There are three important points that you should know regarding the updated CMS final rule. All new requirements must be implemented by October 1st, 2022, to be prepared for this year’s annual enrollment period.
First and foremost, CMS broadened the definition of a Third-Party Marketing Organization (TPMO) to include all independent agents. Although most of the newly founded complaints were from call centers, independent, one-person agencies are feeling the brunt of these new regulations which could be costly just to comply.
Because all agents are now TPMOs, you must use the TPMO disclaimer, “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,” in all of the following scenarios:
- Verbally within the first minute of a sales call
- Electronically when communicating with a beneficiary through email, online chat, or other electronic means of communication
- Prominently on your TPMO website
- All marketing materials, including print materials and TV ads, that you develop, use, or distribute
You are NOT required to use the TPMO disclaimer when meeting with a beneficiary in person, if you only sell plans on behalf of one carrier (this is counter-intuitive since many complaints are from individuals getting shoe-horned into a plan by an agent who only sells one plan), or if you sell plans on behalf of more than one carrier and you sell all commercially available MA or PDP plans in a given service area. Please note that direct-to-consumer plans could be in your area, so you need to check the medicare.gov website. If direct-to-consumer plans are in your area, the disclaimer must be used. In my opinion, I would add to the end of the disclaimer in this situation explaining why you don’t sell all plans.
Finally and the most intrusive mandate, you must record all calls with beneficiaries in their entirety that are part of the “chain of enrollment” process according to pg 199 of Final Rule. This has been interpreted thus far as any telephone call or virtual meeting over a platform such as Zoom, RingCentral, GoToMeeting, etc. that could lead to an application being written. The disclaimer above must be stated within the first minute of the call, and you could possibly add another disclaimer to notify the caller that they are being recorded depending on your state’s law. It is important to remember that these recordings will have PII and PHI in them. Thus, you will need to store them in a HIPAA compliant storage department for 10 years since the recording also falls under Medicare Compliance. Those dollars can add up quick because of the length of time to store and the size of the recordings. God help us if there is a breach because that is a gold mine of information. Moreover, you will be required to obtain a BAA from the vendor providing the HIPAA compliant storage option as well.
How are you going to record and store phone calls? If you are interested with MedicareCENTER’s FREE Solution, please email firstname.lastname@example.org to be put on a list to receive more information. We will send out training links once they become available. Note that most virtual meeting platforms allow you to record. You would then need to store those recordings for 10 years in a HIPAA compliant storage or CRM. If you have a CRM, the most straightforward option is to manually upload your phone call/virtual meeting recordings and attach them to the client’s file or specific activity.
If you are a Medicare Agent and need a local FMO that provides you with solutions, trainings, and continuing education, then check us out at our Agent Services page on our website or RSVP for our SEP Kickoff Fall Broker Meeting. We make Medicare SIMPLE!