Marketing and Communications Oversight for Plan Year 2024
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.
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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.
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
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.
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
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
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
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
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
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
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
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
