TPMO Compliance Corner

CMS is Watching: Chain of Enrollment

• CMS is paying closer attention than ever to how beneficiaries move through the enrollment process – from the very first contact and lead generation all the way to submitting an application.
• Good documentation is not just best practice – it is essential for staying compliant.
• It is important that TPMOs are carefully tracking and documenting each step which means making sure you can clearly show how a beneficiary got from point A to point B.

Federal Register Medicare Program; 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

In 2024, CMS is introducing significant changes to the CMS Marketing Guidelines. The changes are aimed at improving the quality of healthcare services and ensuring that patients receive the right information. They will become effective September 30, 2023.

The primary changes you should be aware of:

• Call recording is limited to the point of enrollment: you no longer need to record appointment scheduling or retention activities
• 48-Hour SOA rule: you will need a signed Scope of Appointment (SOA) form 48 hours prior to the appointment. Exceptions include: the beneficiary is 4 days within the end of a valid election period, or the beneficiary is a walk-in
• Updated disclaimer on Marketing assets: Please use this disclaimer We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which 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." Build your disclaimer HERE.
• You may no longer use the Medicare Name, Logo or Card misleadingly: we recommend not using images of the Medicare card until CMS gives further guidance

These are the additional changes per the Federal Register:

• Plans must notify enrollees annually, in writing, of the ability to opt out of phone calls regarding MA and Part D plan business.
• Agents must explain the effect of an enrollee's enrollment choice on their current coverage whenever the enrollee makes an enrollment decision.
• Limit the time that a sales agent can call a potential enrollee to no more than 12 months following the date that the enrollee first asked for information.
• Prohibit a marketing event from occurring within 12 hours of an educational event at the same location.
• Clarify that the prohibition on door-to-door contact without a prior appointment still applies after the collection of a business reply card (BRC) or scope of appointment (SOA).
• Prohibit marketing of benefits in a service area where those benefits are not available, unless unavoidable because of the use of local or regional media that covers the service area(s)
• Prohibit the marketing of information about savings available 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.
• Require TPMOs to list or mention all the MA organizations or Part D sponsors that they represent on marketing materials.
• Require MA organizations and Part D sponsors to have an oversight plan that monitors agent/broker activities and reports agent/broker non-compliance to CMS.
• Modify the TPMO disclaimer to add SHIPs as an option for beneficiaries to obtain additional help
• Prohibit the collection of Scope of Appointment cards at educational events.
• Prohibit the use of superlatives (for example, words like "best" or "most") in marketing unless the material provides documentation to support the statement and the documentation is based on data from the current or prior year.
• Clarify 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.

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