2016 Marketing Guidelines: Evolve or Pay
There were several significant changes released in the 2016 Medicare Advantage & Part D Medicare Marketing Guidelines (MMGs), all of which communicate the same consistent message from the Centers for Medicare & Medicaid Services (CMS), the focus is on the beneficiary.
Possibly one of the more surprising trends was that with the focus on improving the beneficiary experience, CMS has actually also provided significant leeway in the way that Organizations are permitted to fulfill the requirements. However, with the leeway provided, CMS reminds us that “If CMS finds the Plan/Part D Sponsor failed to comply with applicable rules and guidance, CMS may take compliance action, including intermediate sanctions and civil money penalties.” In other words, “Evolve or Pay”.
In our recent webinar, Nilsa Lennig, GHG’s Vice President of Sales & Marketing Services and I, discussed the new guidelines and what is required of plans to do moving forward.
Below are the top three revisions released in the 2016 MMGs that we believe will have the most significant impact on Organizations:
1. CMS revises current guidance to allow Organizations the option of providing the pharmacy/provider directory to new or renewing enrollees OR a separate notice to alert enrollees where they can find the pharmacy/provider directory online and how they can request a hard copy. In addition, in keeping with the information released in the 2016 Call Letter, CMS includes language requiring Organizations to contact providers monthly to obtain updates to provider information. Once updates from providers are received, Organizations must update the online provider directories in real time.
The operational implications that come along with the changes around network updates and provider directories are huge. While Organizations will have to work through the specifics of these new processes, the cost savings of not having to automatically send printed directories is a clear win for the industry.
2. CMS modifies current guidance to require submission of all agent/broker websites that mention specific products. While this change may be operationally burdensome, we actually view this as a positive. Clearly, this is a revision that has to do with risk areas that have been identified in the industry – anyone who has overseen or reviewed agent/broker websites can attest to that! With the CMS requirement in black and white, we believe that CMS has actually made it easier for Organizations to oversee agent/broker websites in order to ensure Compliance.
3. CMS now specifically states that submission and approval of mobile applications (app) for marketing to prospective enrollees is required. From our perspective, this revision indicates again that CMS has become aware of an area of industry risk. In order to implement this requirement it will be important that Organizations get ahead of this trend and a) ensure that agent/broker/FMO contract language is strong related to which delegates are permitted to develop an app to market plan products and b) ensure that there is a process in place around internal compliance review and submission to CMS of mobile applications.
Conclusions?
- CMS continues method of applying Compliance Actions, as well as Civil Money Penalties
- CMS Continues to have a laser focus on beneficiary protections
- CMS has provided significant flexibility to fulfill certain key requirements — take advantage!
If you have questions or need clarifications regarding any of the information listed above, contact us here and a team member will bee in contact with you shortly.
Resources
Read our recent case study regarding a mid-sized managed care health plan who struggled with appeals, grievances, and Complaint Tracking Module cases (CTMs) to see what their challenges were and how they overcame them. Download now >>
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