Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and business strategies about Medicare Advantage plans, product design, marketing, enrollment, market expansions, CMS audits, and countless federal initiatives in MA and Medicaid managed care.
By James Gutman, Managing Editor
June 21, 2012 Volume 18 Issue 12
Perhaps the best news for Medicare Advantage plans in the final CMS 2013 marketing guidance released June 6 is that the size of the guidance document is 120 pages versus 192 for the 2012 guidance. As the shrinkage may suggest, there are not a lot of new requirements for MA sponsors for the coming marketing season. But there are some changes, including in important areas such as disclaimers, time frames for actions to occur, and website reviews, along with a general toughening of rules regarding marketing on CMS’s star quality ratings.
The “biggest caution” consulting firm Gorman Health Group, LLC has regarding the guidelines, President Jeff Fox tells MAN, is that just because the number of pages shrunk substantially, this does not necessarily mean CMS eliminated requirements. In some cases, Fox notes, CMS instead only eliminated repetition or placed the requirements in other manual chapters or guidance documents instead of this new Chapter 3 in the Medicare Managed Care Manual.
Looking at the 2013 guidance overall, he says one significant change is in the area of disclaimers, such as when material is considered for purposes of enrollment versus just for information. Fox warns that disclaimers constitute the No. 1 reason MA marketing materials are declined by CMS. “Make sure you have the required language,” he says.
Another significant new requirement, according to Fox, is that for 2013 two of the three required outbound enrollment and verification (OEV) calls within 15 days of receipt of the application must be made within the first 10 days. These calls are done on enrollments obtained by both independent and employed agents/brokers to ensure that new members understand the plan’s rules. Fox points out that “the clock starts” the day the beneficiary and agent sign the enrollment, so if agents are very busy and don’t send in the enrollments right away, this can be a problem.
Also newly required is that the Multi-Language Insert containing information translated into several languages and offering free interpreter services for answering questions about plans must be sent with all Summary of Benefits and Annual Notice of Changes (ANOC) documents to members. Plans may incorporate this into those materials or have it as a separate document, but it no longer is required only when at least 5% of the sponsor’s plan benefit package service area has a given foreign language as its primary language. “Everybody has to have it,” Fox emphasizes.
Some of the changes are positive for plans, he notes. Under the 2013 guidelines, for example, says Fox, not all call-center scripts need to be filed with CMS. If the material involved is just informational, he explains, plans just need to maintain it and to produce it if asked during plan audits, but it doesn’t need to be transmitted on an ordinary basis.
Among the areas that have new regulations are ones that are relatively new and hot — including plan websites and the marketing of a plan’s star ratings. The section on websites, for example, Fox says, features a fundamental change. In the past, he recalls, if a plan filed required information for the website and CMS performed a random audit and found a problem, the plan could keep the section with the problem posted and, until the problem is resolved, just add a disclaimer that it is being fixed. Now CMS is saying that if there is an error, the plan must take down the entire section with the error until it is fixed, he says, adding, “This is kind of big.”
So too are some of the changes CMS is making on star-ratings marketing. The agency clearly is concerned about plans that trumpet their high ratings in a particular category of the star ratings and might leave the impression that this score is their overall star rating. So it is setting firm guidelines on how the ratings may and may not be used for marketing purposes.
Overall Star Ratings Must Be Included
“Plan sponsors may only reference the contract’s individual measures in conjunction with its overall performance rating in marketing materials,” the guidance states. “Plan sponsors may not use their star rating in a lower category or measure to imply a higher overall plan rating in their marketing materials than is actually the case.” Citing the example of a plan getting the top score of 5 in customer service promoting itself as a five-star plan when its overall plan rating is only two stars, CMS says, “Sponsors must use their star ratings in marketing materials in a manner that does not mislead beneficiaries into enrolling in plans based on inaccurate information.”
Even five-star plans, which now are allowed to market year-round and to use CMS’s gold-star icon on their marketing materials, are not immune from new requirements regarding that. CMS says, “The icon must be included in a way that is not misleading and makes it clear to the audience that the 5-star rating is for a specific contract(s), as applicable. Parent organizations with only one 5-star contract should not create materials in a way that implies all of its contracts achieved this rating.”
CMS is concerned that star ratings might be misconstrued by consumers, says Mary Kaye Thibert, a vice president at Gorman Health Group. While Thibert tells MAN she didn’t see plans seek to market individual star ratings rather than their overall ratings in the West, where she is based, she would have recommended that MA plans market both a specific major rating and the overall rating in situations where both are strong.
She acknowledges, though, that many Medicare beneficiaries still don’t understand the star ratings. If CMS educates consumers more about the ratings, this could change, she adds.
The most significant star-rating-related marketing guidelines change for 2013, according to Thibert, is a requirement that plans doing stars marketing update the ratings in their promotional materials within 15 days of receipt of the final 2013 ratings, instead of 30 days as previously.
The difficulty on this stems from the calendar: The final ratings last year were released Oct. 12, and product-specific marketing began Oct. 1. The problem, Thibert explains, is that many big plans have the star ratings included in large amounts of pre-collated marketing materials and now would have to rapidly change and replace the affected pages.
Linda Armstrong, executive vice president and health insurance practice leader at direct-marketing specialist DMW Worldwide, says this change in the guidance is manageable. It means DMW will recommend to its MA plan clients that they put anything related to their star ratings in either “buckslips” or personalized copy that can be changed quickly and inexpensively, she says.
A more significant issue for DMW in the guidelines, Armstrong tells MAN, is that television advertising “now appears to be a 45-day [review by CMS] submission.” She bases this conclusion on the lack of a reference as in the previous-year guidelines to TV ads as falling in the “file and use” submission category. By contrast, in the guidelines for 2012, CMS specifically said, “Television advertisements are File & Use documents.”
Because of that previous assurance, adds Armstrong, “we could concentrate on getting direct mail submitted and then work on TV later. Now, this will need to be a part of the 45-day crunch of submissions.”
View the final marketing guidelines at www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/FinalPartCMarketi...
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