The Good, the Bad, and the Ugly! Proposed CMS Marketing Guidelines

 

| Diane Hollie

Regarding the New Proposed Medicare Marketing Guidelines (MMG)

Taking a quick read of the proposed 2017 MMG, our marketing team had some initial thoughts about the proposed changes we would like to share.

The Good

  • It’s only February, and we have the proposed 2017 MMG. This is great for us “Marketers” since we can plan now and won’t get sucker-punched at the last moment with changes we weren’t expecting.
  • The proposed MMG state you no longer have to put the disclaimer about “Availability of Non-English Translations” on print ads and postcards except in the language in which the ad is printed. With so little space to work with on ads and postcards, this change is very welcome.
  • Although already released in previous guidance, CMS now includes the following key provider directory updates in the MMG:
    • CMS includes more specific guidance on timely updating of directories.  Hard copy directories are proposed to be updated monthly; using addendums for the updates is acceptable. Online directories are expected to be completed within 30 days of notification. Although updating directories monthly or within 30 days is very difficult, it is better than real time, which was stated last year.
    • CMS states all providers and/or pharmacies represented in the directory have a current contract in effect to participate in a Plan’s network. At a minimum, any provider and/or pharmacy listed in the hard copy or online directory for the upcoming plan year should have a contract in effect for the first full month of the plan year.  This greatly helps those of us in Marketing and Sales as nothing derails a sale better than stating a provider is in the network only to find out later the provider is not in the network.
    • Last year the MMG stated Plans needed to contact their providers on a monthly basis to update their information.  CMS has updated the previous language to state the provider contact is required quarterly.
  • CMS is clarifying when it is acceptable to use the term “free” in marketing materials. CMS states the term “free” may be used when describing mandatory supplemental benefits that are provided at $0 cost sharing for all enrollees.

The Bad

  • Unfortunately, CMS has also proposed Plans cannot use the term “free” to describe $0 premium plans, Part B premium buy-downs, low-income subsidy, or dual-eligibility.
  • CMS has clarified guidance from last year to state if an agent is conducting a one-on-one appointment telephonically, the agent must follow the Scope of Appointment guidance.

The Ugly

  • CMS includes language stating it will no longer generate Summaries of Benefits (SBs), and Plans will be required to develop their SBs based on their bid data in the Health Plan Management System (HPMS) and required data elements provided in an SB guidance memo. First-year changes like this are always ugly since there are always interpretation issues, and timing on these documents is already tight.  However, we fully expect CMS to provide additional guidance around the implementation of this change in the months to come.

Not a BIG deal but Worth Mentioning:

  • There is a proposed fifth mailing statement to be utilized for the Annual Notice of Changes (ANOC) mailing only:  “Important information about the changes to your Medicare drug and health plan.”
  • CMS has included what they stated in a memo last year: the ANOC/Evidence of Coverage (EOC), directories, formulary, Utilization Management documents, and Multi-Language Insert must be on the website by September 30, with some exceptions.

Changes to the MMG are never wanted, unless it makes our lives easier, but having a “heads up” related to potential changes in February is a great way to get started for the upcoming Annual Election Period―thank you, CMS!

 

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