CMS Monitoring Activities and Best Practices during AEP

While there are no changes to current guidelines, CMS reiterated their concern regarding the marketing practices of all entities, including Third Party Marketing Organizations (TPMOs), and through secret shopping, initiatives have identified numerous areas of concern. Primarily, information being provided to beneficiaries that is confusing, misleading, and/or inaccurate. Their concerns are centered around not only marketing materials but also beneficiary experience, including TPMOs (including agents) unduly pressuring individuals, as well as failing to provide accurate or enough information to assist a beneficiary in making an enrollment decision that fits their needs.

The memo highlights the following immediate actions they will be taking during the 2023 AEP to address these concerns:

  • Enhanced review of select materials submitted under the File and Use criteria
  • Reviewing selected materials submitted previously under the File and Use criteria
  • Reviewing all marketing complaints received during the AEP and targeting oversight and review on MA organizations and Part D sponsors with high or increasing rates of complaints
  • Reviewing recordings of agent and broker calls with potential beneficiaries
  • Continuing secret shopping initiatives through the AEP by calling numbers associated with TV advertisements, mailings, newspaper advertisements, and internet searches/social media.

CMS also issued several best practices and reminders for plans so I would not be surprised if we see increased oversight by the plans regarding the following areas:

  1. Enhanced reviews of sales allegations and addressing agent behavior promptly
  2. Tracking complaints and rapid disenrollments looking for outliers
  3. Ensuring agents are capturing and retaining SOAs
  4. Increased oversight of Field Marketing Organizations (FMOs)
  5. Ensure marketing materials clearly explain when benefits may not be available to all enrollees
  6. Ensure agents are reviewing the pre-enrollment checklist prior to enrollment
  7. Ensure agents are using carrier-provided presentations, talking points, etc. when presenting plans to beneficiaries

Upcoming Changes: Starting January 1, 2023, TV Advertisements will no longer go through the File and Use process in HPMS but will require a full, 45-day review by CMS prior to use.

As a reminder, we encourage all agents to use communication materials instead of marketing materials whenever possible. Both should be submitted to your upline for review prior to use and marketing materials should never be used until they have been reviewed and accepted by all carriers and have a Use Date assigned through the HPMS system.

Additionally, agents should ensure the following:

  1. A Scope of Appointment form is captured before speaking to a beneficiary regarding MA or Part D plans. SOAs are event specific so a new one should be captured each time you speak with a beneficiary if they do not enroll initially.
  2. All calls with beneficiaries must be recorded. This includes pre-enrollment, sales and enrollment, and post-enrollment calls, and recordings must be stored for a period of 10 years.
  3. The TPMO disclaimer must be read verbally at the start of each sales call (within the first 60 seconds) and must also be present on agent websites, email communications, and online chats.
  4. Marketing materials should not be misleading or confusing and must be compliant with all CMS and carrier guidelines, including all applicable disclaimers. Marketing materials must also be filed with CMS and opted-in by all carriers you represent prior to use.

CLICK HERE for HPMS Marketing Practices Memo