Medicare Advantage & Part D Poised to See Significant Compliance Changes in 2024

February 16, 2023

The 2024 Proposed Rule from the Centers for Medicare & Medicaid Services suggests a return to more controlled Medicare communications and marketing standards.

Medicare sales call recording regulations and new third-party marketing organization criteria became required for agents selling Medicare Advantage and prescription drug plans in 2023. In an ongoing effort to tighten down on misleading sales tactics, CMS has proposed clarifying a few points connected to these requirements, bringing back a few outdated rules, and adding a few new ones for 2024.

NABIP, formerly NAHU, submitted a comment letter to CMS this week in response to a new Medicare marketing proposed rule. It’s the ultimate hope that the proposed rule will not go into effect as currently laid out.

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The impending Medicare Advantage and Part D rule modifications that will likely be completed prior to this year’s Annual Enrollment Period are summarized below.

Remember TPMO from 2023.  The Centers for Medicare and Medicaid Services (CMS) published its 2023 Final Rule this past spring. The Final Rule announces changes that have been made to existing marketing and communication requirements for both Medicare Advantage and Part D plans.

These changes sought to strengthen the oversight of third-party marketing organizations (TPMO) and include new consumer protections.

TPMO Sharing of Beneficiary Information

TPMOs are defined by CMS as organizations and individuals who are compensated to perform lead generation, marketing, sales, and enrollment-related functions as part of the chain of enrollment. (The steps taken by a beneficiary from becoming aware of a Medicare plan or plans to make an enrollment decision). TPMO also includes independent agents/brokers.

The sharing of personal beneficiary information with other TPMOs would now become prohibited, and the TPMO disclaimer has been updated.

State Health Insurance Programs (SHIPs) will need to be listed in the updated disclaimer as a way for beneficiaries to get further assistance, in addition to an MA organization and Part D sponsor with which the TPMO has a contract in the beneficiary’s service region.

“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 which are [insert list of MA organizations or Part D sponsors]. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.”

Updates to the 2023 Final Rule on Call Recording

Only sales, marketing, and enrollment calls between TPMOs and beneficiaries must be recorded according to CMS. This should do away with the requirement to record calls for scheduling appointments and check-ins following sales. Calls with current clients, however, must be recorded for client retention reasons.

Additionally, CMS is requiring that all virtual calls for enrollment, marketing, and sales that are conducted by video conferencing or other forms of virtual telepresence be recorded.

Scope of Appointment Rule Change

In order to prevent personal marketing appointments from happening before 48 hours have passed since a potential enrollee has finished a Scope of Appointment, SOA, CMS plans to reestablish the 48-hour SOA time restriction. If you are familiar with the prior 48-hour SOA requirement you should know that the phrase “when practicable” will not be included in the new rule. It will be necessary to obtain SOAs at least 48 hours beforehand.

An SOA is only valid for six months after the beneficiary signs it, according to CMS.

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Holding an Education Event

Agents will not be permitted to make future selling appointments at educational events or gather SOAs or beneficiary contact information. Additionally, agents will not be allowed to have a sales event there within 12 hours of the educational event. (The entire building or nearby buildings are considered to be in the same place.)

How Pinnacle Can Help

We recognize that these changes will present significant challenges for you when assisting clients with their Medicare coverage. Please keep in mind that we are here to assist you as you work through them to conduct your business compliantly, continue growing your sales, and provide the best service to your clients.

Please reach out to the team at Pinnacle Financial Services for additional information on these or any other questions you have, by contacting our Compliance team by email at compliance@pfsinsurance.com.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Bob Brzyski

Bob Brzyski

Vice President - Marketing

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881


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