Marketing and Communications Oversight for Plan Year 2024

undefined
 
 
 
Marketing Updates PY 2024
 
Presentation to the
NAIC
 
Nyetta Patton
Ken Gardner
 
August 2023
Disclaimer
 
This information is current at the time of presentation but
Medicare, Medicaid and Marketplace policy is subject to
change. The contents of this document do not have the force
and effect of law and are not meant to bind the public in any
way, unless specifically incorporated into a contract. This
document is intended only to provide clarity to the public
regarding existing requirements under the law. This
communication was printed, published, or produced and
disseminated at U.S. tax payer expense.
 
3
 
Definition of Marketing
 
Communications:
 activities and use of materials created or administered by
the plans or any downstream entity to provide information to current and
prospective enrollees. All activities and materials aimed at prospective and
current enrollees, including their caregivers, are “communications” within the
scope of the regulations at 42 CFR Parts 417, 422, and 423
 
Marketing: 
a subset of communications and must, unless otherwise noted,
adhere to all communication requirements. To be considered marketing,
communications materials must meet both 
intent 
and 
content
 standards. In
evaluating the intent of an activity or material, CMS will consider objective
information including, but not limited to, the audience, timing, and other
context of the activity or material, as well as other information
communicated by the activity or material. The organization's stated intent will
be reviewed but not solely relied upon
 
HPMS Memo Issued 5/10/23
 
Expanding 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.
 
U
p
d
a
t
e
d
 
I
n
t
e
r
p
r
e
t
a
t
i
o
n
 
o
f
 
t
h
e
 
D
e
f
i
n
i
t
i
o
n
 
o
f
M
a
r
k
e
t
i
n
g
 
 
 
For plan year 2024, CMS is continuing to strengthen
its marketing and communications oversight with
several regulatory updates
 
Marketing & Communications Oversight
Improvements for Plan Year 2024
 
6
 
Prohibit marketing unless the names of MA organizations or marketing name(s)
of entities offering the referenced products or plans, benefits, or costs are
identified in the marketing material
MA organizations can’t use the 
Medicare name, logo, and Medicare card
 image
in a misleading way
Use of the Medicare card image is permi
tted only with authorization from
CMS
Prohibit
 unsubstantiated statements without supporting data
 in the marketing
piece    (supporting data must be current year or one year prior)
Prohibit 
advertising benefits not available in the service area
 where the
marketing appears
Prohibit
 marketing of "savings" not realized: MA organizations cannot advertise
about savings available that are based on a comparison of typical expenses for
uninsured individuals, unpaid costs of dually eligible beneficiaries, or other
unrealized costs of person with Medicare
 
 
Marketing & Communications Oversight
Improvements for Plan Year 2024
 
7
 
Clarify the prohibition of unsolicited door to door contact
 
Opt
-out Notice: 
Requirement for an MA plan to annually offer
current members an opt-out of future calls regarding plan business
 
Prohibit
 
marketing
 events from taking place within 12 hours of an
educational event
 
Require a Scope of Appointment record with the person with
Medicare at least 48 hours prior to scheduled personal marketing
 
Limit
 the time a sales agent can call a potential enrollee: up to 12
months following the date that the enrollee first asked for
information
 
Marketing & Communications Oversight
Improvements for Plan Year 2024
 
8
 
Requirement 
that, prior to an enrollment, CMS’ required
questions and topics regarding the individual’s needs in a
health plan choice are fully discussed
 
Section 
added to the Pre-enrollment checklist (PECL)
explaining the effect of enrolling in a new plan
 
Requiring that medical benefits are listed in specific order and
at the top of a plan’s Summary of Benefits
 
 
 
 
Marketing & Communications Oversight
Improvements for Plan Year 2024
 
9
 
 
Update to the Third-Party Marketing Organization (TPMO) Disclaimer:
SHIPs added as an option for beneficiaries to get additional help
Must include the number of organizations/plans represented
 
Limit
 the requirement to record calls between TPMOs and people with
Medicare to marketing (sales) enrollment calls
 
TPMOs must list all MA organizations and Part D Sponsor that they
represent on marketing materials
 
MA organizations must establish and implement an oversight plan that
monitors agent and broker activities, identifies non-compliance with CMS
requirements, and reports non-compliance to CMS
 
 
 
 
Marketing & Communications Oversight
Improvements for Plan Year 2024
 
Increased types of material prospectively reviewed by CMS
Television Ads
Online Videos
Radio Ads
Provider Office Material
Sales Presentations
Enrollment Forms
Errata
 
 
 
A
d
d
i
t
i
o
n
a
l
 
O
v
e
r
s
i
g
h
t
 
f
o
r
 
P
Y
 
2
0
2
4
:
 
Call 1-800-Medicare
Marketing Misrepresentation Cases where a beneficiary’s
enrollment was affected
1-800 will determine if a marketing misrepresentation took place and can
fix the enrollment
 Plans will investigate the case, and CMS will review the investigation
notes
 
Contact your CMS DOI Liaison
 
Unallowed marketing practices you observe
Questions about Agent/Broker Do’s & Don’ts
 
Communicate through the NAIC Marketing Sub-group
 
A CMS Marketing SME attends meetings
 
Reporting Issues to CMS
 
DOI Liaison Listing
 
 
Questions?
Slide Note
Embed
Share

Enhancements in marketing and communication oversight for Plan Year 2024 include regulatory updates to strengthen CMS's monitoring. Marketing materials must now clearly identify MA organizations or entities offering products or plans. The definition of marketing communications has been expanded to cover content influencing beneficiaries' decisions, subject to review. Stay informed to comply with the evolving regulations affecting Medicare, Medicaid, and Marketplace policy.


Uploaded on Apr 03, 2024 | 0 Views


Download Presentation

Please find below an Image/Link to download the presentation.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.

E N D

Presentation Transcript


  1. Marketing Updates PY 2024 Presentation to the NAIC Nyetta Patton Ken Gardner August 2023

  2. Disclaimer This information is current at the time of presentation but Medicare, Medicaid and Marketplace policy is subject to change. The contents of this document do not have the force and effect of law and are not meant to bind the public in any way, unless specifically incorporated into a contract. This document is intended only to provide clarity to the public regarding existing requirements under the law. This communication was printed, published, or produced and disseminated at U.S. tax payer expense.

  3. Definition of Marketing Communications: activities and use of materials created or administered by the plans or any downstream entity to provide information to current and prospective enrollees. All activities and materials aimed at prospective and current enrollees, including their caregivers, are communications within the scope of the regulations at 42 CFR Parts 417, 422, and 423 Marketing: a subset of communications and must, unless otherwise noted, adhere to all communication requirements. To be considered marketing, communications materials must meet both intent and content standards. In evaluating the intent of an activity or material, CMS will consider objective information including, but not limited to, the audience, timing, and other context of the activity or material, as well as other information communicated by the activity or material. The organization's stated intent will be reviewed but not solely relied upon 3

  4. Updated Interpretation of the Definition of Marketing HPMS Memo Issued 5/10/23 Expanding 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.

  5. Marketing & Communications Oversight Improvements for Plan Year 2024 For plan year 2024, CMS is continuing to strengthen its marketing and communications oversight with several regulatory updates

  6. Marketing & Communications Oversight Improvements for Plan Year 2024 Prohibit marketing unless the names of MA organizations or marketing name(s) of entities offering the referenced products or plans, benefits, or costs are identified in the marketing material MA organizations can t use the Medicare name, logo, and Medicare card image in a misleading way Use of the Medicare card image is permitted only with authorization from CMS Prohibit unsubstantiated statements without supporting data in the marketing piece (supporting data must be current year or one year prior) Prohibit advertising benefits not available in the service area where the marketing appears Prohibit marketing of "savings" not realized: MA organizations cannot advertise about savings available that are based on a comparison of typical expenses for uninsured individuals, unpaid costs of dually eligible beneficiaries, or other unrealized costs of person with Medicare 6

  7. Marketing & Communications Oversight Improvements for Plan Year 2024 Clarify the prohibition of unsolicited door to door contact Opt-out Notice: Requirement for an MA plan to annually offer current members an opt-out of future calls regarding plan business Prohibit marketing events from taking place within 12 hours of an educational event Require a Scope of Appointment record with the person with Medicare at least 48 hours prior to scheduled personal marketing Limit the time a sales agent can call a potential enrollee: up to 12 months following the date that the enrollee first asked for information 7

  8. Marketing & Communications Oversight Improvements for Plan Year 2024 Requirement that, prior to an enrollment, CMS required questions and topics regarding the individual s needs in a health plan choice are fully discussed Section added to the Pre-enrollment checklist (PECL) explaining the effect of enrolling in a new plan Requiring that medical benefits are listed in specific order and at the top of a plan s Summary of Benefits 8

  9. Marketing & Communications Oversight Improvements for Plan Year 2024 Update to the Third-Party Marketing Organization (TPMO) Disclaimer: SHIPs added as an option for beneficiaries to get additional help Must include the number of organizations/plans represented Limit the requirement to record calls between TPMOs and people with Medicare to marketing (sales) enrollment calls TPMOs must list all MA organizations and Part D Sponsor that they represent on marketing materials MA organizations must establish and implement an oversight plan that monitors agent and broker activities, identifies non-compliance with CMS requirements, and reports non-compliance to CMS 9

  10. Additional Oversight for PY 2024: Increased types of material prospectively reviewed by CMS Television Ads Online Videos Radio Ads Provider Office Material Sales Presentations Enrollment Forms Errata

  11. Reporting Issues to CMS Call 1-800-Medicare Marketing Misrepresentation Cases where a beneficiary s enrollment was affected 1-800 will determine if a marketing misrepresentation took place and can fix the enrollment Plans will investigate the case, and CMS will review the investigation notes Contact your CMS DOI Liaison Unallowed marketing practices you observe Questions about Agent/Broker Do s & Don ts Communicate through the NAIC Marketing Sub-group A CMS Marketing SME attends meetings

  12. DOI Liaison Listing Region l City Boston States Name Email Scott.Labrecque@cms.hhs.gov CT, MA, ME, NH, RI, VT Scott Labrecque Sherice.Fleet@cms.hhs.gov II New York NY, NJ, PR, VI Sherice Fleet scott.beach@cms.hhs.gov lll Philadelphia DC, DE, MD, PA, VA, WV Scott Beach IV Atlanta AL, FL,GA, KY, MS, NC, SC, TN Hugo Huapaya hugo.huapaya@cms.hhs.gov michael.reardon@cms.hhs.gov V Chicago IL, IN, MI,MN, OH, WI Mike Reardon lindsay.swindall@cms.hhs.gov VI Dallas TX, AR, LA, NM Lindsay Swindell cynthia.ford@cms.hhs.gov VII Kansas City IA, KS, MO, NE Cindy Ford lindsay.swindall@cms.hhs.gov VIII Denver CO, MT, ND, SD, UT, WY Lindsay Swindell kaihe.akahane@cms.hhs.gov IX San Francisco AZ CA, NV, HI, PACIFIC TERRITORIES AK, ID, OR, WA Kaihe Akahane Harold Goodwin harold.goodwin@cms.hhs.gov george.lombard@cms.hhs.gov X Seattle George Lombard

  13. Questions?

Related


More Related Content

giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#