ARE YOU AFFECTED BY THE PROPOSED CMS GUIDELINES? If You Purchase Leads, Sell Leads Or Are Involved In Marketing, Then YES!
Hey TCPA World, I wanted to provide some additional insight to the CMS Proposed Rules published in late December 2022. We want to make sure that you understand the implications of these proposed rules. Comments Are Due In 14 Days! (see information below)
Are you a lead generator?
Are you a lead aggregator?
Are you a lead seller?
Are you an insurance sales agent?
Do you use Business Reply Cards or Scope of Appointment for lead generation?
Are you responsible for quality assurance related to Medicare or Medicare Advantage?
Are you responsible for marketing related to Medicare or Medicare Advantage?
Do you use the Medicare logo?
Do you plan educational events followed by marketing to consumers related to Medicare or Medicare Advantage?
Are you responsible for operations related to Medicare Advantage?
Are you a Third-Party Marketing Organization (TPMO)?
Do you work with a Third-Party Marketing Organization (TPMO)?
Do you know someone who may qualify for any of these? If so, please share!!
THEN, you should absolutely review our earlier blog and the CMS Proposed Rules at *2022-26956.pdf (federalregister.gov).
As I mentioned, the proposed changes will have some significant impact to the marketing and lead generation industry surrounding Medicare, Medicare Advantage, Marketing Standards and Implementation.
Some proposed changes include:
notifying enrollees annually, in writing, of the ability to opt out of phone calls regarding MA and Part D plan business;
requiring agents to explain the effect of an enrollee’s enrollment choice on their current coverage whenever the enrollee makes an enrollment decision;
requiring agents to share key pre-enrollment information with potential enrollees when processing telephonic enrollments;
simplifying plan comparisons by requiring medical benefits be in a specific order and listed at the top of a plan’s Summary of Benefits;
limiting the time that a sales agent can call a potential enrollee to no more than six months following the date that the enrollee first asked for information;
limiting the requirement to record calls between third-party marketing organizations (TPMOs) and beneficiaries to marketing (sales) and enrollment calls;
clarifying that the prohibition on door-to-door contact without a prior appointment still applies after collection of a business reply card (BRC) or scope of appointment (SOA);
prohibiting marketing of benefits in a service area where those benefits are not available;
prohibiting the marketing of information about savings available to potential enrollees that are based on a comparison of typical expenses borne by uninsured individuals, unpaid costs of dually eligible beneficiaries, or other unrealized costs of a Medicare beneficiary;
requiring TPMOs to list or mention all of the MA organization or Part D sponsors that they sell;
requiring MA organizations and Part D sponsors to have an oversight plan that monitors agent/broker activities and reports agent/broker non-compliance to CMS;
modifying the TPMO disclaimer to add SHIPs as an option for beneficiaries to obtain additional help;
placing discrete limits around the use of the Medicare name, logo, and Medicare card;
prohibit the use of superlatives in marketing unless the material provides documentation to support the statement, and the documentation is for the current or prior year and
clarifying the requirement to record calls between TPMOs and beneficiaries, such that it is clear that the requirement includes virtual connections such as video conferencing and other virtual telepresence methods.
CMS solicits comment on these marketing and communications proposals and whether the proposed regulatory changes will sufficiently achieve the goals outlined of protecting beneficiaries. Comments may be submitted via email to http://www.regulations.gov, or mail (regular, overnight or express).