MEDICARE PROGRAM; MEDICARE ADVANTAGE AND PRESCRIPTION DRUG BENEFIT PROGRAMS: FINAL MARKETING PROVISIONS (CMS 4131-F)
This final rule was announced on September 15, 2008. It is effective upon publication and applies beginning October 1, 2008, the start of the 2009 marketing season.
The rule recodifies and modifies existing marketing regulations and finalizes six new marketing provisions that were proposed in the May 16, 2008, proposed rule that coincides with provisions of the Medicare Improvements for Patients and Providers Act (MIPPA) enacted in July, 2008. The new provisions prevent agents and brokers from engaging in sales and marketing activities that may pressure beneficiaries to make plan choices for reasons other than those that best meet their health care needs.
Standards for MA and PDP marketing
- Prohibits plans (and their representatives) from providing meals to prospective enrollees at promotional and sales events.
- Prohibits plans (and their representatives) from contacting potential enrollees directly without the potential enrollee first initiating contact. Unsolicited direct contact like door-to-door solicitation, outbound telemarketing, approaching beneficiaries in parking lots, or follow-up calls about mailings without prior consent are some examples of the activities that are prohibited.
- Prohibits plans (and their representatives) from cross-selling non-health care related products during Medicare sales or marketing activities.
- Prohibits plans (and their representatives) from conducting sales presentations or distributing and accepting plan applications in provider offices or other places where health care is delivered, except in the case where such activities are conducted in common areas in health care settings.
- Prohibits plans (and their representatives) from conducting sales presentations or distributing and accepting plan applications at educational events.
Licensing and appointment of marketing representatives
Requires plans to appoint and use only State licensed representatives to conduct marketing activities in accordance with applicable State appointment laws.
Disclosure of plan information
Requires plans to disclose certain beneficiary information at the time of enrollment and 15 days before the annual coordinated election period.
Medicare Advantage and Part D marketing requirements.
This includes definitions concerning marketing materials, review and distribution of marketing materials, guidelines for CMS review, and deemed approval, the majority of which were addressed in prior regulations.
The final rule implementing MIPPA marketing requirements may be viewed at http://www.cms.hhs.gov/HealthPlansGenInfo/.