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Wellcare | Important CMS Regulatory Update: New Call Recording and TPMO Disclaimer Requirement

September 15, 2022

Attention Valued Partner,

We would like to inform you of new requirements for Third-Party Marketing Organizations (TPMO)resulting from a recent ruling made by the Centers for Medicare and Medicaid Services (CMS). All of the following new requirements go into effect on October 1, 2022.

Please review the following sections to learn more about each new CMS requirement.

WellCare

Telephonic Recordings

Beginning October 1, 2022, for all 2023 activities, all TPMOs, including all third-party marketing/lead generation vendors, agencies, 1099 agents, and brokers (captive, independent street brokers, TeleDigital agents, etc.), will be required to record all beneficiary calls (sales, enrollment, administrative, etc.) – inbound and outbound – in their entirety, with no exception. Other important requirements:

  •  Applies to all telephonic activities, even if it does not result in enrollment.
  • The requirement applies to all beneficiaries and members. There is no distinction made between new and existing clients.
  • Consent to the record must be obtained for all calls.
  • Recordings are not required for in-person activities.
  • Medicare requires all records be maintained for 10 years.

Remote Agent Telephonic Enrollment (RATE) through Ascend will be updated to include outbound call recording functionality. Recordings may be captured outside of Ascend but must comply with all relevant regulations and laws (consent, retention, producibility, etc.).   

TPMO Disclaimer Language

Beginning October 1, 2022, the TPMO Disclaimer must be used by any TPMO that sells plans on behalf of more than one MA plan provider unless the TPMO sells all commercially available MA plans in a given service area. The disclaimer must 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 (regardless of content).
  • Prominently displayed on TPMO websites (regardless of content).
  • Included in any marketing materials, including print materials and television advertisements, developed, used, or distributed by the TPMO.

Lead Generation Activities

Beginning October 1, 2022, lead-generating activities (either directly or indirectly) facilitated by a TPMO will need to include a notice to the beneficiary that their information may be shared with a licensed agent for future contact. The disclosure must be provided:

  • 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.
  • When beneficiary information is requested or collected (e.g., web forms, consent to contact, etc.), a call transfer will take place.

The disclosure must also be made to the beneficiary that he or she is being transferred to a licensed agent who can enroll them into a new plan.

Oversight & Reporting

To fully comply with the new CMS requirements, TPMOs must:

  • Report to the plans monthly any staff disciplinary actions associated with beneficiary interaction.
  • Report all violations made by TPMOs of those rules that apply to the plans.
  • Make available all enrollment lead sources to the Plan upon request.
  • Disclose any subcontracted relationships used for marketing, lead generation, and enrollment.

New 2023 TPME Contracts

As required by CMS, the 2023 Centene Third-Party Marketing Entity (TPME) contracts include the new TPMO contract requirements. No future action is needed if you have already signed the 2023 contract. In order to be considered Ready To Sell (RTS) with Centene/Wellcare, the 2023 Centene TPME contract must be signed.

The new contract updates relating to TPMO requirements include:

  • Disclosure of any subcontracted relationships used for marketing, lead generation, and enrollment.
  • The requirement to record all beneficiary calls in their entirety.
  • Report to the plans monthly any staff disciplinary actions associated with beneficiary interaction.
  • Report all violations made by TPMOs of those rules that apply to the plans.
  • Applicable TPMO marketing disclaimer/disclosure. 
For more information, contact a Pinnacle Financial Services representative today

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

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

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