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Oct
07
,
2022

Humana: Important Update to the CMS 2023 Final Rule - Updated

October 7, 2022

Important Compliance Communication Regarding Third Party Marketing Organizations (TPMOs)

NOTE: This communication does not constitute and must not be construed as legal advice. Humana does not represent that compliance with this communication will ensure that any activity will comply with any applicable laws, rules or regulations. TPMOs are required to review and adhere to all applicable state and federal laws, rules, regulations, and policies.

In the second quarter, the Centers for Medicare and Medicaid Services (CMS) published its 2023 Final Rule. The Final Rule announces changes that have been made to existing marketing and communication requirements for both Medicare Advantage and Part D plans. These changes strengthen the oversight of third-party marketing organizations (TPMOs) and include new consumer protections. These new provisions are effective October 1, 2022 and apply to any marketing or communications occurring October 1, 2022 and later.

CMS defines Third Party Marketing Organizations (TPMOs) as: Organizations and individuals, including independent agent and brokers, who are compensated to perform lead generation, marketing, sales and enrollment-related functions as part of the ‘chain of enrollment’ (the steps taken by a beneficiary from becoming aware of a Medicare plan or plans to make an enrollment decision).TPMOs may be First tier, downstream, or related entity (FDRs),but may also be entities that are not FDRs but provide services to a MA/Part D plan or an MA/Part D plan’s FDR.

Agent Impacts

The Final Rule includes additional compliance requirements for agents who fall under the TPMO definition:

  • Disclose to Humana any subcontracted relationships used for marketing, lead generation, and enrollment.
  • Record all calls with beneficiaries in their entirety, including the enrollment process. Humana understands that this recording requirement includes but is not limited to all calls that relate to the sale and/or are within the chain of enrollment, that is the steps taken by a beneficiary from becoming aware of a Medicare plan or plans to making an enrollment decision. Examples of this include, but are not limited to: calling leads, scheduling appointments, collecting Scope of Appointments, educational calls/presentations, collecting drugs and pharmacy information, and phone enrollments, calls to validate understanding and intent to enroll, re-enrollments, or post-enrollment sales efforts. Although the regulation does not specify which calls would not require recording, Humana believes that post-enrollment calls that, are not part of the chain of enrollment may not require recording, unless they involve a potential plan change. Humana believes that calls such as 3-30-60-90-day calls or a call to conduct the Member Care Assessment would generally not be part of the chain of enrollment, unless such a call turns into a sales or chain of enrollment call, such as a potential plan change... Please note, Face-to-Face beneficiary engagements are not required to be recorded.      
  • Provide Humana with monthly reports of staff disciplinary actions and violations associated with beneficiary interaction.
  • Provide the following disclaimer in marketing materials and verbally (as applicable) for AEP 2023: “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 disclaimer is required as follows: Include on any marketing materials including, print and television, and prominently displayed on websites; electronically conveyed when communicating with a beneficiary through email, online chat or electronic means of communication; if the TPMO is providing information to the customer verbally, the disclaimer must be stated within the first minute of the sales call.
  • When conducting lead generating activities, make the following disclosures to the beneficiary: Disclose to the beneficiary that their information will be provided to a licensed agent for future contact; Disclose to the beneficiary that they are being transferred to a licensed agent who can enroll them into a new plan.

Operationalizing These New Requirements

Humana understands that this recording requirement includes, but is not limited to, all calls that relate to the sale and/or are within the chain of enrollment, that is the steps taken by a beneficiary from becoming aware of a Medicare plan or plans to making an enrollment decision. Examples of this include, but are not limited to: calling leads, scheduling appointments, collecting Scope of Appointments, educational calls/presentations, collecting drugs and pharmacy information, and phone enrollments, calls to validate understanding and intent to enroll, re-enrollments, or post-enrollment sales efforts. Although the regulation does not specify which calls would not require recording, Humana believes that post-enrollment calls that, are not part of the chain of enrollment may not require recording, unless they involve a potential plan change. Humana believes that calls such as 3-30-60-90-day calls or a call to conduct the Member Care Assessment would generally not be part of the chain of enrollment, unless such a call turns into a sales or chain of enrollment call, such as a potential plan change. Humana will utilize a vendor to provide recording capabilities. Internal agents will be required to use the vendor process for call recording. Partner agents will have the flexibility to utilize their preferred recording technology.

Instructional content is available via MPU – click the links below to access the information. You will need to sign in prior to accessing the content.

Read the TMPO Agent Requirements here

Updated 10/7/2022

Humana is supporting agents by making a call recording service available. That service is now live. Agents begin recording calls with clients on October 1, 2022. TPMO agents are required to record telephone calls and may choose a recording service that meets their needs. One option is Humana’s call recording service for Humana pre-sales calls and enrollments. TMPO agents use a different recording service for enrollments of other carrier’s plans.

A call recording job aid, video demonstration and FAQ can be found on MarketPoint University. The call recording phone number is 1-872-234-8269.Try out the recording service in the next few days before the start of AEP.

Call Recording FAQ – REVISED 
TMPO Agent Requirements
Call Recording Steps
How to Use the Humana CarePlus Recorded Phone Line

View Details >View Details >

Questions? Call us at 855-888-8326.

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