Medicare Plan Marketing in the Regulatory Crosshairs: New Enforcement Initiatives

Table of Contents

Guidance and Guidelines for Medicare Advantage and Part D Marketing

• CMS’s Marketing Surveillance Could Lead to More Regulations
• CMS Issues Marketing Guidelines, Tightens Up Review Of Materials
• CMS Issues Its Final Guidance on 2010 MA/Part D Marketing
• Sponsors Must Pay Immediate Attention to New Marketing Rules or Face Stiff Penalties
• Plans Should Work on Scripts, Await Call Guidance, CMS Says
• New Rule Would Impose Burdens on Plans, but CMS Retreats on Downstream Entities
• CMS Erroneously Notifies 400,000 Seniors That MA Products Won’t Be Available Jan. 1, 2010
• Draft 2011 Marketing Rules Highlight New OEV Requirements
• OIG Report, Draft ’11 Marketing Guidelines Would Lead to More Regulation for MA Plans

CMS Enforcement of Marketing Regulations

• CMS Suspends Citrus Marketing, Enrollment
• WellCare’s Marketing Suspension Provides Compliance Lessons
• Kansas Blues Plan Using WellPoint to Administer PDP Is Sanctioned
• CMS Lifts WellPoint Suspension, Keeps Tabs on Plan’s Activities
• CMS Orders MA, Part D Plans to Stop Health Reform Mailings to Members
• CMS Warns Humana to Stop Mailings to MA Members on Potential Ill Effects of Reform
• CMS Slaps Humana on Wrist, Warns Plans of Improper Outreach

Agent/Broker Concerns

• New CMS Marketing Guidelines Could Signal Impending Change in Broker Pay
• CMS Sets Low-End FMV for Compensation, Moving Up ‘Low Outliers’ to Level the Field
• CMS Retrenches on Agent Compensation Guidance in Light of Widespread Confusion
• CMS Says It Will Train and Test Agents, Expects to Begin National Pilot
• CMS Issues Revised Guidance on 2009 Sales-Agent Compensation
• CMS Proposes MA Enrollment Assistance Demo, Seen as Step Toward Curbing Agents
• CMS Narrows Applicability of Outbound Verification Guidance
• Sponsors Should Monitor Agents’ Sales Events, Use Checklists

Written By

This book was written by the editorial staff of AIS.

Written For

• Health plan business and financial managers (CEOs, CFOs, product and sales managers, government affairs managers)
• Executives of pharmaceutical manufacturers and PBMs
• Hospital and health system business and financial executives
• Consultants, actuaries, financial analysts and attorneys

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• Read the Introduction to this Report