WASHINGTON – The U.S. Centers for Medicare & Medicaid Services last week proposed a new regulation that would tighten the marketing standards for Medicare Advantage (managed-care, also known as MA) and Part D (prescription drug) plans, aiming to protect seniors from abuse.
The proposal would incorporate into regulation a number of requirements that CMS has previously stated as “operational guidance,” add extra restrictions, and seek to avoid abuses involving broker/agent commissions, going beyond recent changes in the industry.
Specifically, the proposal would:
• Prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances. Cross-selling of non-health care-related products to a prospective MA or Part D enrollee would also be prohibited.
• Prohibit sales activities at educational events such as health information fairs and community meetings or in areas such as patient waiting rooms.
• Require that MA organizations that use independent agents to market MA and Part D plans use state-licensed agents for such marketing and report their use to the states.
• Require MA organizations to establish commission structures for sales agents and brokers that are level across all years and across all MA plan product types. Commission structures for prescription drug plans would have to be level across the sponsors’ plans as well.
The proposed rule also seeks to streamline eligibility determinations for low-income subsidies and protect low-income beneficiaries from unnecessary cost-sharing, and to add new protections for beneficiaries in special-needs plans.
In addition, the rule would give CMS greater flexibility in determining penalties for violations that adversely affect beneficiaries, giving the agency clear authority to levy a penalty of up to $25,000 for each enrollee affected, or likely to be affected, by the violation.
“These proposed changes will have a direct, positive impact on people with Medicare,” said Kerry Weems, acting administrator of CMS, in a news release. “The Medicare Advantage program is a valuable source of enhanced benefits and coordinated care for beneficiaries, and it should not be undermined by the actions of a limited number of unscrupulous sales agents.”
CMS noted that the proposed rule is part of a broader effort to enhance compliance and oversight of the Medicare Advantage program over the past 10 months. Other actions have included posting the summaries of corrective actions taken against MA plans on the CMS Web site; establishing five-star ratings for plan performance; embarking on a “secret shopping” program of plan marketing events; and requiring private-fee-for-service plans to call new enrollees to verify their desire to join the plan.
The proposed regulation has been posted on the CMS Web site, www.cms.hhs.gov. Comments must be submitted by July 15.
