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CMS Memo: Definition of Marketing

Posted by www.psmbrokerage.com Admin on Mon, May 15, 2023 @ 11:24 AM

CMS Memo- Definition of Marketing

Date: May 10, 2023

To: Medicare Advantage Organizations, Medicare Advantage-Prescription Drug Plans, Prescription Drug Plan Sponsors, and Section 1876 Cost Plans

From: Kathryn A. Coleman, Director

Subject: Definition of Marketing

📑 Download the official announcement

In order to ensure Medicare beneficiaries are making enrollment decisions based on up-to-date and accurate information, the Centers for Medicare & Medicaid Services (CMS) is issuing this memo to clarify the definition of marketing for Medicare Advantage-Prescription Drug Plans, stand-alone Prescription Drug Plans, 1876 Cost Plans, and Third-Party Marketing Organizations (TPMOs).

Regulations at 42 CFR §§ 422.2260 and 423.2260 define marketing as communication materials and activities which meet specific intent and content standards.

  • The intent component of the definition of “marketing” is met when any material or activity is intended to draw a beneficiary's attention to plan or plans, influence a beneficiary's decision-making process when selecting a plan, or influence a beneficiary's decision to stay enrolled in a plan (that is, retention-based marketing).

  • The content component of the definition of “marketing” is met when any material or activity includes or addresses plan benefits, benefits structure, premiums, or cost sharing; measuring or ranking standards; or rewards and incentives.

To date, CMS has permitted the mentioning of widely available benefits (i.e., vision, dental, premium reduction, and hearing) in materials or activities without those materials or activities being considered marketing subject to the marketing regulations. We did not believe the general descriptions were made with sufficient intent to draw attention to a particular plan or subset of plans. This interpretation was predicated on the assumption that a beneficiary would be unlikely to make an enrollment decision based on widely offered benefits advertised without information on the associated costs for enrollees. CMS monitors both organization and TPMO marketing by reviewing marketing and communication materials and activities, reviewing complaints received through 1-800-Medicare, and listening to marketing and enrollment calls.

Due primarily to the recent proliferation of TPMO advertising, we have found, however, through our surveillance, reviews, and discussions with interested parties that many beneficiaries do inquire and some enroll based on the original advertisement of these types of benefits. Beneficiaries have contacted agents, made calls to 1-800 numbers, and responded to flyers asking about the dental, vision, hearing, and cost-savings being marketed. Therefore, we are expanding our interpretation of the regulatory definition of “marketing” to include content that mentions any type of benefit covered by the plan and is intended to draw a beneficiary's attention to plan or plans, influence a beneficiary's decision-making process when selecting a plan, or influence a beneficiary's decision to stay enrolled in a plan (that is, retention-based marketing) and thus subject to review.

As stated above, marketing requires both intent and content. Content that beneficiaries can receive benefits such as dental, vision, cost-savings, and/or hearing services is sufficient information about plan benefits, benefits structure or cost sharing to meet the content standard in the definition of marketing in §§ 422.2260 and 423.2260. Further, the use of these statements in advertisements and activities directed to Medicare beneficiaries clearly meets the intent standard. Therefore, beginning July 10, 2023, any material or activity that is distributed via any means (e.g., mailing, television, social media, etc.) that mentions any benefit will be considered marketing and must be submitted into HPMS. This clarification, along with the new marketing safeguards codified in the Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly final rule (CMS-4201-F), will help ensure that beneficiaries have accurate information when shopping for Medicare coverage and are protected from potentially misleading marketing activities.

Questions may be sent to marketing@cms.hhs.gov. Please copy your Marketing Reviewer.

Tags: CMS, Compliance, Marketing

Avoid These 5 Common Compliance Mistakes

Posted by www.psmbrokerage.com Admin on Thu, May 11, 2023 @ 10:20 AM

Compliance Mistakes-1

Here are five common mistakes and what you can do to remain in compliance with the Centers for Medicare and Medicaid Services (CMS) when working with Medicare beneficiaries on their coverage.

 

 

1. Not Keeping SOAs on File
Beneficiaries must sign a scope of appointment before discussing Medicare Advantage or Part D plans. Remember to have your client sign an SOA at every appointment, and keep the forms on file for 10 years.

2. Not Determining Health Care Providers
Before you can help someone with their Medicare plan, you need to know every physician and specialist that client sees. Compare current providers with those in their chosen plan’s network so their service isn’t disrupted.

3. Not Reviewing the Drug Formulary
An unexpected increase in prescription prices can quickly change the client-agent relationship. Be sure to review enrollment data and fix it on the spot so the application isn’t returned.

4. Not Discussing Summary of Benefits
Provide your client with this at the time they enroll, summarizing key features, such as covered benefits and cost sharing. This summary needs to be discussed prior to signature collection and verification of intent to enroll.

5. Not Submitting Applications on Time
Be sure to submit all applications in the required 24-48-hour time frame, after doublechecking all the details and ensuring the application is complete.

In this industry, we’re busy year-round, and unintentional mistakes can always happen. It’s important to stay on top of the application process and to know exactly what’s needed to remain compliant as we do business.

 

Tags: Compliance

Important Notice For Agents Conducting Telephonic Enrollments

Posted by www.psmbrokerage.com Admin on Wed, Mar 22, 2023 @ 02:43 PM

Important Notice For Agents Conducting Telephonic Enrollments-1

Important Notice

It is essential that agents are aware of CMS and Carrier expectations when conducting telephonic enrollments. Doing so not only protects the client, but also protects the agent from corrective action.

Please review the information below and ensure these elements are covered during a telephonic sale to remain compliant and to protect clients.



1.) Review the Summary of Benefits prior to completion of the enrollment:

Agent Must:

 Complete the SOB (Summary of Benefits) per approved script requirement.
  Accurately answer all additional questions asked by applicant or their legal representative
 Provide accurate information on plan details described.



2.) Read all required disclosures for the determined plan of interest:

Agent Must:

 Read all relevant disclosures as outlined in CMS approved script (i.e., verbally or via IVR(INTERACTIVE VOICE RESPONSE)) and collect agreement/understanding. This will include disclosures listed in the application (i.e.: pop up, required statements)



3.) Accurately complete the caller's application and review the following: 1) contact information, 2) payment options, 3) language preference, and 4) alternate format election:

Agent Must:

  Provide the plan name
  Advise of the plan's effective date
 
Confirm the beneficiary is ready to complete the enrollment



4.) Provide a compliant call closing:

Agent Must:

  Provide carrier name and customer service phone number
  Provide TTY
  Provide application confirmation number



5.) Obtain and document permission from the beneficiary prior to accessing MARx to determine eligibility on their behalf.
Agent must obtain permission from the beneficiary to access MARx on their behalf and explain they may note details regarding the following:

  Current enrollment
  Medicare Part A & B entitlement dates
 
Eligibility information
 
Incarceration, etc...



Note:
Agents do not need to list every detail to be compliant. There may be high-level discussion information that can be viewed by listing examples.

Thank you for your continued support in upholding compliant sales practices! If you have any questions regarding this information, please contact us.

 

Tags: Medicare Advantage, phone sales, Telesales, Compliance

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