It was a hot summer night when the Centers for Medicare & Medicaid Services (CMS) released the final version of the calendar year 2018 Medicare Marketing Guidelines (MMG), and a few hot summer days have passed while the industry digests the changes. Don’t make the mistake and only share the MMG with sales and marketing; those handling enrollment, customer service, mailings, printing, Star Ratings and quality, compliance and oversight, legal affairs, provider relations, and finance (including delegates handling these functions) all have a stake in this chapter.
My colleague Nilsa Lennig Rudisill and I will be hosting a free webinar to address some of the key changes in the guidelines on August 15. Register for the webinar here. In the meantime, highlights include the following:
- Some no-brainer language was added in Section 30.4, Anti-Discrimination. Plans/Part D Sponsors must comply with their obligations under other anti-discrimination rules and requirements, including Section 1557 of the Patient Protection and Affordable Care Act. This may sound simple, but unless you are a legal professional, you may be unsure of which rules and requirements apply to your organization. Partner with your legal team to ensure you not only have policies and procedures addressing your organization’s commitment to these rules, but make sure everyone is walking the talk, especially in member-facing operations. You may be discriminating and might not even know it.
- For those living in the material world, CMS has finalized Appendices 4 and 5 for Summary of Benefits Instructions and Disclaimers, respectively. This should be a welcome change for sponsors who have used the MMG and other CMS memos in the past as a reference and have created their own tools for use.
- CMS provides additional guidance regarding the mailing of materials to enrollees at the same address. The organization needs to either have reasonable assurance the individuals are related or have otherwise received consent from the recipients in case they are not related. We recognize CMS provided flexibility here, but we implore organizations not to take any shortcuts in documenting their criteria for “reasonable assurance.”
- Speaking of materials, CMS has provided sponsors the flexibility to either send enrollees a hard copy of the full or abridged formulary at the time of enrollment and annually, or send a hard copy notice describing where enrollees can find the online formulary and how to request the formulary in hard copy. Sponsors should note, however, the 2018 Evidence of Coverage template states the formulary is either attached or mailed separately, indicating a slight disconnect. This was not addressed in the July 27 corrections memo either, so perhaps more is to come.
- Sponsors no longer need to upload educational or formal or informal marketing and sales events into the Health Plan Management System. CMS still requires the sponsor to keep accurate records of events as they may request the information at any time, so we anticipate sponsors will still require reporting of events from agents and brokers. None of the secret shopping tools have been updated in the Surveillance Module for quite some time, and some sponsors have experienced a drop in surveillance activities conducted by the agency. This change could indicate a shift in focus for the agency and their resources.
- For those who were eagerly awaiting the final language pertaining to agent compensation, see my colleague Betsy Seals’ blog for the detail on that topic.
- CMS is now allowing sponsors to market via electronic communications, including email. “Although in the past, email has not typically garnered a large return of leads, it will be interesting for marketers to test this channel again to understand its effectiveness in the marketplace today,” notes Diane Hollie, Senior Director of Sales, Marketing & Strategy. Remember to review the disclaimers in Appendix 5 since there are disclaimers particular to email.
- There remains no mention of the 48-hour time frame for Scopes of Appointment (SOAs), only that the sponsor must document the SOA prior to the appointment. Given that this provides significant flexibility for agents, it stands to reason SOAs may be obtained minutes before an appointment takes place. CMS requires the SOA documentation to include the date of appointment, but if the SOA date and appointment date are the same, this leaves an organization open to scrutiny as to whether the SOA was obtained after the appointment. Capturing the time on SOA methods not currently capturing the time would fill this gap.
- In case you may have missed it, CMS released a sample Summary of Benefits document. Organizations are not required to use this document as long as they follow the requirements outlined in the MMG.
You’ve got to wonder if each revised chapter CMS issues is a collection of lessons learned from the previous period of time. Regardless, the agency seems to be streamlining and refining guidance not only to ease burden on sponsors but to also provide necessary clarification as needed. More to come during our webinar scheduled for August 15. If there are any questions you’d like us to review ahead of time, send them to us here. What changes are impacting your organization and to what extent? Contact us on ways we can help your operations be successful in implementing the MMG.
Want to stay up to date on policy and regulation changes? The Insider is GHG’s exclusive intelligence briefing, providing in-depth analysis and expert summaries of the most critical legislative and political activities impacting and shaping your organization. Read our full press release >>
Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG’s weekly newsletter. Subscribe >>