New compliance rules and guidelines that apply to Medicare Advantage and Part D plans are coming. From new disclaimers to a call recording and 10-year storage requirement, these major changes will affect all independent insurance agents this AEP.
Here's everything you need to know about the upcoming CMS compliance changes, including solutions that will be baked right into MedicareCENTER.
Disclaimer: The information in this article is how we interpret the new CMS compliance rules and guidelines. If any more details or clarifications are made available, we will update you as soon as possible.
CMS Compliance Changes
CMS rolled out a lot of compliance changes that apply to all plan enrollments with a 2023 effective date.
The changes that will affect you, the agent, the most include:
- You must record all calls with beneficiaries
- You must store these call recordings for 10 years
- You must provide a new disclaimer during sales calls, in emails or online chats, on your website, and on all marketing materials
Here's the disclaimer:
“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.”
When do I need to start complying?
Since AEP is the start of marketing for plan year 2023 enrollments, you should start adhering to the new CMS compliance changes beginning on October 1, 2022.
When do I provide the new disclaimer?
Within the first minute of any call with a beneficiary, you must verbally provide this new disclaimer:
"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.”
You must also provide the disclaimer in these other areas:
- Electronically when communicating with a beneficiary through email, online chat, or other electronic communication
- Prominently on your website
- Visually on all marketing materials that you develop, use, or distribute
When in doubt, include the disclaimer.
You are not required to use this disclaimer for in-person meetings with a beneficiary, if you only sell plans on behalf of one carrier, or if you truly sell all commercially available MA or PDPs in a given service area (very, very unlikely).
Recording Client Calls
Independent agents and brokers are considered third-party marketing organizations (TPMOs). As such, you now must record all calls with beneficiaries in their entirety – including the enrollment. You also need to inform the individual that the call is being recorded.
Ensure your call is recording when you verbally inform the individual that the call is being recorded. You'll also need proof that you recited the disclaimer within the first minute of the sales call.
All inbound and outbound calls along the full "chain of enrollment" must be recorded.
What is the chain of enrollment?
Chain of enrollment definition: the events from a beneficiary becoming aware of an MA/PDP plan to the end of the enrollment process.
All of the following call types are considered a part of the chain of enrollment, and they must be recorded and stored:
- Calling leads
- Collecting scopes of appointments telephonically
- Presenting plans
- Discussing different plans if an individual wants to switch
- Collecting prescription drug lists and physician lists
- Mid-year policy reviews
- Educational discussion of Medicare options
- Annual check-ins
- Telephonic enrollments
- Marketing calls
How do I record my calls?
We have great news for you — Integrity is building a call recording capability into MedicareCENTER.
This convenient and easy-to-use call recording technology will be FREE for all Integrity partners and their downline independent agents and brokers.
How to Store Recorded Calls
Another huge responsibility is storing your recorded calls for the required 10 years. Where do you store them, and how do you know the storage solution is HIPAA compliant and secure?
Here’s more great news — MedicareCENTER will have the capability to store call recordings for 10 years. If you choose to use a different call recording resource, make sure it provides you with 10-year access to all your call recordings.
- Download the MedicareCENTER Call Recording Flyer
MedicareCENTER Makes It Easy
While these new compliance rules and guidelines are a big change, MedicareCENTER makes it easy.
In advance of AEP, MedicareCENTER will be able to handle:
- Inbound call recording, store, and download solutions
- Outbound call recording, store, and download solutions
- Call recording storage for 10 years, as required by CMS
- CMS-required scripting for the beginning of each prospect call
Be sure to download our new Agent FAQs document to learn more about these compliance changes.
We will be sharing more information and agent training materials leading up to AEP, so please be sure you subscribe to our email newsletter!