Wellcare would like to inform you of new requirements for Third-Party Marketing Organizations (TPMO) resulting from a recent ruling made by the Centers for Medicare and Medicaid Services (CMS). All of the following new requirements go into effect October 1, 2022.
Please review the following sections to learn more about each new CMS requirement.
Beginning October 1, 2022, for all 2023 activities, all TPMOs, including all third-party marketing/lead generation vendors, agencies, 1099 agents and brokers (captive, independent street brokers, TeleDigital agents, etc.), will be required to record all beneficiary calls (sales, enrollment, administrative, etc.) – inbound and outbound – in their entirety, with no exception. Other important requirements:
Remote Agent Telephonic Enrollment (RATE) through Ascend will be updated to include outbound call recording functionality. Recordings may be captured outside of Ascend but must comply with all relevant regulations and laws (consent, retention, producibility, etc.).
Beginning October 1, 2022, the TPMO Disclaimer must be used by any TPMO that sells plans on behalf of more than one MA plan provider unless the TPMO sells all commercially available MA plans in a given service area. The disclaimer must be:
Beginning October 1, 2022, lead generating activities (either directly or indirectly) facilitated by a TPMO will need to include a notice to the beneficiary that their information may be shared with a licensed agent for future contact. The disclosure must be provided:
Disclosure must also be made to the beneficiary that he or she is being transferred to a licensed agent who can enroll them into anew plan.
To fully comply with the new CMS requirements, TPMOs must:
As required by CMS, the 2023 Centene Third-Party Marketing Entity (TPME) contracts include the new TPMO contract requirements. No future action is needed if you have already signed the 2023 contract. In order to be considered Ready To Sell (RTS) with Centene/Wellcare, the 2023 Centene TPME contract must be signed.
The new contract updates relating to TPMO requirements include:
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