CMS Proposes New Rule for 2025

 

CMS Proposes Sweeping Changes to Medicare Advantage Marketing: Is Everything Now Considered Marketing?

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule that could significantly impact the way Medicare Advantage (MA) plans market their services. The proposed rule aims to strengthen consumer protections and ensure that beneficiaries receive accurate and unbiased information. However, some industry experts are concerned that the broad definition of "marketing" included in the rule could have unintended consequences.

What's Included in the Proposed Rule?

The proposed rule outlines several key changes to MA marketing regulations:

• Expanded Definition of Marketing: CMS proposes to broaden the definition of "marketing" to include a wider range of activities, such as social media posts, blog articles, and even certain types of educational materials. This means that more of a plan's communications could be subject to CMS oversight and approval.
• Increased Oversight of Marketing Materials: CMS would have greater authority to review and approve marketing materials, including advertisements, brochures, and sales presentations. This could lead to longer review times and potential delays in launching new marketing campaigns.
• Stricter Rules for Agent and Broker Compensation: CMS proposes to limit the types of compensation that agents and brokers can receive from MA plans. This could impact the way agents and brokers are incentivized to enroll beneficiaries in certain plans.
• Enhanced Consumer Protections: The proposed rule includes measures to protect beneficiaries from misleading or inaccurate information, such as requiring plans to disclose potential savings and limitations more clearly.
• Who is responsible for this change Chiquita Brooks-LaSure is the Administrator for the Centers for Medicare and Medicaid Services (CMS), where she oversees programs including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act (ACA) health insurance Marketplaces.

Proposed Rule for 2025 How does this affect you

Potential Impacts on the Industry

The proposed rule could have a significant impact on the MA industry. Some of the potential consequences include:

• Increased Costs: The additional oversight and compliance requirements associated with the proposed rule could increase costs for MA plans.
• Reduced Flexibility: The broader definition of marketing could limit the flexibility of MA plans to communicate with beneficiaries and promote their services.
• Potential Disruptions to Enrollment: Stricter rules for agent and broker compensation could disrupt the enrollment process and make it more difficult for beneficiaries to choose the right plan.

Concerns About the Broad Definition of Marketing

Some industry experts are concerned that the broad definition of marketing could have unintended consequences. For example, a simple social media post about a health-related topic could be considered marketing if it includes any mention of an MA plan. This could lead to increased scrutiny and potential penalties for plans that inadvertently violate the rules.

It's important to note that the proposed rule is still under review, and CMS is accepting public comments on the proposal. Industry stakeholders have an opportunity to express their concerns and suggest alternative approaches that could achieve the same goals without imposing undue burdens on the industry.

Conclusion

The CMS proposed rule on Medicare Advantage marketing has the potential to significantly impact the industry. While the goal of protecting beneficiaries is commendable, the broad definition of marketing and increased oversight could have unintended consequences. It's crucial for industry stakeholders to engage with CMS and provide feedback on the proposed rule to ensure that it strikes the right balance between consumer protection and industry flexibility.

If you would like to speak out about this proposed rule you may address your concerns

no later than 5 p.m. Eastern Time on January 27, 2025. ADDRESSES: In commenting, please refer to file code CMS-4208-P. Because of staff andresource limitations, we cannot accept comments by facsimile (FAX) transmission.

Comments, including mass comment submissions, must be submitted in one of the following three ways (please choose only one of the ways listed):This document is scheduled to be published in the Federal Register on 12/10/2024 and available online at

https://federalregister.gov/d/2024-27939, and on https://govinfo.gov1. Electronically. You may submit electronic comments on this regulation to

http://www.regulations.gov. Follow the "Submit a comment" instructions.2. By regular mail. You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-4208-P,P.O. Box 8013,

Baltimore, MD 21244-8013.Please allow sufficient time for mailed comments to be received before the close of the comment period.3. By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-4208-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850. For information on viewing public comments, see the beginning of the “SUPPLEMENTARY INFORMATION” section. FOR FURTHER INFORMATION CONTACT: Matthania Volmy, (667) 290-8662 – General Questions. Naseem Tarmohamed, (410) 786-0814 – Part C and Cost Plan Issues. Matthania Volmy, (667) 290-8662 – Part D Issues. Kristy Nishimoto, (206) 615-2367 – Beneficiary Enrollment and Appeal Issues. Alissa Stoneking, (410) 786-1120 – Parts C and D Payment Issues. Hunter Coohill, (720) 853-2804 – Enforcement Issues. Lauren Brandow, (410) 786-9765 – PACE Issues. Sara Klotz, (410) 786-1984 – D-SNP Issues.

• HealthcareDive https://www.healthcaredive.com/news/medicare-advantage-prior-authorization-ai-marketing-proposed-rule/734111/
• CMS Proposed Rule: https://www.healthcarefinancenews.com/news/cms-proposes-rule-to-tighten-medicare-advantage-marketing
• CMS Fact Sheet: https://www.cms.gov/medicare/health-drug-plans/managed-care-marketing/medicare-guidelines
• American Health Care Association Comments: https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/ICYMI-Senate-Investigative-Report-Finds-Medicare-Advantage-Beneficiaries-Denied-Post-Acute-Care-Nations-Largest-Insurers.aspx
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