Medicare Marketing Modifications: The Old and the New

Written by Elixir | May 12, 2022 1:29:18 PM

This February, Centers for Medicare and Medicaid Services (CMS) announced an update to the Medicare Communications and Marketing Guidelines (MCMG). The update represents a significant change to the MCMG and is effective for Contract Year (CY) 2022 for Medicare Advantage (MA) plans, section 1876 cost plans and Medicare Prescription Drug Plans (PDP).

What’s New in the MCMG?

CMS reorganized the MCMG to align with the regulatory requirements in 42 CFR Part 422 Subpart V and 42 CFR Part 423 Subpart V.

  • The table of contents now includes CFR references. The previous version contained CFR references, but only within the body of each section. This makes for a faster way to go straight to the relevant section of the Code, as opposed to needing to navigate to the section within the document.
  • Definitions, previously located in Appendix 1, now appear as the first substantive section in the MCMG. Most definitions were revised and some were removed from the MCMG.
  • The term “Communication” was revised to include “activities and use of materials created or administered by the Part D sponsor or any downstream entity to provide information to current and prospective enrollees. Marketing is a subset of communications.”[1]
  • The term “Marketing” means communications materials and activities that meet the standards for both intent and content.[2]
  • All marketing materials, election forms and certain designated communications materials used by a plan, including those used by third-party and downstream entities, must be submitted to CMS for review.[3]
  • “Standardized material identification” (SMID), referenced through the MCMG, replaces the “Material ID” previously used.

What is the Same in the MCMG?

Much of the same content is found in the revised MCMG, albeit in a different location. For example, the guidelines regarding “nominal gifts” that appeared in Section 40 in the previous version now appear under General Marketing Requirements.

The references to the Code of Federal Regulations are still listed for each of the sections. Also, most of the previous appendices are the same, except for the following:

Appendix Title Previous Version New Version
Pre-Enrollment Checklist Appendix 3 Appendix 1
(as Standardized Pre-Enrollment Checklist)
External Links Appendix 4 Appendix 5
Summary of Benefits Instructions Appendix 5 Appendix 2
(as Model Summary of Benefits Instructions)
Employer/Union Group Health Plans Appendix 6 Appendix 3
Use of Medicare Mark for Part D Sponsors Appendix 7 Appendix 4

 

What is “Missing” from the MCMG?

  • Call Center Standards:

The Call Center requirements and standards for hours of operation, average hold times and answer speed (formerly at MMG Section 80.1) no longer appear in the MCMG but remain codified at 42 CFR 422.111(h) and 42 CFR 423.128(d).[4]

  • Appendix 2 – Disclaimers:

“Disclaimers” as Appendix 2 has been removed and some of the disclaimers have been either removed or revised as follows:

Disclaimer Status
Benefit Disclaimer Removed
Availability of Non-English Translations Removed
Plan Online Enrollment Center Removed
Star Ratings Revised with more information
Accommodations Revised with more information
Special Supplemental Benefits for the Chronically Ill (SSBCI) New
Provider Co-Branding Materials Revised with more information
Materials Developed by a Third Party Removed
Part D Sponsors with Limited Access to Preferred Cost Sharing Pharmacies Removed
NCQA SNP Approval Revised

 

Other Key Points:

  • The Code still controls! Although several sections no longer appear in the MCMG, the requirements remain in place as codified in the CFR. This means that the MCMG should not be considered a comprehensive reference for all related regulations. We recommend keeping a copy of the previous version of the MCMG as a reference point for those topics that have been omitted.
  • Plans are responsible for ensuring compliance with CMS’ marketing and communications regulations.
  • Plans are responsible for monitoring and overseeing the activities of their subcontractors, downstream entities and/or delegated entities.
  • Sales Agents are subject to the same requirements as health plans for communications with Medicare enrollees, marketing, sales, presentations, enrollment activities, etc.

Elixir has thoroughly reviewed the changes to the MCMG and is prepared to make any needed changes for any materials we produce for our Medicare clients.

 

[1] 42 CFR 422.2260; 42 CFR 423.2260
[2] Id.
[3] MCMG, Submission, Review, and Distribution of Materials, General requirements
[4] 86 FR 6005 (January 19, 2021).
View full post