2018 CMS Marketing Guidelines

Discussion in 'Senior Insurance Forum' started by Justin Bilyj, Jul 24, 2017.

  1. Ronnie Carter
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    I found this one a bit interesting:

    *********************
    70.4.1 – Educational and Marketing Events
    42 CFR 422.2268, 423.2268, 422.504(f)(2), 423.505(f)(2)
    Plans/Part D Sponsors are not required to upload educational, formal and/or
    informal marketing/sales events in HPMS. Plans/Part D Sponsors must keep
    accurate records of all marketing/sales and educational events, and CMS
    reserves the right to request event information at any time.
    *********************

    I suppose the reporting requirements proffered by plan sponsors will still be on the "strict" side.
     
  2. craig_ritter
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    craig_ritter Super Genius

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    No 48 hour rule for Scope of Appointment. YUGE!
     
  3. sman
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    Yep. It was a stunt man. He missed the landing pad.
     
  4. Devin01
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    Question Has anyone paid a referal fee to a non liscensed person for a MAPD PLan? Section 120.4 does not explicitly say you can or can not.It does say you can pay an agent 100 dollars

    120.4 - Compensation Applicability and Definitions
    42 CFR 422.2274, 423.2274

    Referral/Finder’s Fees: Referral/Finder’s fees paid to agents and brokers, including independent, employed, and captive agents and brokers, may not exceed $100 ($25 for PDPs). CMS expects that this amount will not provide enough financial incentive for an agent or broker to recommend or enroll a beneficiary into a plan that is not the most appropriate for the beneficiary’s needs.
     
  5. sman
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    Am I missing something? Are you saying the 48 hour rule is no more? I just went back and looked at the AHIP material and it still shows it as a requirement.
     
  6. somarco
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    Paying for a referral is fine if not contingent on a sale. I believe the IRS and possibly your state DOI takes issue with referral fees in xs of $25
     
  7. craig_ritter
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    craig_ritter Super Genius

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    Yes, you don't need to get an SOA 48 hours in advance. The 2018 MMG says you need to get it in advance of making a presentation, which we interpret as being immediately before the presentation, IE, same day SOA.

    It's a bit clearer what I mean if you look at the 2017 and 2018 MMG side by side (section 70.4.3).

    We're talking to a lot of the carriers about it and, eventually, they will clarify, but from the way this reads, if you have permission to contact (like a client), you can call them, schedule an appointment for 8am the next morning, show up at their house, have them sign an SOA right then, present a new plan and enroll them.

    For Medicareful, you can call a client, have them do an SOA electronically, present the plan over the phone and have them enroll electronically ALL IN ONE PHONE CALL.

    I think this is pretty big news. Maybe it's just not out there yet?!?

    ----------

    It's probably not in the AHIP training because the 2018 MMG came out on July 20th which is after the AHIP training was developed. Typically, the MMG comes out around the first week in June, it was about a month and a half late this year.

    I am going to blog on all the agent relevant changes later today. I think there are about 15-20 things agents need to know. Also, as the carriers digest the MMG, a consensus will develop around what everything means. We might interpret things one way and a carrier sees it differently, but generally, it crystallizes into a pretty uniform standard.

    For example, I'm also trying to get clarification on some requirements around CMS approval of BRC's. The wording seems a bit contradictory. We may be able to use generic BRC's again for permission to contact and with the same day SOA, that might make direct mail cost effective again. Not 100% sure on that.
     
    Last edited: Jul 26, 2017
  8. Todd King
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    As big of a change as that is, you would think we would hear about it by now though. You're correct though, it's Yuge!
     
  9. craig_ritter
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    craig_ritter Super Genius

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    Just to make it easier, here is a "side by side" of 2017 and 2018:

    2017:
    When conducting marketing activities, in-person or telephonically, a
    Plan/Part D Sponsor may not market any health care related product during
    a marketing appointment beyond the scope that the beneficiary agreed
    before the meeting with that individual. The Plan/Part D Sponsor must
    document the scope of the agreement 48 hours prior to the appointment,
    when practicable. Distinct lines of plan business include MA, PDP and Cost
    Plan products. If a Plan/Part D Sponsor would like to discuss additional
    products during the appointment in which the beneficiary indicated interest,
    but did not agree to discuss in advance, the Plan/Part D Sponsor must
    document a second scope of appointment (SOA) for the additional product
    type to continue the appointment.

    2018:
    When conducting marketing activities, in-person or telephonically, a
    Plan/Part D Sponsor may not market any health care related product during
    a marketing appointment beyond the scope that the beneficiary agreed to
    before the meeting. The Plan/Part D Sponsor must document the scope of
    the appointment prior to the appointment. Distinct lines of plan business
    include MA, PDP and Cost Plan products. If a Plan/Part D Sponsor would like
    to discuss additional products during the appointment in which the
    beneficiary indicated interest, but did not agree to discuss in advance, the
    Plan/Part D Sponsor must document a second scope of appointment (SOA)
    for the additional product type to continue the appointment.
     
  10. sman
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    Thanks for the update Craig. I'm definitely excited about using the Medicareful SOA.
     
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