PDP plan to the end of the enrollment process.
Some examples of what the new recording rules cover include:
Contacting potential clients
Scheduling appointments for new and current clients
Collecting drug and provider lists
Hosting informational meetings
Enrolling clients by phone
All agents will also be required to include the following disclaimer:
“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 your options.”
The disclaimer must be included in the following places:
Verbally expressed within the first minute of a sales phone call
Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means
Prominently displayed on the agent’s or broker’s website
Included in all marketing materials, including print collateral (12-point font) and television advertisements
Additionally, the following requirements must be included in all call recordings and appointment forms:
Date of appointment
Beneficiary and agent contact information
Product types to be discussed
CMS has stated that there is no obligation to re-enroll current Medicare participants and their enrollment status will not be affected. Automatic enrollment will also not occur. That said, a new Scope of Appointment (SOA) is required if the beneficiary requests information about a plan not previously discussed.
NOTE: CMS has not laid out a compliance verification or auditing plan for the Final Rule 2023 changes.
How to Achieve Compliance
Ensuring agents can meet these new CMS requirements by October 1, 2022, comes down to two primary factors: technology and training.
PSM and YourMedicare have launched the Telephony system to agents nationwide. This new system gives agents the ability to make and receive calls through the YourMedicare SunFire platform. The system assigns agents a virtual phone number with a customizable area code, making the number more familiar for their clients.
Let’s address the new disclaimer CMS requires agents to state during the first minute of each call. With the YourMedicare SunFire platform, each call starts with a recording of the disclaimer, so there’s absolutely no need to worry about it.