The Centers for Medicare & Medicaid Services (CMS) discussed its updated communications and marketing guidelines during its annual Medicare Advantage and Prescription Drug Plan fall conference on Sept. 6. In this article, we look at the most notable changes.
A new definition of marketing, the addition of the term communications, and guidance for the pre-enrollment checklist are just a few of the changes that CMS has introduced in its updated Medicare Communications and Marketing Guidelines.
CMS’ Christine M. Reinhard and Jeremy C. Willard, who work at the Division of Surveillance, Compliance, and Marketing, Medicare Drug & Health Contract Administration Group, Center for Medicare, presented the changes during the agency’s Medicare Advantage and Prescription Drug Plan fall conference on Sept. 6. A PowerPoint of their presentation (Session 1) can be found here. A video of the presentation will soon be added to the CMS You Tube Channel. Here are a few of the biggest changes:
Marketing now falls under Communications
Communications refers to all materials and activities that provide information to current and prospective enrollees.
Marketing is now considered a subset of communications. But CMS tweaked the definition to focus on materials and activities meant to influence a beneficiary's decision about their healthcare coverage.
In a PowerPoint presentation, Reinhard and Willard explained that marketing’s intent is to draw attention to a plan or plans and influence an enrollment decision, including retention. Marketing’s content includes information about the plan’s benefit structure, cost sharing and measuring or ranking standards. However, it excludes materials that may include the content, but do not meet the definition of “intent.”
To meet the new definition of marketing, the material or activity must meet both the intent and content requirements. If it doesn’t meet both standards, CMS considers it a communication. For example, the Evidence of Coverage (EOC) may have content that would meet the definition of marketing, but its intent is to advise beneficiaries about their benefits, not to convince them to enroll in the health plan. Therefore, CMS would consider it a communication.
The agency spells out the designations for all required materials in Section 100, but health plans must decide whether other materials and activities fall under the definition of marketing or communication.
Plans can now compare themselves to competitors provided the information is factual
Any comparison to another Plan/Part D sponsor must be supported by fact, such as studies or statistical data, and can’t be misleading. Materials that include plan comparisons fall under the definition of marketing.
Marketing dos and don’ts
Plans/Part D sponsors may contact current enrollees and prospective ones via email if there is a process for beneficiaries to opt-out of the messages, so consumers can elect to no longer receive emails.
However, you can’t text or use other forms of electronic direct messages (such as social media platforms). Texting would fall under unsolicited contact and is not allowed.
New guidance on pre-enrollment checklists
Pre-enrollment checklists fall under the communications definition and must be provided to potential beneficiaries with the Summary of Benefits (SB) when the SB accompanies an enrollment form. Plans/Part D sponsors may remove portions of the checklist that aren’t applicable to a plan type or product.
Although you may not change disclaimer language, CMS will allow Plans/Part D sponsors to include additional language before or after the disclaimer to clarify how a disclaimer applies to different products. In the Medicare Communications and Marketing Guidelines, CMS gives the following example: “When selecting an HMO product, remember that except in emergency or urgent situations, we do not cover services by out-of-network providers who are not listed in the provider directory." This disclaimer wouldn't apply to a stand-alone Part D plan.
The presentation slides also include a peek into other changes under consideration at CMS. The agency is in the process of updating the Health Plan Management System marketing submission codes. CMS also plans to conduct retrospective reviews to monitor compliance with the new requirements. These reviews may include requests to submit marketing and communications materials.
RISE will discuss the latest CMS guidance and changes, as well as audit preparation times, best practices for FDR oversight, and strategies to increase compliance program effectiveness at this year’s CompliancePalooza, Oct. 29-30 in Baltimore. You can also learn more about this topic at The 12th Annual Medicare Marketing & Sales Summit, Feb 25-26, 2019 in Las Vegas.