CMS Announces New Marketing Regulations (Part 3)

CMS has approached the 2013 Marketing Regulations with a critical eye, and an editorial focus. In an effort to simplify and clarify the rules, CMS has removed around 70 pages from the document. Over the next few weeks, we’ll look at some of those changes, and explore what motivated CMS to make such drastic edits.

We've explained some of the motivation behind core rules in the CMS 2013 Marketing Regulations. This week, we'll take a look at some specific rules, and how they will impact your marketing materials in 2013.

First of all, CMS is requiring all plans to create a document called the Multi-Language Insert. This document must be included with the Summary of Benefits and the ANOC or EOC no later than September 30th, 2013. The Multi-Language Insert is a document that contains the following statement, printed in Spanish, Chinese, Tagalog, French, Vietnamese, German, Korean, Russian, Arabic, Italian, Portuguese, French Creole, Polish, Hindi, and Japanese.

“We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at [1-xxx-xxx-xxxx]. Someone who speaks [language] can help you. This is a free service.”

This statement cannot be modified, other than to include additional languages.

In addition to the Multi-Language Document, there are also materials that are required to be included with any electronic or printed enrollment form. These include

• A Plan's CMS STAR Ratings Information
• Summary of Benefits

New or renewing members at enrollment and thereafter must receive

• Annual Notice of Change /Evidence of Coverage (ANOC/EOC) or EOC as applicable
• Multi-Language Insert
• Comprehensive formulary or abridged formulary (Part D sponsors only)
• Pharmacy directory (For all plan sponsors offering a Part D benefit, this is required at time of enrollment)
• Provider directory (For all plan types except PDPs, this is required at time of enrollment)
• Membership Identification Card (required only at time of enrollment and as needed or required by plan sponsor post enrollment)

Too much to take in? Don't worry, we'll be wrapping up next week by revisiting some of the guideline rules that carried over from previous years.

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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 Pamela.Argeris@merrillcorp.com.

 

CMS Announces New Marketing Regulations (Part 2)

CMS has approached the 2013 Marketing Regulations with a critical eye, and an editorial focus. In an effort to simplify and clarify the rules, CMS has removed around 70 pages from the document. Over the next few weeks, we’ll look at some of those changes, and explore what motivated CMS to make such drastic edits.

Last week, we introduced some of the basic concepts behind the latest version of CMS’ marketing regulations. Today, we’ll finish explaining the last two of three guiding principles that served as the basis for the document.

CMS clearly states plan sponsors are responsible for full disclosure when collecting and disseminating information to beneficiaries about plan benefits, policies, and procedures.

 This rule simply lays out transparency and responsibility for plan marketing and beneficiary information. For example, beneficiaries must be provided enough information to make an informed decision about health plans. In addition, plan sponsors must use sound judgment in all aspects regarding the beneficiaries and their delegated entities.

CMS states plan sponsors are responsible for documenting compliance with all applicable Medicare Marketing Guideline Requirements.

This rule ensures that plans:

•  Have systems and processes in place for all aspects of the marketing program,
• Provide oversight of those systems and processes, and
• That those processes are clearly defined and understandable.

As is always the case with these regulation documents, the focus of energy should be on providing the most transparent information possible for the beneficiaries and end users. Plan marketing needs to be developed in such a way as to provide the clearest possible idea for what a beneficiary is getting into.

Be sure to join us next week, as we delve deeper into the 2013 CMS Marketing Guidelines.

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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 Pamela.Argeris@merrillcorp.com.

CMS Announces New Marketing Regulations (Part 1)

CMS has approached the 2013 Marketing Regulations with a critical eye, and an editorial focus. In an effort to simplify and clarify the rules, CMS has removed around 70 pages from the document. Over the next few weeks, we’ll look at some of those changes, and explore what motivated CMS to make such drastic edits.

For starters, let’s take a look at some of the motivating factors behind these changes.

Focus on Marketing Requirements

CMS rules in previous years may have been unnecessarily complex or confusing. 2012’s Rules document makes an attempt to lessen that confusion by narrowing the scope of the regulatory focus. It makes sense at even the most basic level: if you have less information to take in, you are more likely to take in all of it, right?

Eliminate Redundancy

Here is another easy win. CMS took a critical look at the 2013 Marketing Guidelines, and cut out any repetitious, redundant, or pointless language. The result is more concise, easily-digested content.

So what did all of this renewed focus get us? The regulation document breaks down to three guiding principles. Here is the first:

Plan sponsors are responsible for ensuring compliance with CMS’ current marketing regulations and guidance, including monitoring and overseeing the activities of their subcontractors, downstream entities, and/or delegated entities.

This applies to anyone that a plan has delegated some responsibility to implement, and includes – but is not limited to – marketing events, marketing materials, the distribution of those materials, and collecting or disseminating information.

Next week, we'll look at the two other guiding principals.

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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 Pamela.Argeris@merrillcorp.com.