Gorman Health Group will conduct a webinar on the new guidelines in the next couple of weeks, but we wanted to get this out right away as the Centers for Medicare & Medicaid Services (CMS) has rewritten the Medicare Marketing Guidelines (MMG) for 2019. A lot of information is the same but just condensed – there are a lot changes! Here is the top 10 list of 2019 CMS MCMG changes:
- CMS has grouped activities and materials into Communications and Marketing that are distinguished based on intent and content. It will be important to understand the differences and educate your staff since interactions with beneficiaries can start out as a communication and end up as a marketing communication – with different compliance requirements.
- Plans/Sponsors may compare their plan to another plan/sponsor provided they can support the comparison through studies or statistical data and the comparisons are factually based. CMS does not provide any detail on the scope of studies or time periods required for statistical data, so proceed with caution if considering publishing plan comparisons.
- Plans cannot market during the Open Enrollment Period (OEP) or engage or promote agent/broker activities to target the OEP as an additional marketing opportunity but can do the following:
- Market to beneficiaries who are new to Medicare, also known as “age-ins,” who have not yet made an enrollment decision
- 5-star plans can continue the Special Enrollment Period (SEP)
- Market to dual-eligible and low-income subsidy (LIS) beneficiaries
- Send marketing materials and have meetings with those who request the information/meeting, and provide OEP information via the call center
- CMS has provided detailed guidance on activities in the healthcare setting with an emphasis on differentiating between activities a provider (or pharmacist!) performs as a matter of a course of treatment versus activities a plan or provider performs aimed at influencing an enrollment decision. If you recall, this was one of the specific topics for consideration for which the agency sought feedback in its April 12, 2018, request for input on this guidance.
- There is a new Material ID process – plans must use a “C” for communication materials or “M” for marketing materials at the end of the Material ID. Here is an example: H1234_abc567_C.
- Documents such as the Summary of Benefits (SB), Evidence of Coverage (EOC), Annual Notice of Changes (ANOC), directories, and formularies need to be posted by October 15. CMS has listed each required document in a chart that describes to whom required, timing, method of delivery, Health Plan Management System (HPMS) timing, format, additional guidance, and translation requirements. This is very helpful.
- Plans no longer have to mail the EOC to existing enrollees, but the ANOC must be mailed. If a new member enrolling throughout the year (for example, for a June 1 effective date) requests hard copy materials to be mailed to him/her, the hard copy request must be fulfilled within three business days, and the request remains in effect until the member leaves the plan or requests that hard copies be stopped.
- Plans must keep their call centers open 7 days a week, from 8 a.m. to 8 p.m., for an additional 6 weeks – from February 14 to March 31. These additional costs need to be factored into next year’s budget, and sponsors should be having conversations with any call center vendors supporting this line of business.
- The rules for disclaimers have changed again, but now it’s easier! Make sure you read each disclaimer since parts of some disclaimers are still needed or if you mention 10 or more benefits.
- Plans must submit website marketing content for review, including contracted third-party websites. Plans do not need to submit web pages with or containing CMS-required content for review. This is a 45-day review! This means almost every website needs to be reviewed now. Website content that has not been reviewed/approved cannot be viewable to the public. This is a significant change as sponsors were previously permitted to post websites that were pending review.
This is not a year to skim through the guidelines—we are still reading and re-reading the document to make sure we understand the implications. Good luck, and watch for our webinar in the upcoming weeks!
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