CMS’s New One-to-One Consent Regulations for Contract Year 2025 (CMS-4205-F)

In an ongoing effort to enhance consumer protection and transparency in Medicare marketing, the Centers for Medicare & Medicaid Services (CMS) has introduced significant regulatory changes for Contract Year 2025. Under the final rule CMS-4205-F, a new one-to-one consent regulation requires Third-Party Marketing Organizations (TPMOs) to obtain prior express written consent before sharing beneficiary information with any other TPMO.

This updated regulation is pivotal for insurance agents and organizations working in the Medicare space. Let’s break down the implications, requirements, and best practices for complying with these new rules.

What is the One-to-One Consent Rule?

The CMS one-to-one consent regulation mandates that TPMOs must:

• Obtain Prior Written Consent: Before collecting or sharing any beneficiary information with another TPMO, explicit written consent from the consumer must be secured.
• Apply This Rule to All Contacts: The requirement applies even when agents or organizations contact consumers manually, not just through automated systems.

The intent behind this rule is to enhance transparency and ensure that consumers understand and approve how their personal information will be used.

Why Did CMS Introduce This Regulation?

CMS implemented these changes in response to increasing consumer complaints about aggressive marketing practices, including the sharing of beneficiary information without their knowledge or consent. By requiring prior express written consent, CMS aims to:

• Protect beneficiaries from unwanted solicitation.
• Prevent unauthorized sharing of personal data.
• Build trust between consumers and Medicare marketing organizations.

Quote from CMS:
“This rule reflects our commitment to ensuring that all Medicare beneficiaries have control over how their personal information is used and shared.”

What Does This Mean for Agents and TPMOs?

Key Implications:

1. Stricter Compliance Standards: TPMOs must implement systems and processes to obtain and store written consent from beneficiaries.
2. Manual Dialing is Not Exempt: Even non-automated calls require consent, emphasizing the importance of robust compliance protocols across all communication methods.
3. Increased Accountability: Failure to comply could lead to penalties, damage to reputation, and loss of consumer trust.

Best Practices for Compliance

To meet these new requirements, here are some actionable steps for agents and TPMOs:

1. Develop a Clear Consent Form

   • Include specific language detailing what information will be shared and with whom.
   • Use simple, understandable terms to avoid consumer confusion.

2. Implement a Consent Management System

   • Use digital tools to securely collect, store, and manage written consents.
   • Ensure that consent records are easily accessible for audits or compliance checks.

3. Train Your Team

   • Educate agents and staff about the new requirements and the importance of compliance.
   • Provide clear guidelines on how to obtain and document consent.

4. Review Marketing Practices

   • Eliminate any lead-generation strategies that rely on unauthorized sharing of beneficiary information.
   • Partner with trusted organizations to ensure compliance across all marketing activities.

5. Regular Compliance Audits

   • Conduct routine reviews of your processes to ensure ongoing adherence to CMS guidelines.

What Are the Consequences of Non-Compliance?

Failing to comply with the new one-to-one consent regulation can lead to serious repercussions:

• Monetary Penalties: CMS may impose fines for violations.
• Revoked Contracts: Non-compliant organizations risk losing contracts with carriers.
• Reputational Damage: Violations can harm your credibility and consumer trust.

Looking Ahead: Navigating the Future of Medicare Marketing

The one-to-one consent regulation is part of CMS’s broader efforts to improve the Medicare enrollment experience for beneficiaries. While the rule poses new challenges for agents and TPMOs, it also offers an opportunity to build stronger, trust-based relationships with clients.

By prioritizing transparency and adhering to compliance requirements, agents can differentiate themselves as ethical, consumer-focused professionals in a competitive marketplace.

Partner with PSM Brokerage for Compliance Support

At PSM Brokerage, we understand the challenges agents face in navigating CMS regulations. That’s why we’re here to support you every step of the way with:

• Compliance Training: Stay informed about the latest rules and best practices.
• Marketing Tools: Access compliant lead-generation and marketing resources.
• Expert Guidance: Get personalized support to ensure your processes align with CMS guidelines.

Ready to elevate your Medicare marketing strategy while staying compliant? Contact us today and let’s ensure your success in the evolving Medicare landscape.

By embracing these new rules, you’ll not only protect your business but also solidify your reputation as a trustworthy advocate for Medicare beneficiaries.

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