CMS Updates 2020 Guidelines for Medicare & Medicaid Marketing

by | Sep 17, 2019

It’s That Time of Year Again

Are you ready for the updates to the Center for Medicare and Medicaid’s (CMS) 2020 Medicare and Marketing Communications Guidelines (MCMG)? It’s a good idea to understand the changes fully so your outreach follows the guidelines. Compliance requirements differ depending on whether outreach is considered communications or marketing by CMS standards. Outreach and interaction can start as communications and turn into marketing, so being aware of how each is defined will help ensure you’re following the rules.

Keep in mind that the new guidelines memo is to be used in conjunction with the 2019 guidelines as CMS will not be providing a full document this year.

Do you know what constitutes marketing and communications under the guidelines? CMS refers to communications as “activities and use of materials to provide information to current and prospective enrollees.” This means that all activities and materials aimed at prospective and current enrollees, including their caregivers and other decision-makers, are communications within the scope of the regulations.

An example of communications is a letter sent to enrollees by a specific plan to remind them to get their flu shot. The intent of the letter is not to steer the reader into making a plan selection or to stay with the plan, but rather to encourage existing enrollees to get a flu shot. The letter contains factual information about coverage and was provided only to current enrollees.

Marketing is defined as “a subset of communications and includes activities and use of materials by the Plan/Part D sponsor with the intent to draw a beneficiary’s attention to a plan or plans and to influence a beneficiary’s decision-making process when selecting a plan for enrollment or deciding to stay enrolled in a plan.” CMS states that marketing contains information about the plan’s benefit structure, cost-sharing, measuring, or ranking standards.

Excluded are materials that may meet the definition of marketing based on content, but don’t meet the intent requirements of marketing. Examples of things that CMS considers marketing are general audience materials, such as general circulation brochures, direct mail, newspapers, magazines, television, radio, and billboards.

There are many changes to the guidelines for 2020, and we suggest that you look over them carefully. Here are a few we found interesting and how we interpreted them:

  • CMS deleted the phrase: “If a potential enrollee provides permission to be contacted, the contact must be event-specific and may not be treated as open-ended permission for future contacts.” Now that this phrase is gone from the guidelines, it appears that if a potential enrollee grants permission to be contacted, that same permission can be used during different election periods. With CMS removing the phrase, the door is open to more extended permission to contact those eligible for Medicare.
  • How you market to outside service areas is changing. CMS removed the wording that stated Plan/Part D sponsors may only advertise in their defined service area. Advertising can now be done outside of the plan’s county.
  • Open Enrollment Period (OEP) can now be defined and discussed on plan sponsors’ websites.
  • Regarding educational events, wording changes and deletions within the guidelines suggest that agents can complete and submit a Scope of Appointment form, which allows beneficiaries to initiate contact. This suggests that agents can now do this at the end of educational events, and an agent can hold more than one event back-to-back. It’ll be easier for agents to set appointments and make sales related to these events.
  • It is now required that access to applicable disclaimers be included on your website. A link to this information is all that’s required.
  • Any website CMS considered marketing must be submitted for review and approval through the Health Plan Management System (HPMS).
  • Plans may now contact potential enrollees through email. This is in addition to ads and direct mail that were previously approved. All email marketing must include an opt-out capability, and if it meets marketing standards as defined by CMS, it must be submitted for approval. Emails that are considered communication do not have to be submitted for approval. Text messaging and other forms of electronic direct messaging such as social media would fall under unsolicited contact and is still not permitted.
  • Another change was made to marketing and sales events. In 2019, plan sponsors were required to submit scripts and presentation to SMC prior to the event. That included those to be used by agents or brokers. The word “script” has been replaced by “talking points,” which indicates that the agents can now deliver a more improvised and interactive presentation.

Before long, the MCMG will be updated for 2021. Look for those updates as early as July but most likely in early September 2020. Find the full list here.


Need Help Navigating These Updates?

As a healthcare-focused marketing firm, Graphcom work with many health plans by helping with secure marketing and communications outreach to enrollees and potential enrollees. 

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