On October 1, 2022, the CMS 2023 Final Rule introducing new call recording requirements for agents and brokers who market Medicare Advantage and Part D plans went into effect. The intent of the ruling was to protect Medicare beneficiaries from inappropriate marketing strategies and ensure agents are providing accurate and complete information.
After much confusion and criticism, the 2024 CMS Final Rule revised the original ruling and provided additional clarification on which calls need to be recorded and which calls do not. The revised rule became effective June 5, 2023. Here’s what you need to know to stay compliant with the current call recording regulations.
What The Ruling Says
Health plans and their TPMO’s must record all conversations with customers who want to discuss Medicare Advantage and Part D prescription drug plans. They must also store these call recordings for a minimum of 10 years in a HIPAA compliant manner. This storage requirement ensures agents have documentation of their customer interactions in case of a potential complaint or grievance that CMS would investigate. This protects the beneficiary as well as the agent in the event of a dispute.
Additionally, the CMS ruling also requires that specific disclaimer information must be communicated to a beneficiary during the first minute of a recorded call.
Who It Applies To
CMS defines a TPMO as any organization that is paid to “perform lead generation, marketing, sales and enrollment-related functions as a part of the chain of enrollment” in a Medicare Advantage plan or a Medicare Part D prescription drug plan This definition includes individuals who perform those functions, such as independent agents and brokers.
What Type of Calls
In the 2024 ruling, CMS clarified that the only calls that must be recorded are marketing, sales, and enrollment calls. This includes calling leads or prospects as well as retention-based marketing with existing clients. This applies to inbound and outbound calls. The ruling also applies to calls made via teleconferencing or other virtual methods such as Zoom, WebEx, or Facetime. In person meetings do not have to be recorded.
The call recording requirement is specific to Medicare Advantage and Part D products. It does not apply to products such as Medicare supplement plans or ancillary products. It also does not apply to non-sales calls such as calls for event invitations, calls to schedule appointments, follow up calls after a sale or to verify the receipt of ID cards.
The client or prospect does not have to consent to the call recording. This is a federal rule that supersedes any state laws. There is no opt out option for anyone who does not want to be recorded. In these cases, you will have to schedule a face-to-face meeting as the phone call cannot continue unrecorded.
What the Disclaimer Says
CMS requires all TPMO’s to mention both State Health Insurance Assistance Programs and the number of organizations and plans they represent. The appropriate disclaimer must be used on all marketing materials and within the first minute of a phone call. The disclaimer cannot be modified. It does not need to be used when meeting in person.
The disclaimer must be specific to the beneficiary’s service area. There are two different disclaimers depending on the specific situation:
“We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.”
Or, if you do represent all plans in an area, this disclaimer should be used:
“Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. You can always contact Medicare.gov, 1-800- MEDICARE, or your local State Health Insurance Assistance Program (SHIP) for help with plan choices.”
WAP Can Help You Be Compliant
As a WAP agent you have access to the technology and tools needed to be successful and compliant. Call recording capability is available to all our agents through the Integrity for Agents platform. This convenient and easy to use call recording technology is FREE for all Integrity partners and their downline independent agents and brokers.
The recording capabilities will include:
- Inbound and outbound call recording with store and download solutions
- Call recording storage for 10 years as required by CMS
- CMS required disclaimer script for the beginning of each sales, marketing, and enrollment call
While following all the requirements to ensure compliance may seem burdensome, agents who do not fully comply may face penalties including fines and the possible loss of their license. WAP offers compliance support and guidance to ensure you stay up to date on all regulatory requirements. Contact us today.