Third-Party Marketing Organization (TPMO): CMS defines TPMO as organizations and individuals, including independent agents and brokers, who are compensated to perform lead generation, marketing, sales, and enrollment-related functions as a part of the chain of enrollment (the steps taken by a beneficiary from becoming aware of an MA plan or plans to make an enrollment decision). [42 CFR 423.2260]. Please view the amendment to your agreement effective October 1, 2022, that outlines the applicable changes described below. 

New Call Recording Requirements 

Effective October 1, 2022, TPMOs must record all calls with Medicare beneficiaries in their entirety, including the enrollment process, to comply with the new CMS guidelines.

• Face-to-face interactions, such as in-person appointments, do not need to be recorded.
• Agents must obtain verbal consent from all parties prior to recording calls with beneficiaries or their authorized representatives.

• Agents must receive a clear “yes” or “no” before continuing the conversation.
• If they decline to be recorded, the agent should thank them for calling and advise they cannot continue with the call.  Violations can result in civil and/or criminal penalties, depending on the state.

• All call recordings must be retained for a minimum of 10 years to meet CMS retention requirements.
• Agents must be able to provide all call recordings related to a specific beneficiary interaction upon our request.

New Disclaimer Language for Plan Year 2023  

Effective October 1, 2022, TPMOs must record all calls with Medicare beneficiaries in their entirety, including the enrollment process, to comply with the new CMS guidelines.  

• Face-to-face interactions, such as in-person appointments, do not need to be recorded.  
• Agents must obtain verbal consent from all parties prior to recording calls with beneficiaries or their authorized representatives. 

• Agents must receive a clear “yes” or “no” before continuing the conversation. 
• If they decline to be recorded, the agent should thank them for calling and advise they cannot continue with the call.  Violations can result in civil and/or criminal penalties, depending on the state.
• All call recordings must be retained for a minimum of 10 years to meet CMS retention requirements. 
• Agents must be able to provide all call recordings related to a specific beneficiary interaction upon our request.

New Disclaimer Language for Plan Year 2023  

The Final Rule introduces new disclaimers that must be used on all marketing and communication materials beginning with Contract Year 2023. The following disclaimer needs to be placed on all third-party materials as outlined below: 

“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. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”

This disclaimer needs to be:

• Verbally conveyed within the first minute of a sales call.
• Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication.
• Prominently displayed on TPMO websites.
• Included in any marketing materials, including print materials and television advertisements, developed, used or distributed by the TPMO.

This change in regulation is effective for marketing material for use beginning October 1, 2022. 

When conducting lead-generating activities, either directly or indirectly for an MA organization, TPMO’s must, when applicable:

• Disclose to the beneficiary that his or her information will be provided to a licensed agent for future contact.

This disclosure must be provided as follows:

• Verbally when communicating with a beneficiary through telephone.
• In writing when communicating with a beneficiary through mail or other paper.
• Electronically when communicating with a beneficiary through email, online chat, or another electronic messaging platform.
• Disclose to the beneficiary that he or she is being transferred to a licensed agent who can enroll him or her into a new plan.

Additional Oversight Activities

The Final Rule expands the plan oversight requirements of TPMOs. As a result, Devoted Health Plan will be sending TMPOs a contract amendment that will incorporate the additional obligations in the Final Rule. Additionally, Devoted Health will monitor and audit the following TPMO activities for compliance:

• Disclosure to Devoted Health of any subcontracted relationships used for marketing, lead generation, and enrollment.
• Recording of all sales calls with beneficiaries in their entirety, including the enrollment process. 
• Retention of recordings of sales calls and presentation of recordings to Devoted Health upon request.
• Monthly reports of any staff disciplinary actions or violations of any requirements that apply to Devoted Health plans associated with beneficiary interaction to the plan.