Ritter Insurance Marketing

This came in 3 parts. . .I’m linking all three together.  This is a lot!

Part 1:

Part 2:

Implementing the Medicare Improvements For Patients & Providers Act Of 2008 (MIPPA):
New MA And Part D Regulations CMS 4131-F And CMS 4138- IFC
 
The September 23, 2008 issue of Coventry Connection outlined key details of the new CMS marketing regulations for Medicare Advantage and Medicare Prescription Drug programs that were implemented on September 18th.  Included were:

• Marketing Through Unsolicited Contacts is Prohibited
• What an Organization is Permitted to Do
• Cross-Selling Non-Health Care Related Products is Prohibited
• Scope of Appointments

In this issue we will discuss two more of the new regulations and CMS guidance: State licensing and appointments for agents/brokers, and annual agent training and testing requirements.

State Licensure and Appointment of Agents
Agents and brokers now are required to both be licensed and appointed in accordance with state laws where conducting marketing.

• Applies to both contracted and employed agents/brokers
• In most states, Customer Service Representatives can
  • Provide factual information
  • Fulfill a request for plan materials, and 
  • Accept an enrollment application at the initiative of the enrollee

Agent/Broker Training and Testing
All agents/brokers must be trained and tested annually. The following guidelines apply for training content and timeline: 

• Medicare rules and regulations
• Plan details specific to plan products being sold
• Both contracted and employed agents must successfully complete training
• Must be successfully completed before able to market for the plan  

New guidance, effective on September 18, 2008:

•  Testing requires passing score of at least 85%

 Part 3:

Implementing the Medicare Improvements For Patients & Providers Act Of 2008 (MIPPA):
New MA And Part D Regulations CMS 4131-F And CMS 4138- IFC
  In the September 24, 2008 issue of Coventry Connection we outlined CMS guidance on the new regulations for agent and/or broker licensure and state appointment, as well as the scope and minimum passing score for training and testing.

In this issue, the third of our 3-part series this week on MIPPA updates that went into effect on September 18, 2008, we will highlight more of the new guidance such as:

• Sales/Marketing Activities in Health Care Settings or Educational Events
• Nominal Gifts provision
• No Meals provision
• Aggressive Sales Tactics Unacceptable

Sales / Marketing in Health Care Settings or Educational Events

• Educational Event is an event that is sponsored by the
  Medicare plan or by outside entities, and promoted to be educational in nature, not to steer toward specific plans, and have multiple vendors. (Examples: health information fairs, conference expositions, state-or community-sponsored events.) 
• Sales Event is an event that is sponsored by the Medicare Advantage plan or another entity with the purpose of marketing to potential members and steering, or attempting to steer potential members toward a specific or limited number of plans.

Beginning September 18, 2008, educational events may not include sales activities such as the distribution of marketing materials or the distribution or collection of plan applications.

CMS has clarified that the purpose of educational events is to provide objective information about the Medicare program in general (not specific plans) and/or health improvement and wellness.  These requirements apply regardless of whether the events are already scheduled.

Agents and/or Brokers who sponsor or participate in educational events must include a disclaimer on event advertising materials that the event is “educational only and information regarding the plan will not be available.”

Sales or marketing activity, presentations, or distribution/collection of plan applications and/or business reply cards in the following areas or events are prohibited:

• In health care settings unless in common areas; common areas include areas such as hospital or nursing home cafeterias, community or recreational rooms, and conference rooms; areas where patients primarily intend to receive health care services.
• Restricted areas, include, but are not limited to: waiting rooms, exam rooms, hospital patient rooms, dialysis centers, and pharmacy counter areas.  If a pharmacy counter is located within a retail store, common areas would include the space outside where patients wait for services or interact with pharmacy providers and obtain medications. 
• Only upon a beneficiary’s request, the broker/agent is permitted to schedule an appointment with the beneficiary residing in long-term care facilities. Appropriate documentation of the beneficiary’s request and agreement for the appointment is required.
• Medicare and/or health educational materials must contain no marketing information.  

Nominal Gifts

Effective September 18, 2008, Agents and/or Brokers, or an organization may only offer gifts of nominal value, based on retail purchase price regardless of actual cost, which is currently $15.00*, to potential enrollees only if:

• The item/ gift is not readily convertible to cash and
• The item/gift is provided to all whether or not the individual enrolls in the plan.  

* CMS will update the nominal value in guidance as necessary to account for inflation and other relevant factors.

Prohibition of Meals  Effective September 18, 2008, prospective enrollees to a Medicare Advantage and/or Medicare Prescription Drug Plan may not be provided meals, or have meals subsidized, at any event or meeting at which plan benefits are being discussed and/or plan materials are being distributed.

• Agents and/or Brokers are allowed to provide refreshments and light snacks to prospective enrollees and must use their best judgment on the appropriateness of food products provided.
• Agents and/or Brokers must ensure that items provided could not be reasonably considered a meal, and/or that multiple items are not being ”bundled” and provided as if a meal. 
• CMS does not intend to define the term “meal” or create a comprehensive list of food products that qualify as light snacks. Items similar to the following could generally be considered acceptable: fruit, raw vegetables, pastries, cookies or other small dessert items, crackers, muffins, cheese, chips, yogurt and nuts.

Aggressive Marketing Behavior or Scare Tactics Are Unacceptable  

Beneficiaries must not be subject to and must be protected from aggressive marketing behavior from agents and brokers.  Coventry takes this CMS mandate very seriously and will promptly investigate, track and discipline any such behavior.

Examples of behavior that are not acceptable are:

• An agent who uses high pressure sales or scare tactics that are meant to cause concern, especially by implying a beneficiary’s Medicare benefits are at stake.  
• An agent not ending the meeting if the beneficiary states he/she is not interested in the plan.