Get ready now: The Centers for Medicare & Medicaid Services’ 2024 Proposed Rule leans toward more regulations around Medicare communications and marketing guidelines for the approaching plan year.
In 2023, agents selling Medicare Advantage and prescription drug plans were subject to new third-party marketing organizations requirements and Medicare sales call recording rules. For 2024, CMS has proposed clarifying a few items related to this newer regulation, bringing back a few old rules, and adding in some new ones in a continued effort to crack down on deceptive sales practices.
Here’s a summary of the upcoming Medicare Advantage and Part D rule changes we expect to be finalized before this year’s Annual Enrollment Period.
New Medicare Lead Generation Rules
For 2024, CMS is proposing multiple changes related to lead generation, including bringing back the 48-hour Scope of Appointment (SOA) rule, clarifying how long permission to contact and SOAs remain in effect, and a few more third-party marketing organization (TPMO) requirements.
SOA 48-Hour & 6-Month Rules
Arguably the biggest change facing agents next year: CMS intends to reinstate the 48-hour SOA time frame, prohibiting personal marketing appointments from taking place until 48 hours after a potential enrollee completes an SOA. If you are familiar with the old 48-hour SOA requirement (relaxed for the 2018 AEP), the previous language of “when practicable” will not be included in the new rule. SOAs will need to be obtained at least 48 hours in advance.
CMS also adds that an SOA will only remain valid for six months from the beneficiary’s signature date.
Permission to Contact 6-Month Rule
Similar to the SOA validity change, CMS states that permission to contact will only remain valid for six months after an enrollee or potential enrollee first asked for information.
TPMO Revised Disclaimer & Data Sharing Restrictions
There are two changes related to TPMOs: prohibiting the sharing of personal beneficiary data with other TPMOs and revising the TPMO disclaimer.
The revised disclaimer will need to include State Health Insurance Programs (SHIPs) as an option for beneficiaries to obtain additional help as well as a list of every MA organization or Part D sponsor with which the TPMO contracts in a beneficiary’s service area.
- Revised disclaimer for TPMOs that don’t contract with every MA organization or Part D sponsor within a service area:
“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area which are [insert list of MA organizations or Part D sponsors]. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.”
- Revised disclaimer for TPMOs that contract with every MA organization or Part D sponsor in the service area:
“We offer the following plans in your area [insert list of MA organizations or Part D sponsors]. You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program for help with plan choices.”
New Medicare Sales Presentation Rules
Are there proposed changes that will affect the way agents complete Medicare Advantage and prescription drug plan (PDP) sales presentations for 2024? In short, yes and they primarily involve limiting what calls need recorded, sharing key enrollment details with clients, and reinstating previous restrictions related to educational events.
Defining What Calls Need Recorded
CMS is limiting the requirement to record calls between TPMOs and beneficiaries to sales, marketing, and enrollment calls. This should eliminate the need to record appointment setting calls and check-ins after sales. However, calls with current clients for retention purposes must be recorded.
Additionally, CMS is specifying that virtual sales, marketing, and enrollment calls, such as those completed through video conferencing and other virtual telepresence methods, must be recorded.
Enrollment Info to Be Provided
Agents will need to explain to an enrollee the effect of their enrollment choice on their current coverage, including disenrollment from other plans and cost changes. For telephonic sales, agents must also share key pre-enrollment information with potential enrollees when processing enrollments.
Educational Event Restrictions
Returning to stricter guidelines, agents will no longer be able to collect SOAs or beneficiary contact info, or schedule future marketing appointments, at educational events. Agents will also be prohibited from holding a marketing event within 12 hours of the educational event in the same location. (The same location is defined as the entire building or adjacent buildings.)
Cash Equivalent Definition
“Cash equivalent,” in the framework of reward and incentive, will include gift cards offered by large retailers or online vendors that sell a wide variety of items (e.g., big-box stores or Amazon).
New & Revised Medicare Special Enrollment Periods
Lastly, CMS is proposing the following new special enrollment periods (SEPs) or changes to existing ones.
Changing the Part D SEP Related to Part B GEP Enrollment
Earlier this year, the Consolidated Appropriations Act changed Medicare rules regarding Part B effective dates when beneficiaries enroll during the General Enrollment Period (GEP). CMS intends to revise the Part D SEP for individuals who enroll in Part B during the GEP to align with the new Part B effective dates for GEP enrollment.
The revised Part D SEP will allow an individual who is not entitled to premium-free Part A and who enrolls in Part B during the GEP to request enrollment in a Part D plan between the time the individual submits the application for Part B through the first two months of their enrollment in Part B. The effective date of the Part D coverage will change to the first of the month following the month the Part D sponsor receives the enrollment request.
With this change, CMS expects simplification of the enrollment process and a reduction of potential gaps in prescription drug coverage. It’s important to note that the revised SEP will also align with most Part D enrollment and SEP timeframes.
New Exceptional Condition Part C & D SEPs
When signed into law, the Consolidated Appropriations Act also gave CMS authority to create SEPs based on exceptional conditions for enrollment into Medicare Parts A and B. CMS is adding corresponding exceptional condition SEPs for Part C (MA) and Part D.
An exceptional condition is defined as unusual or not typical (e.g., government declared emergency, misinformed by employer, released from incarceration, loss of Medicaid eligibility, or circumstances determined by the Social Security Administration) and applies to individuals who miss an Initial Enrollment Period, the GEP, or another SEP.
The new SEPs will allow individuals who use an exceptional condition to enroll in premium Part A and/or Part B a chance to enroll in an MA plan or PDP. The new Part C and D exceptional condition SEPs will begin when a person submits a premium Part A or Part B application and continue for the first two months of their enrollment in Part A and Part B. Coverage for MA or Part D plan will be effective the first of the month following when the plan receives the enrollment request.