CMS Regulations

By: Tony Jackson


New CMS Regulations provide further clarification about what Medicare Advantage and Prescription Drug Plan marketing organizations and agents may and may not do in their marketing practices.

Following is a summary for agents. At the end of this article, you can find a link to the full relevant document from CMS.
What Agents May Do and May Not Do in Marketing MA and MAPD products:

1) Agents may offer nominal gifts to prospects ($15 or less, based on the retail purchase price). Effective September 18, 2008

a. Gifts cannot be readily convertible to cash.

b. Gifts must be provided regardless of whether or not the prospect enrolls in the plan.

2) Agents may not contact prospects by telephone or by personal visits. Effective September 18, 2008. This includes:

a. No outbound marketing calls, unless the beneficiary has requested the call.

b. No calls to former members who have disenrolled, or to current members who are in the process of disenrolling.

c. No calls to prospects to confirm the receipt of mailed marketing materials.

d. No calls to prospects to confirm acceptance of appointments made by third parties or independent agents.

e. No approaching prospects in common areas (such as parking lots and hallways).

f. No calls or visits to prospects who attend sales events, unless they provide specific permission.

3) Agents may contact clients under the following conditions. Effective September 18, 2008. This includes:

a. Calls to members (enrolled clients) to help them with needs concerning their plan.

b. Calls to members who have been involuntarily disenrolled from a plan and are in need of assistance.

c. Calls to former members, after the disenrollment effective date for the express purpose of conducting a disenrollment survey. This call (or other communication) may not include marketing materials.

d. Agents may call a beneficiary while they are currently enrolled in one of their plans.

e. Agents may call a prospect who has specifically requested a call, through such means as a Business Reply Card.

All outgoing call scripts must be approved in advance of their use.

4) No Cross Selling, Effective September 18, 2008
CMS is rightly concerned about a beneficiary’s need to focus on the difficult decisions they face with their Medicare coverage. For this reason, there is to be no cross-selling (such as Life Insurance) during an MA or MAPD presentation.
One of the biggest changes in marketing has to do with what CMS is calling the “Scope of the Appointment.”

5) The Scope of the Appointment, Effective September 18, 2008
The issue with this regulation is documentation. In other words, the agent (or agency) must document, either in writing or by phone recording that the prospect understands what kinds of products will be discussed in the presentation (i.e. MA, MAPD or Medicare Supplement). The beneficiary must agree (either in writing, or on a phone recording) that they agree to discuss any or all plans.

6) No Sales and Marketing in Health Care Settings, Effective September 18, 2008
This regulation really has not changed. As a Medicare agent, you may not sell or market in any area where Medical services are received. You may market (but not enroll) in a common area, such as a cafeteria.

7) No Sales and Marketing at Educational Events, Effective September 18, 2008
This regulation is fairly straightforward. Educational events are to be held for educational purposes only. You cannot talk about specific plans or present any marketing materials. In fact, your advertisements for these events must include the following disclaimer: “educational only and information regarding the plan will not be available.”
This does not mean that you cannot give a commercial about your services, namely that you are available for appointments if anyone would like to schedule an appointment.

8) No Meals May be Provided (i.e. Seminars at Restaurants) Effective September 18, 2008
Agents or agencies may provide snacks, but not meals at marketing events.

The full text and explanation of these regulations may be found at the following link:
http://www.cms.hhs.gov/HealthPlansGenInfo/Downloads/MIPPA_Imp_memo091208Final.pdf

If you would like to learn more about how you can effectively market your business, while working with these regulations, click here.

About the Author:

Tony Jackson is a leading authority on CMS Regulations. Tony is also the author of Medicare Marketing Gold