SCOPE 48 Hours Rule ?

[midwestbroker]

Here is the Medicare Marketing Guidelines for SOAs:

Section 70.9.3 (issued 7/2/2015)

When conducting marketing activities, 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 marketing appointment.

The MMG continues to say:
SOA documentation is subject to the following requirements:
...
An explanation why the SOA was not documented 48 hours prior to the appointment, if applicable

 

[TwoCents]

[Midwestbroker just beat me to it.]

From the CMS Marketing Guidelines (1 of several bullet points):

SOA documentation is subject to the following requirements:
An explanation why the SOA was not documented 48 hours prior to the appointment, if applicable.

So documenting that it was a next day appointment seems to fulfill this need.

Furthermore:
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 marketing appointment.

And the section about walk-ins:
In instances where a beneficiary visits a Plan/Part D Sponsor or an agent/broker office on his/her own accord, the Plan/Part D Sponsor or agent/broker must document the SOA prior to discussing MA, PDP, or cost plans.

Don't drink the Kool Aid from the plans. Know the source of the rules and know how to read them that way if anything comes up, you'll have ammunition to fight.

 

[MedicareAgent]

just put "time constraints" on the reason why it wasn't signed 48 hours before.

 

[axeman462]

Has anybody actually had to produce a SOA from an old appointment? Let alone 'splain any details? I remember a local plan not accepting apps without scopes but that's all.

Yes, I had a section A a couple years back. I had to produce the SOA for that appointment for the investigation.

 

[kstein]

How did you prove it was 48 hours in advance vs 44?

 

[yogooglethis]

How did you prove it was 48 hours in advance vs 44?

I don't believe they ask if was signed 48 hours prior on complaints because it doesn't have be signed 48 hours in advance however they know because agents have to put dates on scopes and application .

 

[axeman462]

I don't believe they ask if was signed 48 hours prior on complaints because it doesn't have be signed 48 hours in advance however they know because agents have to put dates on scopes and application .

Yeah, they never asked. They just wanted to see that one was signed.

 

[vaxmanid]

just put "time constraints" on the reason why it wasn't signed 48 hours before.

I use "Insufficient time prior. Called (date prior which is usually the case) for appointment."

Of course CMS is not looking at this realisticly with the 10 year record keeping rule. Say CMS wants to pull a SOA from 2010 and the beneficiary now has dementia or is deceased and try to argue the agent did wrong. Oh and the family member challenging this (which is fictional because they don't have a clue about the rule) wasn't at the appointment when grandma was of sound mind. SOAs and the rules surrounding them are nonsense.

I don't follow this board (which is very good by the way) daily, but has anyone shared an instance when an agent had to pull a copy of a SOA? If so, what were the circumstances and was there any actions taken by the carrier and CMS?

Having said all that, I understand why the rules are in place. It's due to the few that want SELL everything in their laptop in one shot rather than building a relationship or being satisfied with THAT sale. Even a used car salesman recognizes that on one sale you can't sell 16 more to the same customer on the same day.

 

[axeman462]

I use "Insufficient time prior. Called (date prior which is usually the case) for appointment."

Of course CMS is not looking at this realisticly with the 10 year record keeping rule. Say CMS wants to pull a SOA from 2010 and the beneficiary now has dementia or is deceased and try to argue the agent did wrong. Oh and the family member challenging this (which is fictional because they don't have a clue about the rule) wasn't at the appointment when grandma was of sound mind. SOAs and the rules surrounding them are nonsense.

I don't follow this board (which is very good by the way) daily, but has anyone shared an instance when an agent had to pull a copy of a SOA? If so, what were the circumstances and was there any actions taken by the carrier and CMS?

Having said all that, I understand why the rules are in place. It's due to the few that want SELL everything in their laptop in one shot rather than building a relationship or being satisfied with THAT sale. Even a used car salesman recognizes that on one sale you can't sell 16 more to the same customer on the same day.

I understand not following the entire forum, but at least follow the single thread that you're posting on...

 

[ICACharleston]

Axeman,
Pardon my ignorance but what's a Section A?