Thursday, April 8, 2010

CMS Releases 2011 Draft Medicare Marketing Guidelines

As a follow-up to our blog on the CMS 2011 Call Letter draft, a draft of the 2011 Medicare Marketing Guidelines has also been released. The summary of significant changes included within are as follows:

Summary of Significant Changes

  • Clarified guidance related to requirements for plan sponsors with non-English speaking or special needs populations (section 30.7).
  • Added guidance related to material status and date stamp for file & use materials (section 40.1).
  • Clarified guidance related to customer service hours of operation requirements and added a new section on agent/broker customer service number requirements (sections 40.11 and 40.11.1).
  • Significantly restructured and consolidated disclaimer requirements (section 50).
  • Clarified and restructured guidance related to advertising/explanatory marketing requirements (sections 50.1 and 50.1.1).
  • Clarified plan mailing statements (section 50.2; formerly section 50.6).
  • Clarified the responsibility for the summary of benefits review on the comprehensive statement in section 4 regarding accuracy of SNP benefits (section 60.1).
  • Clarified guidance related to provider and pharmacy directory mailing requirements (sections 60.4.1 and 60.4.2).
  • Clarified that door hangings are considered unsolicited contacts (section 70.4).
  • Revised our policy with regard to outbound enrollment verification (OEV) requirements, including applicability of OEV requirements to enrollment changes within organizations and to agents when acting as customer service representatives only, operational timeframes, and guidance on recording and retaining verification calls. We also added Medicare Medical Savings Account OEV requirements to this section (sections 70.6 & 70.6.1).
  • Restructured and revised guidance regarding educational events and sales/marketing events to encompass relevant topics or examples from current Guidelines sections 70.7.1-70.8.3 (sections 70.7 and 70.8; formerly 70.8 and 70.9).
  • Added guidance on resubmitting previously disapproved marketing pieces (section 90.4).
  • Revised the submission of template materials (section 90.10).
  • Extended website requirements to Part C organizations and to social networking sites (section 100.1).
  • Added requirements regarding the prohibition of charging additional marketing fees (section
  • Added and clarified requirements with respect to the charge back for agents and brokers (section 120.5.6).
  • Clarified that the Medicare Mark will be incorporated in the contract management module in HPMS and that further guidance will be forthcoming as part of the annual contracting process (section 150).
  • Added previously released policy guidance on the use of Federal funds and the use of Medicare beneficiary information obtained from CMS requirements (sections 160 and 170).
If you would like more information on the guidelines, click HERE (as a note, at the time of this blog, the CMS website was being updated).


Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at

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