Just after markets closed on November 25, the Centers for Medicare and Medicaid Services (CMS) released its proposed rule for the Medicare market for Contract Year 2027. The rule is wide-ranging: there’s talk of implementing the Part D redesign; proposals to reconfigure Star Ratings; and a proposal to create a Special Election Period when a beneficiary’s doctor leaves their Medicare Advantage plan’s network.
For now, though, let’s focus on how CMS is proposing to relax many marketing requirements Medicare agents and brokers have grown accustomed to.
Currently, CMS requires agents and brokers to read one of two standardized disclaimers within the first minute of a telephone or video call with a beneficiary. The disclaimers are meant to inform the beneficiary that the agent/broker does or does not represent all of the plan options available in an area, and that there may be more options than what is presented within the marketing appointment.
Citing industry feedback that the requirements are unwieldy and unnecessary unless and until the agent/broker begins talking about benefits on the call, CMS is proposing to modify these rules.
Instead, agents/brokers would be required to read the disclaimer prior to the discussion of any benefits. This would allow you to greet the customer and confirm the nature of the call before introducing the script.
Notably, CMS would also remove the requirement to mention State Health Insurance Assistance Programs (SHIP) in the disclaimer. Citing wide variations in the implementation of such programs and the quality of support they might provide to beneficiaries, CMS wishes to reduce beneficiary confusion and streamline their conversations with agents and brokers.
The call recording requirement has seen a topsy-turvy road since its inception. Most recently, the requirement was narrowed to require agents only to record their sales, marketing, and enrollment calls. And, those recordings need to be retained for the current year plus ten years, just like other enrollment materials.
Citing the cost and administrative burden of storing potentially millions of calls, CMS is proposing to reduce the retention requirement for sales and marketing calls only to six years. Enrollment calls would still need to be retained for 10 years.
CMS is also seeking comment on other ways to reduce the cost burden:
No matter what CMS decides to finalize here, though, the industry can likely breathe a sigh of relief. Storing data isn’t cheap.
Medicare educational events (or Medicare 101s) have long been a staple in every agent’s community-based marketing. But, current rules require a 12-hour gap between an educational event and a marketing event held at the same venue. That leaves many agents with the interesting problem of having built the foundation of a relationship with their educational attendees, only to lose steam as they walk out the door.
Under the proposed rule, CMS would once again allow marketing events, where plan-specific information can be discussed, directly after an educational event. As beneficiaries might have issues with transportation, CMS feels the rule creates barriers to timely enrollment advice – especially for beneficiaries who live in rural areas.
CMS would require, however, agents and brokers are transparent about the change in topics. Either a written notation on the day’s agenda or a verbal announcement would be sufficient. And, beneficiaries must be allowed to leave between the education and marketing portions– such as during a restroom or snack break.
As part of the effort to keep educational events solely educational, CMS currently prohibits agents from taking Scope of Appointment forms at educational events. The agency has previously expressed concerns that beneficiaries may feel unduly pressured to complete the scope of appointment.
Now, though, the agency is reversing course. The ban would be lifted, again citing transportation and ease of access concerns.
Which brings us to another stunning reversal…
CMS has waffled a few times on whether beneficiaries should be entitled to a 48-hour “cooling off” period between the signing of a Scope of Appointment and when the appointment should take place. Currently, the rule is in effect, and is meant to reduce the pressure on beneficiaries to make an enrollment decision in the heat of the moment.
The pendulum has swung back the other way, though: CMS now sees the 48-hour rule as a barrier to “smooth, informed, and timely decision making,” which puts more of a burden on the beneficiary than it’s worth.
In effect, the removal of the 48-hour rule, in conjunction with the proposed changes to events noted above, would allow agents to conduct marketing appointments immediately following an educational event.
CMS is also proposing minor adjustments to regulations to improve clarity around the Scope of Appointment (SOA) process. The proposed rule would alter the definition of a personal marketing appointment to read:
“Personal marketing appointments are those appointments that are tailored to an individual or small group (for example, a married couple) for the purposes of discussing marketing topics.”
CMS notes that this rewrite would slightly alter the interpretation of some SOA rules: personal marketing appointments with small groups of related people, or those living in the same household, would only require one Scope of Appointment.
However, meetings with unrelated beneficiaries, whether at a home or in a public space (think ANOC meetings) would require a Scope of Appointment for each participant.
The agency would also maintain that SOAs would be required for all personal marketing appointments, regardless of who initiated the call. A new caveat would be added, though – the SOA would need to be completed in writing for in-person appointments. That would seem to preclude gathering the SOA via text or e-signature, at least as the regulation is currently proposed.
CMS also takes pains to note that SOAs are valid for 12 months following signature or the beneficiary’s initial request for information. During that 12 months, plans and agents may contact beneficiaries regarding any product noted on the SOA. And, the SOA can be used for multiple telephonic or in-person contacts or appointments – there would be no need to get an SOA every time you touch a client.
As we said at the top, there are a number of other provisions in the proposed rule. CMS is taking significant steps to continue implementing the Part D redesign under the Inflation Reduction Act of 2022. It’s also proposing several key changes to the ever-contentious star ratings systems. We’ll publish more on those next week.
For now, though, we can look forward to a 2027 where there just may be fewer compliance hurdles to clear before you can do what you do best: helping your clients find good-fitting plans.