2023 CMS Final Rule
Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs
Over 23 million individuals receive Part D coverage through standalone Part D plans.
The primary purpose of this final rule is to implement changes to the MA and Part D programs. This final rule implements changes related to marketing and communications, past performance, Star Ratings, network adequacy, medical loss ratio reporting, special requirements during disasters or public emergencies, and pharmacy price concessions. This final rule also revises regulations related to dual eligible special needs plans (D-SNPs), other special needs plans, and Medicare cost contract plans.
New CMS Call Recording Requirements
CMS has new Medicare marketing rules that affect how you work as an agent and will likely mean big changes for you and your agency.
These changes include: Read More
- New requirement for third-party marketing organizations (like GoldenCare)
- A new process for submitting marketing materials to CMS
- A new, broader definition of “marketing” that expands the types of materials that must be submitted to CMS.
- New requirements for agents to record all calls with beneficiaries
Additional Details: All calls with beneficiaries must be recorded in their entirety. You are responsible for compliance with this requirement. The requirements are effective now for plan enrollments beginning on January 1, 2023. As AEP is the start of marketing for plan year 2023 enrollments, this means that you should record all calls in their entirety beginning on October 1, 2022.
CMS Requires New Verbal Disclaimer to be Read During Telephonic Sales Calls
The disclaimer announced in the 2023 CMS Final Rule extends to telesales calls and must be read within the first minute of the call. This disclaimer now applies to all third-party CY2023 materials as well as telesales calls 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.”
This rule was implemented after CMS reviewed beneficiary complaints and listened to the sales organizations’ telephonic enrollments. From this, CMS determined that many beneficiaries are confused about the enrollment process as well as the plan choices available to them. This disclaimer was created to help clear up that confusion.
Although it may feel as though the disclaimer emphasizes what you do not offer, stay focused on what you can offer your prospects. Take time to consider their experience with Medicare benefits, what kind of plan would improve their experience, and work with them to figure out what plans would be best meet their medical and financial needs.
Note: It is anticipated that CMS will conduct surveillance of telesales call recordings to assess compliance during the next year, and they expect all organizations to provide a disclaimer during sales calls.
It is important to update your documents and scripts to ensure that you are incorporating the new disclaimer in time for AEP sales.