New Requirements for TPMO When Selling Medicare Advantage and/or Part D Plans
The Centers for Medicare & Medicaid Services (CMS) have released their final ruling on requirements for the marketing and communication of Medicare Advantage and Part D plans. The requirements are aimed at safeguarding Medicare beneficiaries and include requirements for disclaimers and recording of phone calls. If Medicare Part D is included in a bundle with another product, the sales process is still subject to this law. There has been an increase in complaints to CMS as it relates to misleading advertisements f rom third-party marketing organizations (TPMOs) and CMS has now expanded the definition of TPMO to include agents and brokers. If you sell Medicare Advantage or Medicare Part D plans, you are required to follow these new regulations and must be in compliance by October 1st, 2022.
This exact disclaimer must be used in the following places:
“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 your options.”
Verbally conveyed within the first minute of a sales call or in-person meeting.
Electronically or in writing when interacting with the beneficiary through email, online chat other electronic means of communication.
Prominently displayed on your website
Included in any marketing materials such as print materials and television advertising.
Call Recording Requirement:
All sales calls with beneficiaries must be recorded in their entirety. This means that all marketing calls with both clients and prospects where Medicare Advantage and Medicare Part D plans are discussed must be recorded. The recordings must also be retained in a HIPAA-compliant manner for 10 years.
Any conversation within the “chain of enrollment” must be recorded. This includes everything from the moment a beneficiary becomes aware of Medicare Advantage or Part D plans to the enrollment process itself. Medicare supplements are not included in the new call recording rules.
In-person, face-to-face marketing and sales meetings are excluded from the recording
requirement (not the disclaimer requirement), however, follow-up calls related to those meetings would need to be recorded. Also, agents must report any staff disciplinary actions associated with Medicare beneficiary interaction on a monthly basis.
What You Need to do
Update your website footer and any contact/submission form on your website to include: “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 your options.”
Update any marketing materials supplied via hard-copy or email to include the disclaimer.
If you use a chatbot or online messaging system with clients, add the disclaimer so it’s prominently displayed.
Create a new Medicare-only email signature which includes the disclaimer.
Update workflows to include a review of the disclaimer when on the phone or having an in-person contact.
Recording Phone Conversations:
Record all conversations following CMS guidelines
Save all conversations in a HIPAA-compliantsystem for ten years