2023 CMS Final Rule – Third-Party Marketing Organization guidelines

Medicare Advantage organizations are responsible for ensuring that Third-Party Marketing Organizations (TPMOs) adhere to all applicable laws, regulations and CMS guidelines, including the requirements for conducting lead generation, marketing, selling, and enrollment activities with Medicare beneficiaries as outlined within the 2023 CMS Final Rule released May 9, 2022.

Please review and implement the new requirements outlined below.

New TPMO disclaimer

The following new disclaimer needs to be on all third-party CY2023 materials, effective for marketing beginning October 1, 2022:

“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.”

TPMOs must add this disclaimer to any previously approved material.

This 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.
• Prominently displayed on TPMO websites.
• Included in any marketing materials, including print materials and television advertisements, developed, used or distributed by the TPMO.

Compliance oversight of all lead sources

TPMOs are responsible for compliance oversight including ensuring all lead sources used to solicit Medicare product enrollments are compliant with CMS guidelines, and all other state or federal laws, rules and regulations.

This includes but is not limited to ensuring that the TPMO, when conducting lead generating activities, either directly or indirectly, for an MA organization, must:

• Disclose to the beneficiary that his or her information will be provided to a licensed agent for future contact. This must be done:
• Verbally when communicating with a beneficiary by phone.
• In writing when communicating with a beneficiary through mail or other paper.
• Electronically when communicating with a beneficiary through email, online chat, or other 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.

Recording calls with beneficiaries

TPMOs, including lead generation vendors and downstream related entities, must record all calls with beneficiaries in their entirety. In addition, TPMOs must retain and make the recordings available upon request for a minimum of 10 years. This includes calls that are part of the chain of enrollment into a Medicare Advantage or Part D Plan (the steps taken by a beneficiary from becoming aware of a Medicare plan or plans to making an enrollment decision), as well as post-enrollment telephonic discussions

This rule applies to telephonic conversations only, not face-to-face meetings.

Questions?

Thank you for your cooperation in ensuring compliance with these requirements. If you have any questions, please contact us here or call 800-998-7715.

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