Medicare Marketing Guidelines and Cal MediConnect
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www.NSCLC.org Medicare Marketing Guidelines and Cal MediConnect Amber Cutler, Staff Attorney National Senior Citizens Law Center 1 September 23, 2014
Transcript of Medicare Marketing Guidelines and Cal MediConnect
www.NSCLC.org
Medicare Marketing Guidelines and Cal MediConnect
Amber Cutler, Staff Attorney National Senior Citizens Law Center
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September 23, 2014
The National Senior Citizens Law Center is a non-profit organization whose principal mission is to protect the rights of low-income older adults. Through advocacy, litigation, and the education and counseling of local advocates, we seek to ensure the health and economic security of those with limited income and resources, and access to the courts for all. For more information, visit our Web site at www.NSCLC.org.
Medicare Advantage Passive Enrollment in 2015
• Duals in a non-CMC D-SNP not subject to passive enrollment (if enrolled in plan by 12/31/14).
• Duals in a CMC D-SNP subject to passive enrollment 1/1/15
• Duals enrolled in an MA plan or FIDE-SNP not subject to passive enrollment.
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MUST STILL ENROLL IN MEDI-CAL MANAGED CARE
Examples
• CMC-D-SNP: Dual enrolled in Health Net D-SNP in LA County – will be subject to passive enrollment into Cal MediConnect.
• Non CMC D-SNP: Dual enrolled in Easy Choice in LA County – will not be subject to passive enrollment into Cal MediConnect if enrolled by December 31, 2014.*
• Kaiser – if enrolled in Kaiser D-SNP or Kaiser Medi-Cal plan not subject to CMC passive enrollment
• Medicare Advantage – not subject to CMC passive enrollment
• FIDE-SNP – not subject to CMC passive enrollment
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Medicare Marketing Guidelines: Applicability
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Applies
• Medicare Advantage Plans
• Part D Plans
Applies with Additional Guidance
• Cal MediConnect Plans
Does NOT Apply
• PACE Plans
Medicare Marketing guidelines Available at http://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/FinalPartCMarketingGuidelines.html Cal MediConnect Marketing Guidance available at http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/CY2014FinalMarketingGuidanceforCAHPMS071013.pdf
Marketing Definition
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Includes
• General audience materials (brochures, direct mail, radio, Internet)
• Scripts/outlines
• Presentation materials
• Promotional Materials
• Membership communications
Does NOT Include
• Privacy Notices
• Press releases
• Newsletters
• Blank letterhead
• Educational non-plan specific materials
• HRAs
• Surveys
Promotional Activities
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• Designed to attract the attention of prospective enrollees
• Anything offered during promotional activities must have only a nominal value ($15); no discrimination; must be offered to all regardless of enrollment; cannot be a health benefit
– Nominal Gifts cannot be more than $15 and cannot be provided in cash or monetary rebates
– No meals as a nominal gift
Unsolicited Contact
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Telephonic • Can contact current enrollees to discuss
business
• No Bait and Switch
• No calls based on referrals
• No calls to former enrollees who have disenrolled
• No calls to beneficiaries who attended an event except with permission
Electronic • No email or direct message unless
permission
• Plans cannot rent or purchase email lists
• Must provide opt-out process
In general, plans cannot market through unsolicited contact. NO: Door-to-Door solicitation
NO: Approaching beneficiaries in common areas NO: Telephonic or electronic solicitation
Educational vs. Marketing/Sales Events
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EDUCATIONAL
• Designed to inform beneficiaries about programs
• Must be held in a public venue
• No distribution of marketing materials
• Materials must be free of plan-specific information
• Reps cannot discuss plan-specific information
• Cannot distribute or display business reply cards, enrollment forms or sign-up sheets ; cannot set up individual sales appointments
• A marketing/sales event cannot immediately follow an educational event in the same general location
Educational vs. Marketing/Sales Events
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MARKETING/SALES EVENTS
• Designed to steer potential enrollees toward a plan or limited set of plans
• Representatives may discuss plan specific information and collect applications
• Formal v. informal
• Plans must submit all sales scripts and presentations for approval
• Plans cannot conduct a health screening
• Plans cannot require beneficiaries to provide contact information in order to attend
Personal/Individual Marketing Appointments
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• Generally take place in the home
• All one-on-one appointments are considered sales/marketing events
• Cannot discuss plan options that were NOT agreed to by the beneficiary
• Cannot market non-health care related products
• Cannot ask for referrals
• Plan must document scope of the appointment
Marketing in Health Care Settings
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• Can only conduct sales activities in common areas
• Prohibited from sales presentations and distributing enrollment materials in areas where patients receive services
• Plans are only permitted to schedule appointments with long-term care residents upon request of the beneficiary
• Providers with the plan can distribute materials but only if the provider makes available all plan materials for all plans with which the provider participates
• Long-term care facilities can provide plan materials in its admission packets for the plans it has contractual relationships with
Provider Activities
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• Providers can engage in marketing-based activities BUT they CANNOT:
• Accept Medicare enrollment applications
• Urge or attempt to persuade patients to enroll in a specific plan based on financial or any other interest of the provider
• Mail marketing materials on behalf of the plan
• Offer anything of value to induce plan enrollees to select them as their provider
• Offer inducements to enroll
• Conduct health screenings as a marketing activity
• Accept compensation from the plan for enrollment
• Distribute plan materials/applications in the exam setting
Marketing Material Requirements
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• Plans must have interpreter services
• Plans must include a multi-language insert
• Beneficiaries must receive Star Ratings information when they receive an enrollment form
• Materials must be in 12-point font Times New Roman
• Plans cannot use absolute superlatives
• Plans cannot claim that they are recommended by CMS, Medicare or the Dept. of Health and Human Services
Cal MediConnect Specific Guidance
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• Marketing materials in non-English must comply with Medi-Cal standards
• Do not have to include the Star Ratings
• Must send specific Cal MediConnect materials to new members
• Must issue only one ID
• Must provide a combined pharmacy/provider directory
• Must provide a combined formulary for both Medicare and Medi-Cal
• No unsolicited personal/individual appointments
• Plans can provide nursing facilities an explanatory brochure
• Enrollments must be accepted by the enrollment broker: HCO
NO CAL MEDICONNECT AGENTS OR BROKERS
How to Report Marketing Violations
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• Obtain information and fill out the SMART Form
• Submit complaints to CMS or HICAP
http://dualsdemoadvocacy.org/wp-content/uploads/2014/05/SMART-Referral-Form_508_060713.pdf
Want to know more? • NSCLC Duals Website
– Advocate’s Guide
– News
• Sign up for alerts: http://dualsdemoadvocacy.org/california
• Contact us:
– Amber Cutler – [email protected]
– Denny Chan – [email protected]
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