In April, the Centers for Medicare and Medicaid Services (CMS) announced their new Final Rule with many sources saying more clarifying information was coming soon. Although we will continue to pass along any guidance and clarification as it is released, we wanted to provide you with important changes for advisors writing Medicare this selling season. These new requirements must officially be put into place on October 1, 2023.
CMS clarified that virtual meetings are considered a call and do need to be recorded. This includes Zoom, Microsoft Teams, Facetime, or any other virtual platform used for virtual calls. In addition, CMS amended the rule to record sales or enrollment calls, rather than all calls that might lead to a sale. Please consider that if a call turns into a sale, it must be recorded.
Scope of Appointments (SOA)
SOAs must be obtained no less than 48 hours prior to presenting or enrolling a beneficiary. CMS clarified that SOAs are valid until a beneficiary enrolls in a plan or for 12 months from the signature date, whichever comes first. Exceptions to the 48-hour rule include:
- If the beneficiary is a walk-in appointment
- If the beneficiary is within the last four days of a valid enrollment period
CMS updated the required disclaimer. Please use the following disclaimer beginning October 1, 2023:
“We do not offer every plan available in your area. Currently, we represent [insert number of organizations] organizations that offer [insert number of plans] products in your area. Please contact Medicare.gov, 1–800–MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.”
According to CMS, marketing consists of steering or attempting to steer a potential enrollee towards a plan or a limited number of plans. Assisting in enrollment and education does not constitute marketing.
According to CMS, communications consist of activities and the use of materials created or administered by the plans or any downstream entity to provide information to current and prospective enrollees.
If you plan to do CMS marketing, please adhere to the following requirements:
- Third-Party Marketing Organizations (TPMOs), which include all agents, must get carriers’ approvals prior to submitting marketing materials in HPMS (the system for submitting marketing materials to CMS for approval).
- Do not advertise benefits in areas where the benefits are not available nor advertise beneficiary savings based on comparisons to an uninsured individual. Benefits must mention specific amounts and list the name of the plan. (Please note that carriers must approve materials that use their name.)
Use of Medicare Name
CMS is strengthening the rules regarding using the term Medicare and any other branded items, such as their logo and images of the Medicare card. The use of these items cannot confuse beneficiaries. CMS now requires prior authorization to use certain logos and assets including the image of the Medicare card.
Sales events can only take place 12 hours or more after an educational event in the same location. Agents are no longer allowed to set future sales meeting appointments nor collect Scope of Appointment forms at the event. Agents can collect Business Reply Cards or Permission to Contact forms if requested by an attendee.
CMS has clarified that Business Reply Cards and Permission to Contact forms do not give an agent permission to show up unscheduled at a beneficiary’s home. Only a scheduled appointment gives the agent permission to go to a beneficiary’s home.
If you have any questions about any of the new compliance rules, please contact La Rae Mills at [email protected] or (800) 255-1932. You can also click here to schedule a call with her at your convenience.