Medicare Marketing Guidelines Summary of Changes — Have They Left You Scratching Your Head?

On June 10, 2016, the Centers for Medicare & Medicaid Services (CMS) announced the release of the 2017 Medicare Marketing Guidelines (MMG) for Medicare Advantage Organizations (MAOs) and Part D Sponsors.

Added language, clarification, and new requirements seem to be the theme with the recent updates.  So how do these changes affect business as we prepare for the 2017 Annual Election Period (AEP)?

At Gorman Health Group (GHG), our team of subject matter experts comes together to provide you with clarification around a few key changes from the final MMG Summary of Changes and recommendations for your organization.

Marketing — Diane Hollie, Senior Director of Sales & Marketing Services, says, “Although CMS has stipulated provider and pharmacy directories are considered non-marketing material, it doesn’t mean the provider directories don’t get submitted to CMS.  In fact, all plans must submit their hard copy provider directories to CMS on an annual basis.”

CMS is now referring Sponsors to the Medicare Managed Care Manual, Chapter 4, for provider directory guidance and the Prescription Drug Benefit Manual, Chapter 5, for pharmacy directory guidance — making it a more complicated process.  The following are just a couple of provider directory rules found in Chapter 4, which were announced earlier this year in a 4/28/16 Health Plan Management System (HPMS) memo.

• All hard copy directories must be uploaded into HPMS as a non-marketing material under the XXX submission code.
• All hard copy directories must be uploaded prior to making the directory available by September 30.
• Because provider directories are considered non-marketing, MAOs should not include a status after the material ID.
• To distinguish the provider directories as non-marketing, the following material ID should be used:  plan’s contract number, followed by an underscore, followed by a series of alpha numeric characters chosen at the discretion of the plan, followed by an underscore, followed by the letters “NM.”  Example:  HXXXX_ABC124_NM

While it is noted the MMG has referred readers to the PDBM, Chapter 5, for pharmacy directory guidance, there is no cross-referenced information.  This could be an indicator a revised Part D Chapter 5 will soon be released. Without it, Sponsors will be left scratching their heads.

Sales — Carrie Barker-Settles, Director of Sales and Marketing Services, understands the importance of agent/broker oversight and Sponsor sales activities.  “Helping plans/Part D Sponsors and agent distribution channels navigate the dos and don’ts of the rules and regulations can be very overwhelming, but at GHG, we can make that challenging task less daunting for both.”

Below are just some of the changes relating to sales oversight:

• Telephonic Contact — Plans/Part D Sponsors may call their current MA and non-MA enrollees or use third parties to contact their current MA and non-MA enrollees about MA/Part D plans.  Examples of allowed contacts include calls to enrollees aging into Medicare from commercial products offered by the same organization and calls to an organization’s existing Medicaid/Medicare-Medicaid Plan (MMP) enrollees to talk about Medicare products. The updated guidance clarifies, when discussing Medicaid products, Sponsors must follow all applicable Medicaid marketing rules. Plans/Part D Sponsors, sellers, and telemarketers may conduct these telephonic activities, but we recommend you fully understand all the regulations for both unsolicited and solicited contact before reaching out to Medicare beneficiaries.
• Compensation Payment Requirements — Whether you use employed, captive, and/or independent agents, you must inform CMS yearly by the end of July which channels you will be using as well as the compensation payment rates or ranges.  The compensation structure must include:
  • How the Plan/Part D Sponsor intends to disseminate compensation, specifying payment amounts for initial and renewal compensation.
    • CMS has clarified in the revised guidance the compensation structure must stay the same for the compensation year that was put in place by October 1.

Some Plan Sponsors may have already been following this process, but if not, yearly requirements outlined in the MMG suggests all Plan Sponsors check policies and procedures to ensure they adhere to their clarification.

“I come from a trust but verify world,” says Regan Pennypacker, Senior Vice President of Compliance Solutions,” and when the updated MMG is released, it’s important Compliance teams disseminate the document to ensure affected business units can determine impact.”  “It’s also important,” she states, “to reconcile and ensure supplemental memos and clarification emails sent between revisions have also been rolled into the new guidance.”  For example, the Part C aspects of the August 13, 2015, “Clarification of CY2016 Medicare Marketing Guidelines” has indeed been rolled into the MMCM, Chapter 4, but as noted above, the Part D aspects pertaining to pharmacy directories has not. “This means plans will need to continue to reference that memo to ensure they are following the guidance as it pertains to pharmacy directories.”

“Overall,” states Regan, “it will be important for Compliance to partner with Sales and Marketing staff to ensure adherence to all changes and clarifications.”

We have highlighted just a few of the key changes, but to learn more, register to join our upcoming webinar on June 28, 2016, from 1 – 2 pm ET.

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Once you have your PBPs in place (we can help with that, too), our teams can develop or review your sales collateral and creative by product type to help ensure your high-impact messaging is both targeted and compliant. Visit our website to learn more >>

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