Compliance Training Requirements May Change Due to Proposed Rule - Western Asset Protection
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Compliance Training Requirements May Change Due to Proposed Rule

A recent proposal could provide relief for Medicare Advantage producers. The Centers for Medicare & Medicaid Services (CMS) has proposed a rule that would change training requirements.

Current Training Requirements

Although Medicare Advantage is sold through private insurers, it is overseen by CMS. As a result, CMS has authority over the compliance training requirements.

Under current regulations, these requirements apply not only to Medicare Advantage Organizations, but also to first-tier, downstream and related entities (FDRs). FDRs can include Medicare Advantage producers. In other words, current regulations require insurance agents selling Medicare Advantage policies to undergo compliance training.

The Proposed Rule Change

Published on November 28, 2017, the proposed rule contains a section called Reducing the Burden of the Compliance Program Training Requirements (§§ 422.503 and 423.504).

According to the proposal:

“The proposed provision would amend the regulation so that first-tier, downstream and related entities (FDR) no longer are required to take the CMS compliance training, which lasts 1 hour, and so that MA organizations and Part D sponsors no longer have a requirement to ensure that FDRs have compliance training. However, it is still the sponsoring organization’s responsibility to manage relationships with its FDRs and ensure compliance with all applicable laws, rules and regulations. Furthermore, we would continue to hold sponsoring organizations accountable for the failures of its FDRs to comply with Medicare program requirements.”

The proposal estimates that the change would eliminate one hour of training per year for each FDR employee impacted by the rule. In explaining the reasoning behind the change, the proposal states, “Although sponsors must still monitor FDRs and implement corrective actions when mistakes are found, we believe that they are currently already doing this. Therefore no additional burden complementing the reduction in burden is anticipated from this proposal to eliminate the CMS training.”

Other Changes in the Proposal

The section on training requirements is only one small part of a very large document with many other proposed rule changes. Some of the other sections deal with the implementation of the Comprehensive Addiction and Recovery Act of 2016 (CARA) provisions and updating the Part D E-Prescribing standards.

How to Comment

CMS is accepting comments on the proposed rule until 5:00 p.m. on January 16, 2018. Comments should reference file code CMS-4182-P. You can deliver your comments by mail, by hand, by courier or by using the website