As plans work through the biggest changes to the Medicare Marketing Guidelines since its inception – including changing the name of the guidance to the Medicare Communications and Marketing Guidelines (MCMG) – the Centers for Medicare and Medicaid Services (CMS) is preparing to present a session on the MCMG and provider directory updates at its upcoming Medicare Advantage (MA) and Prescription Drug Plan (PDP) Fall Conference and Webcast Sept. 6, from 9:30 a.m. to 4:30 p.m. EDT.
Combined Mailing of Required Materials Saves Time and Money
The MCMG training session precedes the Sept. 30 deadline for existing members to receive hard copies of the Annual Notice of Change (ANOC), where they have not opted in to receiving the electronic version. Plans can save time and money by including other annually required documents for existing members in the same mailing as the ANOC. For example, plans can include the notice that required documents (Evidence of Coverage (EOC), Provider/Pharmacy Directories and/or Formularies) are available online with the ANOC. CMS expects the notice to be mailed no earlier than Sept. 24, in time for enrollees to receive the required documents, if they want a hard copy, by Oct. 15. Plans can also include the Low-Income Subsidy (LIS) Rider with the notice that required documents are available online and the ANOC. Enrollees must receive hard copies of the LIS Rider by Oct. 1. Per the table below, plans can maximize savings by mailing all three required documents by Sept. 24.
|Enrollee Receipt Date||Earliest Mailing Date||Required Hard Copy Delivery Material|
|Sept. 24||Notice that Required Documents are Available Online|
|Sept. 30||Annual Notice of Change, if not opted in for electronic version|
|Oct. 1||LIS Rider|
|Oct. 15||EOC, Provider/Pharmacy Directories and/or Formularies, if requested|
Redefining “Communications” and “Marketing”
One of the more interesting changes, first mentioned in the 2019 Final Rule and detailed in the MCMG, is the separation of the ANOC/EOC in 2019. This separation speaks to the heart of CMS redefining the Medicare Marketing Guidelines as the Communications and Marketing Guidelines. The MCMG defines “Communications” as “activities and use of materials to provide information to current and prospective enrollees” and “Marketing” as “a subset of communications and activities and use of materials that are conducted by the Plan/Part D sponsor with the intent to draw a beneficiary’s attention to a MA plan or plans and to influence a beneficiary’s decision-making process when selecting a MA plan for enrollment or deciding to stay enrolled in a plan.”
Under the new definitions, the ANOC is considered a marketing material, one that existing members will use to decide whether they will stay enrolled in a plan or enroll in another plan, and an EOC is considered a communication in which existing members are advised of their benefits. The date by which enrollees must receive the EOC, whether electronically or hard copy, has been changed from Sept. 30 to Oct. 15. CMS will continue to review marketing materials and only required communications material as designated by CMS, such as EOCs, Provider/Pharmacy Directories and/or Formularies.
For prospective enrollees, the Summary of Benefits (SB) is provided when an enrollment form is provided. Whether the SB is provided as a hard copy or electronic depends on the enrollment mechanism. CMS considers the SB to be a marketing material because its main purpose is to influence a prospective enrollee to enroll in a plan, and agents use the SB to sell plans to prospective enrollees. The SB must be provided to prospective enrollees by Oct. 15.
New this year is the Pre-Enrollment Checklist, considered by CMS to be a communications material, that must be provided to potential enrollees with the SB when the SB accompanies an enrollment form. The Pre-Enrollment Checklist consists of a series of phrases pertaining to Understanding the Benefits and Understanding Important Rules that the prospective enrollee checks before making an enrollment decision. For example, CMS moved a key disclaimer to the Understanding Important Rules section of the Pre-Enrollment Checklist: “Benefits, premiums and/or copayments/co-insurance may change on January 1.”
New and renewing plans are required to post SBs, ANOCs, EOCs, Provider/Pharmacy Directories and Formularies to their websites by Oct. 15.
Other sessions to be held at the 2018 MA and PDP Fall Conference and Webcast include Best Practices for Classifying Grievances, Appeals and Coverage Decisions, Medicare Advantage and the Quality Payment Program, and Tackling the Opioid Crisis in Medicare Advantage and Part D.
BluePeak Can Help
BluePeak’s consultants have experience reviewing member materials from their work at plans and for CMS. We can help you populate and/or review the annual required materials, as well as other member communications, such as Explanations of Benefits (EOBs), transition letters, denial notices, etc., that, if in error or not easily understood, could potentially result in CMS enforcement actions, including Civil Money Penalties (CMPs).
For a more in-depth summary of the MCMG, contact BluePeak at email@example.com or (469) 319-1228.