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.