Photographs in the Carol M. Highsmith Archive, Library of Congress, Prints and Photographs Division.
The CMS Final Rules for the upcoming plan year are now here. As a brokerage, it is essential for us to stay informed about regulatory changes that affect Medicare Advantage and Part D plans. Recently, the Centers for Medicare & Medicaid Services (CMS) released a final rule that introduces significant revisions to the Medicare Advantage, Medicare Prescription Drug Benefit (Part D), Medicare Cost Plan, and Programs of All-Inclusive Care for the Elderly (PACE) regulations. These updates encompass a broad range of areas, including Star Ratings, marketing and communications, health equity, provider directories, coverage criteria, prior authorization, and network adequacy.
In this blog post, we will highlight the key revisions of the final rule that directly impact agents and agencies. It is important to remember that we are still awaiting clarification from carriers and CMS on some rule changes, and we will share updates as they become available.
CMS Final Rules
1. Introducing a 48-hour waiting period between obtaining a Scope of Appointment and meeting with a beneficiary: Agents must now wait 48 hours between securing a Scope of Appointment and meeting with a beneficiary, with exceptions for beneficiary-initiated walk-ins and the end of a valid enrollment period.
2. Enhancing the TPMO disclaimer: Third-party marketing organizations (TPMOs) are now required to include SHIPs as an option for beneficiaries seeking additional help and to state the number of organizations and plans represented by the TPMO on marketing materials. MA organizations and Part D sponsors must also implement an oversight plan to monitor agent/broker activities and report non-compliance to CMS.
3. Implementing marketing restrictions: CMS prohibits agents from marketing savings based on unrealistic comparisons or promoting benefits unavailable in specific service areas.
4. Requiring annual notification about opting out of phone calls: Enrollees must be notified annually, in writing, of their ability to opt out of phone calls regarding MA and Part D plan business. Further clarification is needed to determine whether this requirement applies only to carriers or to agents as well.
5. Mandating explanation of enrollment choices: Agents are now required to explain the impact of an enrollee’s enrollment decision on their current coverage. We await carrier guidance on how the sales process will integrate this requirement.
6. Imposing a 12-month limit on sales agent contact: CMS does not allow sales agents to call potential enrollees more than 12 months after the enrollee first requested information. You are required to obtain new permission to contact after the 12-month window.
7. Narrowing call recording requirements: The obligation to record calls between TPMOs and beneficiaries is limited to marketing (sales) and enrollment calls, as opposed to “all calls.”
8. Prohibiting marketing events within 12 hours of educational events: Marketing events are not permitted to take place within 12 hours of an educational event held at the same location.
9. Banning the collection of Scope of Appointment cards at educational events: Agents are no longer allowed to collect Scope of Appointment cards at educational events.
10. Clarifying door-to-door contact rules: The prohibition on door-to-door contact without a prior appointment remains in effect even after collecting a business reply card (BRC) or scope of appointment (SOA).
11. Restricting the use of the Medicare name, logo, and card: CMS restricts agents from using the Medicare name, CMS logo, and Medicare card in a misleading manner, and they can only use the Medicare card image with prior CMS approval.
12. Banning the use of superlatives in marketing: Agents are not allowed to use superlatives (e.g., “best” or “most”) in marketing materials unless they provide supporting documentation based on data from the current or prior year.
Expanding the call recording requirements between TPMOs and beneficiaries: The obligation to record calls between TPMOs and beneficiaries now explicitly includes virtual connections, such as video conferencing and other virtual telepresence methods.
These revisions to the final rule aim to enhance transparency, ensure compliance, and improve the overall experience for Medicare beneficiaries. As the leading national FMO, it is our duty to adapt to these changes and continue providing the highest quality service to our clients. In the upcoming weeks, we will closely monitor updates and clarifications from CMS and carriers regarding these rule changes. We understand the importance of staying informed and being prepared to adjust our practices accordingly. Our team is committed to keeping you up-to-date with the latest information and providing the resources you need to succeed in this ever-changing landscape. Stay connected with us for future updates on these revisions and other important developments in the Medicare industry. If you have any questions or concerns, please do not hesitate to contact us. We are here to help you navigate these changes and ensure you continue delivering top-notch service to your clients.
Agents
We hope that this information on CMS final rules is useful to you. If you want to learn more about challenging youth culture click here.
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