CMS Compliance Recap: Tips and Reminders for 2024 AEP - Western Asset Protection
CMS Compliance

CMS Compliance Recap: Tips and Reminders for 2024 AEP

CMS’s 2024 Final Rule for Medicare Advantage and Part D includes several important changes that impact how you conduct your Medicare events and one-on-ones with clients. For instance, meeting in person has become more complicated. You need to be aware of the new rules to ensure compliance.

As you continue to plan your events and schedule your meetings with clients, keep these changes in mind:

  • You must not set appointments after less than 48 hours of receiving a signed SOA. There are some exceptions, such as walk-ins and if the beneficiary is nearing the end of a valid special enrollment period.
  • SOAs and BRCs are now valid for a 12-month period. You must keep track of the date you received them. If 12 months have passed, you will need to acquire renewed permission to discuss plan details.
  • You must not set appointments or collect SOAs at educational events. You are still allowed to distribute permission-to-contact cards, BRCs, and business cards can be available for elective pick up from the attendees.
  • Sales/marketing events must not occur within 12 hours of an educational event at the same building or an adjacent location.
  • Cover the pre-enrollment checklist with every client who is enrolling.
  • Whenever a client or new prospect makes an enrollment decision, in addition to covering all the plan specifics, you must clearly explain the impact of that decision on the client’s existing coverage. This includes any cost changes and informing clients that they will be disenrolled from their current plans when their new plans go into effect.
  • Always use the carrier Provider/Formulary look-up links. Share a screenshot, if possible, as best practice.

Tips for Holding Compliant Events

Are you holding an educational event or a sales/marketing informal or Formal event? The rules are different for each. There are, however, general tips and rules that apply to all types of events.

Rules for All Events

  • Always schedule your event far enough in advance to secure a location, register the event, advertise, and send out invitations. Some carriers may require filing at 21 days out from your scheduled event.
  • It’s important to know each carrier’s rules for registering your event. Failure to register could mean the loss of sales commissions or even the loss of your carrier contract. Since carriers may use secret shoppers, it’s important to be compliant with their requirements.
  • CMS rules are not the same for all events. At Educational events, you are able to provide full meals, however at Formal events you are only allowed to provide light refreshments but not full meals.
  • Nominal Gifts must be worth less than $15 retail per person. Cash gifts, pre-paid Visa/Mastercard and any retail gift cards are no longer permitted. Only fast food, coffee cards and gas gift cards are allowed. You should not use attendee information for raffles or drawings. Gift cards from local businesses – such as restaurants, gas stations and coffee shops –are allowed. Gift cards for big box retailers are considered cash and are not allowed. Since there is a $75 annual maximum per person, keep track of who received what gift to ensure you don’t exceed the limit. If you are offering a gift to attend your event, you must give gifts to everyone and must announce that you will be offering gifts in advance

Additional Rules for Educational Events

Educational events are a great way to generate leads. The primary purpose of an educational event is to educate and inform, not to market a specific plan or carrier. You should hold educational events in a group setting in a public venue.

Important Dos and Don’ts for Educational Events:

  • Do promote your event using print ads, flyers, direct mailers, and other digital strategies. CMS requires you to market your event as an “educational event.” Ads and invitations must include the following: “For accommodations of persons with special needs at meetings, call <insert number and TTY:711 number>.”
  • Do hand out generic material regarding Medicare – Social Security – Extra Help
  • Do answer attendees’ questions, but do not provide any additional information beyond what they ask.
  • Do provide your business cards and business reply cards for attendees to contact you.
  • Don’t display a sign-in sheet or collect contact information, such as names, addresses, or phone numbers. Attendance at an event is not considered permission to contact.
  • Don’t hand out applications or marketing materials with specific plan details. You should not be leading attendees toward any specific plan or carrier.
  • Don’t collect SOAs or enrollment forms.

Additional Rules for Sales/Marketing Events

There are two types of sales/marketing events: formal events, where you present plan-specific information to an invited audience, and informal events, where you set up a kiosk, table, or booth and offer plan information upon request. In informal settings, you should allow attendees to approach you.

Important Dos and Don’ts for Sales/Marketing Events:

  • Do register your event with the proper parties and hold events in a public setting or common area where individuals do not receive health care services or health screenings.
  • Do publicize your sales event. For events marketing, MA and PDP plans, advertisements, and invitations must include the appropriate TPMO disclaimer. If your flyer meets the definition of marketing, it must be approved by CMS and it must also include the following: “For accommodations of persons with special needs at sales meetings, call <insert number and TDD number>.” Be sure to include the number of organizations and plans represented. (Tip: Send your PURL to yourself to identify numbers. Be sure to count any other FMO plans you may be contracted with.)
  • Do provide a sign-in sheet that clearly states that providing contact information is optional.
  • Do use only carrier- and CMS-approved presentations and talking points.
  • Do name all the products and plan types you will cover before starting your presentation.
  • Do give out your business card and collect enrollment forms, SOAs, and business reply cards.
  • Do arrange follow-up appointments. Remember, you need documented express permission for a follow-up phone call from you after the event.
  • Don’t request or accept referrals.
  • Don’t host a sales event within 12 hours of an educational event in the same building or an adjacent building.

HIPAA Compliance Matters, Too

As a Medicare agent, you are responsible for safeguarding your clients’ PHI. Be proactive in educating your clients on the importance of privacy and security rules that are meant to protect them. Remind your clients that they should never send PHI via unsecured email or share personal information via voicemail. Train your clients to access the secure portal, where they can enter any RX or health information directly instead of sending it to you.

Do you have questions about compliance? Western Asset Protection is here to support you. We are dedicated to your success. Contact us today.