What's new in the Medicare communications and marketing guidelines?
Sep 05, 2018 · The Medicare Communications and Marketing Guidelines (MCMG) interpret and provide guidance on the marketing and communication rules for Medicare Advantage (MA-only, MA- PD) plans (also referred to as “plans”), Medicare Prescription Drug plans (PDP) (also referred to
When does CMS consider a health plan a communication?
Feb 09, 2022 · the marketing and communications requirements for Medicare Advantage (MA) plans , section 1876 cost plans, and Medicare Prescription Drug Plans (collectively referred to as “plans”) governed under Title 42 of the Code of Federal Regulations (CFR), …
Are You using the new CMS guidelines memo in conjunction?
Aug 25, 2020 · Guidance for Medicare Communications and Marketing Guidelines (MCMG) Table of Contents. Download the Guidance Document. Final. Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: September 05, 2018. HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with ...
How do I submit any website CMS considered marketing?
Aug 31, 2020 · Guidance for updated sections 70.1, 90.1, and 90.4 of the Medicare Communications and Marketing Guidelines (MCMG) based on comments received following the release of the MCMG on July 20, 2018. Download the Guidance Document. Final. Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: August 10, 2018.
What is CMS marketing rule?
Marketing Rules CMS also regulates marketing and plan presentations, including when you're allowed to market, and how you market. Agents must wait until October 1 to begin marketing next year's plans to potential beneficiaries and cannot enroll members until October 15.
Do Medicare Advantage plans follow CMS guidelines?
Medicare Advantage Plans Must Follow CMS Guidelines In the United States, according to federal law, Part C providers must provide their beneficiaries with all services and supplies that Original Medicare Parts A and B cover. They must also provide any additional benefits proclaimed in their Part C policy.
Who approves Medicare marketing materials?
All marketing materials need to be filed and approved by CMS. Agent created communications to members do not need CMS approval. Any agent created communication must follow the CMS Medicare Communications and Marketing Guidelines.
Is Event Reporting still required by CMS?
As a rule of thumb, any time you want to partake in marketing activities, structure your event as a sales event. “Talking points” used during the event and presentations used by agents need to be submitted to CMS prior to use.
Can you switch back and forth between Medicare and Medicare Advantage?
If you currently have Medicare, you can switch to Medicare Advantage (Part C) from Original Medicare (Parts A & B), or vice versa, during the Medicare Annual Enrollment Period. If you want to make a switch though, it may also require some additional decisions.
Can you have Medicare and Medicare Advantage at the same time?
If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare. You must use the card from your Medicare Advantage Plan to get your Medicare- covered services.
What are the marketing guidelines?
Content Marketing Guidelines are a set of instructions indicating tone, voice, length, style and topics on how your brand should communicate to your target audience. Let's go into why you need to make this document, even if you're a smaller business, and how to go about doing it.
What are CMS permission to call guidelines?
Specifically, the Medicare Permission to Contact (PTC) rule outlines when it is okay to contact a current or potential Medicare beneficiary, the specific products they are giving you permission to contact them for, how you can approach them, and when you can contact them.Mar 25, 2020
What are CMS guidelines for referrals?
In a CMS compliant situation, you would 1) ask for referrals without mentioning any benefit to the enrollee and then 2) present a thank-you gift for the referrals he or she has provided. Second, the gifts you provide must be of a nominal value.Jul 28, 2017
When must a marketing sales event be reported?
Report all marketing/sales events (including additional events reported throughout the month) prior to advertising the event or 10 calendar days prior to the event's scheduled date, whichever is earlier.
When must a marketing sales event be reported to UnitedHealthcare?
It needs to be reported to UnitedHealthcare prior to advertising and not less than 7 calendar days prior to the date of the event.
What is a CMS Never Event?
“Never events,” like surgery on the wrong body part or mismatched blood transfusion, cause serious injury or death to beneficiaries, and result in increased costs to the Medicare program to treat the consequences of the error.May 18, 2006
What are the Medicare marketing guidelines?
The Marketing guidelines reflect CMS' interpretation of the marketing requirements and related provisions of the Medicare Advantage and Medicare Prescription Drug Benefit rules (Chapter 42 of the Code of Federal Regulations, Parts 422 and 423).
Can Medicare Advantage and Prescription Drug Plans use one document?
The guidelines allow organizations offering both Medicare Advantage and Prescription Drug Plans the ability to reference one document when developing marketing materials.
What is included in CMS marketing?
Excluded are materials that may meet the definition of marketing based on content, but don’t meet the intent requirements of marketing.
What does CMS mean when it says "if a potential enrollee provides permission to be contacted, the contact
CMS deleted the phrase: “If a potential enrollee provides permission to be contacted, the contact must be event-specific and may not be treated as open-ended permission for future contacts.” Now that this phrase is gone from the guidelines, it appears that if a potential enrollee grants permission to be contacted, that same permission can be used during different election periods. With CMS removing the phrase, the door is open to more extended permission to contact those eligible for Medicare.
What is the new word for SMC scripts?
That included those to be used by agents or brokers. The word “script” has been replaced by “talking points,” which indicates that the agents can now deliver a more improvised and interactive presentation.
Do email messages have to be approved?
Emails that are considered communication do not have to be submitted for approval. Text messaging and other forms of electronic direct messaging such as social media would fall under unsolicited contact and is still not permitted. Another change was made to marketing and sales events.
Can a CMS plan sponsor advertise outside of the county?
CMS removed the wording that stated Plan/Part D sponsors may only advertise in their defined service area. Advertising can now be done outside of the plan’s county. Open Enrollment Period (OEP) can now be defined and discussed on plan sponsors’ websites.
Can an agent hold more than one event back to back?
This suggests that agents can now do this at the end of educational events, and an agent can hold more than one event back-to-back. It’ll be easier for agents to set appointments and make sales related to these events. It is now required that access to applicable disclaimers be included on your website.
Does CMS have to be approved through email?
Any website CMS considered marketing must be submitted for review and approval through the Health Plan Management System (HPMS). Plans may now contact potential enrollees through email. This is in addition to ads and direct mail that were previously approved.
What is communications in healthcare?
Communications refers to all materials and activities that provide information to current and prospective enrollees. Marketing is now considered a subset of communications. But CMS tweaked the definition to focus on materials and activities meant to influence a beneficiary's decision about their healthcare coverage.
When is the CMS fall conference?
The Centers for Medicare & Medicaid Services (CMS) discussed its updated communications and marketing guidelines during its annual Medicare Advantage and Prescription Drug Plan fall conference on Sept. 6. In this article, we look at the most notable changes.
What is a pre-enrollment checklist?
Pre-enrollment checklists fall under the communications definition and must be provided to potential beneficiaries with the Summary of Benefits (SB) when the SB accompanies an enrollment form. Plans/Part D sponsors may remove portions of the checklist that aren’t applicable to a plan type or product.
What is a presentation slide CMS?
The presentation slides also include a peek into other changes under consideration at CMS. The agency is in the process of updating the Health Plan Management System marketing submission codes. CMS also plans to conduct retrospective reviews to monitor compliance with the new requirements. These reviews may include requests to submit marketing and communications materials.
What is marketing content?
Marketing’s content includes information about the plan’s benefit structure, cost sharing and measuring or ranking standards. However, it excludes materials that may include the content, but do not meet the definition of “intent.”. To meet the new definition of marketing, the material or activity must meet both the intent and content requirements. ...
Can a plan compare itself to a competitor?
Plans can now compare themselves to competitors provided the information is factual. Any comparison to another Plan/Part D sponsor must be supported by fact, such as studies or statistical data, and can’t be misleading. Materials that include plan comparisons fall under the definition of marketing.
Is CMS a communication?
Therefore, CMS would consider it a communication. The agency spells out the designations for all required materials in Section 100, but health plans must decide whether other materials and activities fall under the definition of marketing or communication.