Important CMS Update to Definition of Marketing Eff July 10, 2023

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CMS has made an update to the Definition of Marketing as it relates to Medicare Advantage/PDP.  Any content included in a MA/PDP piece (mailer, flyer, television, social media, website, etc.) that a beneficiary can receive/view that includes mention of benefits such as Dental, Vision, Hearing, and cost-savings, will meet the standard definition of marketing.  Previously, unless a specific dollar amount was listed, these mentions in a piece would not meet the content standard for marketing and the piece would be considered ‘generic communication’. 

Beginning July 10, 2023, any material or activity that is distributed via any means (e.g., mailing, tv., social media, etc.) that mentions any benefit will be considered marketing and must be submitted for review/approval by CMS. 

What do I need to do?

Review any client-facing assets in-use/planned to use on/after July 10, 2023, either created in-house, through a third-party vendor, or from the Marketing team at Cornerstone Senior Marketing (mailers, flyers, brochures, ads, web pages, social media, etc.).  If any contain benefit information, (ie: mention of dental, vision, hearing, travel, cost-savings, etc. in relation to MA/PDP) and have not already been filed with CMS for review/approval, discontinue use or modify, removing benefit information, on or before July 10, 2023. 

 Alternately, you may send any such materials to Cornerstone Senior Marketing to submit to CMS for review/approval.  Please note the review and approval process may take upwards of 75 days to complete and use of the material on/after July 10, 2023, must be suspended until approval is granted.

 

Compliance Services from Cornerstone Senior Marketing

Client-facing materials for the Medicare market, specifically those that include information about MA/PDP, can be submitted for a compliance review prior to use, by sending via email to: compliance@cornerstoneseniormarketing.com.

 

We highly recommend submitting scripts with storyboards for television/video prior to recording or development of these projects to ensure compliance and avoid potential, costly re-work if the content requires changes in order to be compliant.

 

 CLICK TO READ FULL NEWS RELEASE: MAY 10, 2023| CMS NEWSROOM 

Anthem: Talk Desk Discontinued as of March 20, 2023

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Talk Desk is being discontinued as a tool for recording telephonic scope of appointments and voice signatures. This change comes about due to the CMS implemented requirements of recording all pre-enrollment and post-enrollment calls to prospects and current members.

Additionally, Medicare Voice Signature Services is a new tool that is now available in Producer Toolbox. This tool is only available to use during a face-to-face appointment when the applicant is unable to physically or electronically sign the SOA or enrollment application and does not have a Power of Attorney representative present. The below Quick Reference Guide provides the steps for using the Medicare Voice Signature Service.

Medicare Voice Signature Services Quick Guide – PDF

  • As a reminder, all calls with prospects and current members must be recorded and stored in a HIPAA compliant manner according to the CMS requirements implemented in October 2022. This includes all pre-enrollment calls and post-enrollment calls.
  • By recording all calls, the requirements for recording telephonic scope of appointment and voice signature during enrollment are also fulfilled. It is not necessary to record a telephonic scope of appointment or voice signature separately.
  • Talk Desk, the tool used for recording a telephonic scope of appointment and voice signature, will be discontinued as of March 20, 2023.
  • Historical Talk Desk recordings will continue to be accessible in the Portal.

 

Questions?  Please contact your CSM rep

 

Aetna’s MA Compliance Connection: Feb. 2023 Edition

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In this issue, Aetna will discuss two topics including:

  • Caution to agents: Do not steer clients based on “scheduling fees”
  • Reminder: You can only require a zip code or county, and other location details from clients to review plans

READ FULL NEWSLETTER HERE 

Important:  New CMS Review Time fo TV Commercials/Ads

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NEW CMS REVIEW TIME FOR TV COMMERCIALS/ADS

IMPORTANT CHANGE: We have received notification via our carrier partner, Elevance Health/Anthem, that CMS has confirmed to them a change to the review process and timing for TV commercials/advertisments updated in HPMS on 9/16/22.

Verified by the Anthem Compliance Team (9/19/22), CMS stated: We have recently changed the review period for TV advertismenets to 20 days.  We are currently discussing communication strategies.

The new 20 Day Review will require an official review from CMS prior to use.  This differs from the previous submission type of 5 day File and Use, with no immediate review by CMS at time of filing.

As of Wednesday, 9/21, 10 days remain before AEP marketing can occur.  If you have TV commercials/advertisments you are planning to use and have not yet filed with CMS, please be aware of this change, as this can impact when your TV commercial / advertisement can be released.

 We will share additional details as they become available from CMS.

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Please take a moment to review the definitions of generic communication and marketing, a subset of communications, that requires material submission for review and approval by CMS. Access the most recent version of our Agent Medicare Compliance Guide here for additional information.

Generic Marketing and Communications

We generally refer to advertising pieces – print, radio, tv, website, etc., as marketing however, CMS uses the terms ‘marketing’ and ‘communication’ to make a distinction  between generic advertising.  

 

Communications are all activities and materials used to provide information that is targeted to current and prospective enrollees, including their caregivers and other decision makers.  

Generic mailers and advertising materials you create to promote your business and generate leads fall under the definition of “communication” materials (given they are free of carrier names and specific plan informaiton, and do not list benefits, premiums, copays, and cost sharing).

 

Marketing is a subset of communications and is determined based on both the content and intent of activity or materials.

Marketing includes activities and materials with the intent to draw a beneficiary’s attention to a specific plan or plans and to influence a beneficiary’s decision-making process when selecting a plan for enrollment or deciding to stay enrolled in a plan (retention-based marketing). Additionally, marketing has content with information about the plan’s benefits, cost sharing, measuring, or ranking standards.

Materials that meet the definition of marketing will require submission to CMS through HPMS filing.  The term ‘marketing’ takes on new meaning when we talk compliance. The CMS definition is used to distinguish materials that require review and approval vs. materials that fall under the ‘communication’ definition, which can be used without CMS review/approval.

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We’re here to help.  Call if you have questions (614-763-2255).  If you have marketing materials that require filing with CMS for approval or have marketing or communication materials you want reviewed for compliance, please send them via email to: compliance@cornerstoneseniormarketing.com

Important Compliance Update: CMS Disclaimer Requirement FAQ + Compliance Review Process

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CMS Required Disclaimer FAQ + Lead Time to Approve Materials for use on/after 10/1/22

 

The marketing guidelines for Medicare Advantage and Prescription Drug Plans were recently updated and among the provisions that apply directly to agents is a required disclaimer to be in use by October 1, 2022, for Plan Year 2023.

Important: Marketing materials (as defined further below) require CMS approval and must follow a compliance process that includes carrier review and filing through HPMS which can take up to 75 days to complete. If you have materials that meet the definition of marketing and want to use these materials on/after 10/1/22, NOW is the time to submit these pieces for review.

 

Send materials via email to: compliance@cornerstoneseniormarketing.com

 

Disclaimer Language To Use:

 “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. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”

 

Who must use this disclaimer?

 Any third-party marketing organization (which includes agents and brokers) must include this disclaimer.

 

When/where is the disclaimer used?

  • On all marketing* materials: print, electronically, television, and radio
  • Within the first minute of all sales calls
  • Prominently displayed on TPMO websites
  • Verbally, electronically, or in writing, during any sales meeting with a beneficiary

 

veGeneric Marketing and Communications

 We generally refer to advertising pieces – print, radio, tv, website, etc., as marketing however, CMS uses the terms ‘marketing’ and ‘communication’ to make a distinction  between generic advertising.  

 

Communications are all activities and materials used to provide information that is targeted to current and prospective enrollees, including their caregivers and other decision makers.  

Generic mailers and advertising materials you create to promote your business and generate leads fall under the definition of “communication” materials (given they are free of carrier names and specific plan informaiton, and do not list benefits, premiums, copays, and cost sharing).

 

Marketing is a subset of communications and is determined based on both the content and intent of activity or materials.

Marketing includes activities and materials with the intent to draw a beneficiary’s attention to a specific plan or plans and to influence a beneficiary’s decision-making process when selecting a plan for enrollment or deciding to stay enrolled in a plan (retention-based marketing). Additionally, marketing has content with information about the plan’s benefits, cost sharing, measuring, or ranking standards.

Materials that meet the definition of marketing wil require submission to CMS through HPMS filing.  The term ‘marketing’ takes on new meaning when we talk compliance. Its CMS definition is used to distinguish materials that require review and approval vs. materials that fall under the ‘communication’ definition, which can be used without CMS review/approval.

 

We’re here to help.  Call if you have questions (614-763-2255), and click below to review the 2022 Agent Medicare Compliance Guide. This publication provides many examples of advertising content that is deemed marketing, and requires CMS approval, and includes details around generic communications where filing with CMS is not necessary.

 

Note: Updates to this guide to include the most recent CMS requirements (disclaimer and call recording) are in process so, please keep this in mind when reviewing the current content.  Cornerstone Senior Marketing will make the updated version of this guide available to all our broker partners as soon as it becomes available.

 

 DOWNLOAD THE 2022 AGENT MEDICARE COMPLIANCE GUIDE HERE

 

Worth repeating: If you have marketing materials that require filing with CMS for approval or have marketing or communication materials you want reviewed for compliance, please send them via email to: compliance@cornerstoneseniormarketing.com

CMS Marketing Changes

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The marketing guidelines for Medicare Advantage and Prescription Drug Plans were updated on May 9, 2022. Among the provisions that apply directly to agents, the two most critical, which are to be in use by October 1, 2022, for Plan Year 2023, are a new required disclaimer and a requirement to record all sales calls with beneficiaries. While not comprehensive, the FAQ’s below will provide details. 

Required Disclaimer 

Disclaimer Language To Use:

“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. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.” 

Who must use this disclaimer?

Any third-party marketing organization (which includes agents and brokers) must include this disclaimer. 

When and where do I have to have the disclaimer?

  • On all marketing materials: print (if possible, use a 12pt font), electronically, television, and radio
  • Within the first minute of all sales calls
  • Prominently displayed on TPMO websites
  • Verbally, electronically, or in writing, during any sales meeting with a beneficiary

What if I DO offer all plans in my area? 

While the regulation does provide a carve-out for TPMO’s that truly offer all plans in their area, it is exceedingly rare for an agent to truly be able to do this. In most areas, there are one or more plans that are offered only through captive agents, direct to consumer, or certain types of plans that agents and brokers cannot sell. Even if you do offer all plans in one county or service area, it is possible your marketing or referrals may extend to an area where that is not true, so the disclaimer would still be required. 

Requirement to Record Sales Calls

Under these new guidelines, all sales calls with beneficiaries and TPMO’s MUST be recorded and retained for 10 years, including enrollment calls. 

What constitutes a sales call? 

Any call that is related to what CMS calls the “chain of enrollment,” which has been defined as the events from a beneficiary becoming aware of an MA/PDP plan to the end of the enrollment process. This means that calling leads, scheduling appointments, collecting scopes of appointment (telephonically), presenting plans, collecting drug and doctor lists, and phone enrollments would all fall under this guidance. This list is not exhaustive, and other calls that contain marketing content will also need to be recorded and retained. 

How can I record and store calls? 

We recommend reaching out to your current phone provider to see if they offer call recording. If they do not, or it seems cost prohibitive, consider a VOIP phone system that can be used in the office or the field. Some common options are Ring Central, 8×8, and Vonage. For storage, you will need to develop a process for sorting and storing the calls either on a local drive or cloud-based storage. Since these calls contain sensitive data, most free storage accounts will not be HIPAA compliant. We are currently researching the best options for agents to compliantly store this data. 

What about in person appointments? 

In-person marketing and sales appointments do not need to be recorded, however, calls to set appointments or follow-up calls to answer benefit questions would require recording. Servicing questions about current plan business, such as claims, billing, and requesting in force plan documents, are not sales calls and would not require recording. 

I use my cell phone. How can I handle this? 

Most VOIP services have a mobile app version that would allow calls to be recorded from your mobile device. There are also recording apps that would allow for recording calls without VOIP. Be cautioned, however, as a stand-alone recording app will not include any disclaimers that may be required by your jurisdiction before recording, whereas most VOIP systems offer/include these options.

Please reach out with any questions to your team at Cornerstone Senior Marketing.  (614) 763-2255 |  compliance@cornerstoneseniormarketing.comquirement to Record Sales Calls

Broker Notice Regarding Third Party Marketing

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Cornerstone Senior Marketing will now file third-party marketing materials requiring CMS approval for all our sales/broker partners.  This includes uniquely created materials or those purchased from a third-party lead source vendor¹.

Action Required:

Any advertisement or mailer that mentions a premium, a benefit, a cost/copay, or getting your Part B paid for (even in a general fashion) needs to be sent for approval.  This includes mailers, newspaper or magazine ads, TV/Radio commercials, bulletin boards, flyers, presentations, etc.

Please use this link below to submit any marketing materials that meet the above description that you plan to use, for compliance review. 

If you’re unsure your marketing material requires CMS approval, please submit it for review.  We’re here to help by offering compliance reviews for all marketing and/or communication materials, anytime.

If you are an agency with down line agents, please reach out to them and have them submit their materials as well, as you are responsible for their compliance with CMS regulations.

¹The lead vendors listed below will arrange filing through HPMS, for CMS approval, any marketing pieces that fall within the guidance above.  You DO NOT need to submit  materials to Cornerstone Senior Marketing from these lead vendors.  

Target Leads, Kramer Direct, Main Street, Arm Leads, and Lead Concepts

CSM Tech Tip | Scam of the Week: Email Impersonation Attacks on the Rise

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Technology Tip – Scam of the Week: Email Impersonation Attacks on the Rise

Stay alert! The bad guys are now using CEO fraud and Business Email Compromise attacks more than ever.

These attacks take place when the bad guys impersonate executives within your organization via email and ask you to transfer them a large sum of money. They’re trying to manipulate you – don’t fall for it!

Instead, make sure that any request for a money transfer comes from the right person! Grab the phone and give them a call to verify that the request is legitimate. Better yet, communicate with them face-to-face about the request. They’ll thank you later!

 

Let’s stay safe out there!

NAHU: BENES Act Passes

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Announcement from NAHU from 12/23/20: 

BENES Act Passes Congress

 

NAHU has advocated for passage of the BENES Act and we are pleased to let you know it was included in the final package passed by the Senate early Tuesday morning. We believe its provisions will help your clients who are transitioning to Medicare and those who may need an SEP:

  • The Coverage Gap Closure. The bill eliminates the up to seven-month-long wait for coverage that people can experience when they sign up for Medicare during the General Enrollment Period or in the later months of their Initial Enrollment Period. Beginning in 2023, Medicare coverage will begin the month after enrollment.
  • The “Exceptional Circumstances” SEP. It reduces barriers to care by expanding Medicare’s authority to grant a Special Enrollment Period for “exceptional circumstances.” A long-standing flexibility within Medicare Advantage and Part D, in 2023 this critical tool will be available to facilitate enrollments program-wide, enhancing beneficiary access and administrative consistency.
  • The Enrollment Alignment Study. To further maximize coverage continuity and ease transitions to Medicare, the bill directs HHS to identify ways to align Medicare’s annual enrollment periods. HHS is to present these findings in a report to Congress by January 1, 2023.

Humana MP: Important Update Regarding Plan Changes

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2020 Compliance Communication

Before AEP, we communicated that Humana will no longer accept plan change requests through the Agent Statement of Enrollment Correction (ASEC) form from an agent. Now is a good time to conduct a review of the enrollment applications you have submitted in AEP to ensure they have processed and the member is enrolled in the right plan. If you find a member who was mistakenly enrolled in the wrong Contract/PBP, you will need to obtain a new application prior to December 7 in order to use AEP to correct the member’s enrollment for a January 1, 2021 effective date.

Keep in mind that members must have a valid election code at the time the new enrollment application is being submitted. If you catch the error on December 8, for example, you will no longer be able to submit a new application using AEP to correct the plan type and will need to see if they are eligible for another election period. If they do not have another valid election period, you will need to advise them of their next opportunity to enroll in a plan.

Please ensure you are reviewing every application carefully prior to submitting to ensure you have the correct Contract/PBP and Plan Type Bubble selected.

Please note: The ASEC form may still be used for election type code, effective date, and demographic changes.

Questions? Please reach out to your Cornerstone Senior Marketing Representative.

We’re here to help!

614-763-2255
email: service@cornerstoneseniormarketing.com

Not contracted with Humana? Reach out to your Cornerstone Senior Marketing Sales representative to get appointed!