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Follow-up:
Here is the reply I received from compliance about an un-contracted MA or Part D agent doing educational seminars:
When agents are conferring with consumers about plans, offering advice on any of the benefits, explaining how the plan operates or other terms of the policy, they are taking on the role of an agent, even if the agent does not intend to write the enrollment application or receive a commission. CMS guidance provides that Part D sponsors “must ensure that all agents/brokers (employed/captive or independent) selling Medicare products are trained and tested annually on Medicare rules, regulations, and on details specific to the plan products that they sell.” Medicare Marketing Guidelines, Sect. 120.3.
Here is section 120.3 from MMG (7/2/2015)
120.3 – Agent/Broker Training and Testing
42 CFR 422.2274(c) and (d), 423.2274(c) and (d)
Plans/Part D Sponsors must ensure that all agents/brokers
(employed/captive or independent) selling Medicare products are trained and
tested annually on Medicare rules, regulations, and on details specific to the
plan products that they sell. This means that training and testing must take
place prior to the broker/agent selling the product. In addition,
agents/brokers must obtain a passing score of at least eighty-five percent on
the test.
CMS provides updated guidance annually for agents/brokers training/testing.
Plans/Part D Sponsors must ensure that their agents/brokers training/testing
programs are designed and implemented in a way that maintains the integrity of the training and testing, and must have the ability to provide this
information to CMS upon request.
How I read this: The carriers are going to follow CMS rules to protect themselves from agents out in the field talking about anything Medicare.
However, agents cannot report events to CMS direct, only through HPMS which means through a contracted carrier. If you have no contract with a MA or Part D carrier, you have no way to report the event. The carrier reply will be report it. That covers their side.
Agents can perform the event at their own risk as long as they are giving only a general overview of C and or D plans, but as soon as they get into product specific info they are charting into a gray area that I cannot say how CMS will reply.
Here is the reply I received from compliance about an un-contracted MA or Part D agent doing educational seminars:
When agents are conferring with consumers about plans, offering advice on any of the benefits, explaining how the plan operates or other terms of the policy, they are taking on the role of an agent, even if the agent does not intend to write the enrollment application or receive a commission. CMS guidance provides that Part D sponsors “must ensure that all agents/brokers (employed/captive or independent) selling Medicare products are trained and tested annually on Medicare rules, regulations, and on details specific to the plan products that they sell.” Medicare Marketing Guidelines, Sect. 120.3.
Here is section 120.3 from MMG (7/2/2015)
120.3 – Agent/Broker Training and Testing
42 CFR 422.2274(c) and (d), 423.2274(c) and (d)
Plans/Part D Sponsors must ensure that all agents/brokers
(employed/captive or independent) selling Medicare products are trained and
tested annually on Medicare rules, regulations, and on details specific to the
plan products that they sell. This means that training and testing must take
place prior to the broker/agent selling the product. In addition,
agents/brokers must obtain a passing score of at least eighty-five percent on
the test.
CMS provides updated guidance annually for agents/brokers training/testing.
Plans/Part D Sponsors must ensure that their agents/brokers training/testing
programs are designed and implemented in a way that maintains the integrity of the training and testing, and must have the ability to provide this
information to CMS upon request.
How I read this: The carriers are going to follow CMS rules to protect themselves from agents out in the field talking about anything Medicare.
However, agents cannot report events to CMS direct, only through HPMS which means through a contracted carrier. If you have no contract with a MA or Part D carrier, you have no way to report the event. The carrier reply will be report it. That covers their side.
Agents can perform the event at their own risk as long as they are giving only a general overview of C and or D plans, but as soon as they get into product specific info they are charting into a gray area that I cannot say how CMS will reply.
