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Independent agents and brokers must record calls with beneficiaries, under new CMS final rule

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The CMS 2023 final rule was recently released. Within the document are new requirements for third-party marketing organizations (TPMO), regarding Medicare Advantage and Medicare Prescription Drug Plans. Most importantly, CMS has broadly defined TPMOs as organizations and individuals, including independent agents and brokers, who are compensated to perform lead generation, marketing, sales and enrollment related functions as a part of the chain of enrollment. Despite the fact that the increase in CMS complaints over the past few years have been driven by sales call center activity and lead generation, these rules apply to all individuals and organizations as defined above.

The new rule requires that MA plans must implement a variety of requirements as a part of their oversight of TPMOs. The two listed below will have a significant impact on independent agents:

  1. TPMOs must record all calls with beneficiaries in their entirety, including the enrollment process.
  2. TPMOs must use the following disclaimer within the first minute of a sales call, in electronic communications, on websites and in marketing materials – ‘‘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 (800) MEDICARE to get information on all of your options.’’

There are many outstanding questions regarding these requirements that hopefully CMS will clarify (and hopefully change) prior to October 1. The call recording requirements in particular could prove to be very difficult to implement for field agents. The way the rule is written today it would require you to record all calls with prospects or existing customers in their entirety. A seemingly impossible task for agents not in a call center environment.

Action Benefits will continue to monitor the situation and provide additional information and clarity as it becomes available. We are also looking at solutions to help you comply with the new requirements.

You can read the full final rule here: https://bit.ly/3NizeyN