Is it the End of the Medicare Marketing Guidelines as we Know Them?

For those of us who have worked for years in the marketing and sales arena, the release of the Centers for Medicare & Medicaid Services (CMS) memo, “Request for Input on the 2019 Medicare Communications and Marketing Guidelines,” on April 12, 2018, somehow felt like the end of an era. In this memo, CMS confirms the Medicare Marketing Guidelines (MMG) will be renamed the “Medicare Communication and Marketing Guidelines.”

In addition to the simple name change of the chapter we know and love(?), it is also clear both within the Final Rule and within the request for input memo, the landscape for marketing and sales has changed. While in many areas we see CMS is increasing the level of detail contained within sub-regulatory guidance in order to address non-compliance, within the marketing and sales area, we see a shift and a loosening of the traditionally very prescriptive guidance contained in the MMG.

CMS states within their guidance release memo they will not release draft guidelines in 2018 (don’t panic quite yet). Rather, CMS has requested comment on certain key changes in the Final Rule, which will greatly impact guidance released in the final Medicare Communication and Marketing Guidelines.

Following, we’ve outlined and commented on the top five proposed changes we believe could have substantial impact on strategy, operations, and compliance:

1. CMS proposes removing the restriction on requesting email addresses when asking for referrals from enrollees.
a. GHG Comment: This change is in line with the overall change of permitting email marketing, beginning in 2018.

2. CMS proposes allowing Plans/Part D Sponsors to announce a nominal gift may be offered to enrollees for a referral when soliciting leads.
a. GHG Comment: The combination of permission to announce a nominal gift in exchange for leads as well as allowing those leads to include an email address could be a huge win and a huge change for the sales function.

3. CMS proposes updating the font size rule to only apply to required documents.
a. GHG Comment: We are not a supporter of this proposed change as we believe focus groups support the need for at least 12-point font for the Medicare population.

4. CMS proposes permitting agents to disseminate contact information at educational events.
a. GHG Comment: Again, we see here a (potential) overall softening of the stringent and prescriptive guidance we’ve all been used to in marketing and sales.

5. CMS proposes consolidating many disclaimers into a pre-enrollment checklist and requiring plans to disseminate the checklist one time with the Summary of Benefits instead of requiring the disclaimers on multiple marketing materials.
a. GHG Comment: This may seem like a small change, but for anyone who has had the “pleasure” of working on marketing materials each year, this could take a huge piece of that review away and greatly streamline the compliance review process.

In addition to the overall changes for which CMS is requesting industry comment, CMS also notes additional topics for consideration. Specifically, CMS notes “relationships within the health care industry are changing, resulting in a higher degree of provider-plan integration. Therefore, CMS is specifically soliciting comments on provider-based activities and whether the flexibility offered is broad enough to support and encourage new delivery methods, as well as co-branding relationships”. Last but not least, CMS also seeks comment on the “flexibilities related to Star Ratings and General Marketing Requirements that enhance plans’ ability to market competitively and foster fair comparisons, while making sure beneficiaries have clear and reliable information with which to base their choices.”

While we’ll all be waiting to see where CMS lands in the final Medicare Communication and Marketing Guidelines related to some of these areas for discussion and comment, one thing is clear – the game has changed, and we’ll all have to once again adapt and adjust our sales and marketing strategy, as well as our compliance oversight plan, with what will likely be very short notice once the final Medicare Communication and Marketing Guidelines are released.



Registration is open for the Gorman Health Group 2018 Forum, April 25-26, 2018, at the Red Rock Resort ideally located near the Red Rock Canyon in Las Vegas. Download our agenda here.

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