KEY REVISIONS RELEASED IN THE 2015 MEDICARE MARKETING ...€¦ · key revisions released in the 2015 medicare marketing guidelines . betsy seals . vice president, compliance . july

KEY REVISIONS RELEASED IN THE 2015 MEDICARE MARKETING GUIDELINES

BETSY SEALS VICE PRESIDENT, COMPLIANCE

JULY 23, 2014

MARY KAYE THIBERT SVP, MARKETING, SALES AND STRATEGY

Copyright © 2014, Gorman Health Group, LLC

• “As plan sponsors implement their programs, they should consider the following guiding principles: o Plan sponsors are responsible for ensuring compliance with

CMS’ current marketing regulations and guidance, including monitoring and overseeing the activities of their subcontractors, downstream entities, and/or delegated entities.

o Plan sponsors are responsible for full disclosure when providing information about plan benefits, policies, and procedures.

o Plan sponsors are responsible for documenting compliance with all applicable MMG requirements.”

BACKGROUND Marketing Guidelines – Section 10

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IMPACT OF THE 2015 MEDICARE MARKETING GUIDELINES

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OVERALL REVISION METHOD

• Some big changes which will have significant operational impact

• Removal of some guidance

• Clarification around specific key areas

• Providing additional guidance/revised guidance around areas of industry risk

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GUIDANCE REMOVED – STILL APPLICABLE?

• Notifying CMS of scheduled marketing events

• CMS has removed guidance maintained in other areas

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Marketing Guidelines 70.9.1


QUALIFIED SUPERLATIVES

• CMS modifies current guidance to the prohibition against use of unsubstantiated “qualified superlatives” o As with “absolute superlatives”

the organization must obtain and submit substantiating documentation to CMS along with the material.

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Marketing Guidelines – Section 40.4


• Organizations may not initiate separate electronic, or otherwise, contact (e.g., email, direct message) unless an individual has agreed to receive those communications. o If an individual comments, likes or follows the Organization

on social media, this does not constitute agreement to receive communications outside of the public forum.

o Direct contact may not be initiate by Organizations on Social Media sites.

NEW GUIDANCE – SOCIAL MEDIA Marketing Guidelines – Section 70.4

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NEW GUIDANCE – SOCIAL MEDIA Marketing Guidelines – Section 70.4

• Organizations may respond to a question or statement initiated by the beneficiary, but may not address subjects beyond the scope of the question or statement.

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SOCIAL MEDIA

• NOTE: Re-publication of individual users’ content or comments that promotes an Organization’s product from social media sites is considered product endorsement/testimonial

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• Disclaimers are not required on call scripts or communications written for social media o If a communication written for social media has the

potential to be disseminated via another medium, disclaimers must be included.

• For example, a video produced for YouTube must include disclaimers because the video has the potential to be disseminated by other means.

DISCLAIMERS Marketing Guidelines – Section 50

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DISCLAIMERS – OPERATIONAL STRATEGY

• Disclaimers have already been incorporated into the scripts…

• Best practice would be to include these to ensure there is not beneficiary confusion

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Marketing Guidelines – Section 50


• Continuing affiliation announcements may be made through direct mail, e-mail, phone or advertisement. Continuing affiliation announcements must clearly state that the provider may also contract with other Organizations.

• Changed: Requirement to include a list of all Organizations with which the provider contracts

PROVIDER AFFILIATION Marketing Guidelines - Section 70.11.2

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• CMS modifies current guidance to require that the OEV process is completed for all enrollments, with the exception of: o Employer Group Enrollments o Same plan type changes within the same parent

organization

OUTBOUND ENROLLMENT AND VERIFICATION Marketing Guidelines – Section 70.7

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• Please note: In CMS’ memo titled “Clarification of Medicare Marketing Guidelines and Additional Agent/Broker Compensation Guidance” that was released on August 13, 2014, CMS revises current guidance language to clarify that the OEV process applies exclusively to enrollments in which employed, captive or independent agents/brokers were involved.

OUTBOUND ENROLLMENT AND VERIFICATION – GUIDANCE REVISION Marketing Guidelines – Section 70.7

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OUTBOUND ENROLLMENT AND VERIFICATION Marketing Guidelines – Section 70.7

• CMS modifies current guidance to allow the OEV process to be completed via alternate method, including: o Direct Mail o Email Communication

• If the beneficiary has opted in to receive email communications

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OUTBOUND ENROLLMENT AND VERIFICATION – STRATEGY Marketing Guidelines – Section 70.7

• Utilize the other options to fulfill OEV requirements and use the welcome call to provide the “high quality” beneficiary touch

• Retention starts at the point–of-sale

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COMPENSATION

• CMS includes Guidance related to compensation, including: o Renewal compensation is

paid for each enrollment in Year 2 and beyond up to fifty (50) percent of the current FMV, published by CMS annually.

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• Compensation for referral/finder’s fees paid to all agents and brokers, which includes independent, employed, and captive agents and brokers, may not exceed $100 for an agent or broker to refer or enroll a beneficiary o Reminder: Referral/finder’s fees paid to all agents and

brokers must be part of total compensation not to exceed FMV for that contract year.

COMPENSATION Marketing Guidelines – Section 120.4

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• Please note: In CMS’ memo titled “Clarification of Medicare Marketing Guidelines and Additional Agent/Broker Compensation Guidance” that was released on August 13, 2014, CMS revises current guidance language to clarify that referral fees for PDPs are limited to $25. The referral fee for other plan types remains at $100.

COMPENSATION – REVISED GUIDANCE Marketing Guidelines – Section 120.4

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COMPENSATION

• When an Organization and/or a contracted independent agent/broker terminates the contract, any future payment of existing business will be governed by the terms of the contract.

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TRANSLATED MATERIALS Marketing Guidelines – Section 30.5

• CMS strongly encourages Organizations to translate ad-hoc communications upon request.

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WEBSITE SUBMISSION Marketing Guidelines – Sections 90.2.2 /100.2

• If a portion of the Organization's website is disapproved, the disapproved portion must be removed from the website immediately

• If the website or portions of the website are disapproved, Organizations must submit the revision within 20 days for CMS review.

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• Updates related to Medication Program Therapy Management (MTM) materials that must be posted on the website, for example: o CMS expects there to be a separate section or page about MTM

programs, written in plain language appropriate for beneficiaries o A statement informing beneficiaries about who to contact at the

Part D Sponsor for more information, with customer service personnel prepared to answer questions about the MTM program

o A statement explaining the purpose and benefits of MTM, and that this is a free service for eligible beneficiaries

WEBSITE – REQUIRED CONTENT Marketing Guidelines – Section 100.2

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• Organizations with overall 5-star ratings may market their ability to enroll beneficiaries through the 5-star special enrollment period (SEP). o Must refrain from doing so in a manner that specifically

targets beneficiaries enrolled in poor performing plans o They may not direct the beneficiary to request an SEP.

PLANS WITH AN OVERALL 5-STAR RATING Marketing Guidelines – Section 30.10.2

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T

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Gorman Health Group (GHG) is a national health care and federal programs consultancy staffed by subject matter experts, former health plan executives, and seasoned regulators. For nearly 20 years, hundreds of clients serving millions of consumers have leveraged GHG’s strategic counsel, technology, and knowledge-based solutions to achieve growth objectives, maximize and maintain compliant operations, improve market positions, develop new market opportunities, advance profitability, and provide timely, industry-based content and education. GHG’s solutions continually evolve to meet the needs of our clients. Our customizable knowledge utility, the Point, makes available our knowledge-based offerings and timely, unparalleled expertise. Through the Point, the industry has direct access to the same timely tools and analyses our own consultants use to stay informed. An annual membership to the Point entitles each user to access our archive of educational webinars, podcasts, regulatory summaries, and more. In addition, Gorman UniversityTM makes live and web-based trainings available to your entire organization. Find out more at www.gormanhealthgroup.com.

BETSY SEALS

Vice President

916.838.0044

[email protected]

Mary Kaye Thibert

Senior Vice President

310.923.8333

[email protected]

mailto:[email protected]

mailto:[email protected]

Copyright © 2014, Gorman Health Group, LLC 26

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KEY REVISIONS RELEASED IN THE 2015 MEDICARE MARKETING ...€¦ · key revisions released in the 2015 medicare marketing guidelines . betsy seals . vice president, compliance . july