CMS Violations

CMS is looking at the 2024 year and they have some things to say about sales and marketing.

You can check out a copy of the 2024 Policy and Technical Changes report here. If you start on page 217 and scroll through, you will find things like:

• 48-hour rule for Scope-of-Appointment forms with no "when practicable" language
• Third-Party Marketing Organizations (TPMO) cannot sell beneficiary data to other TPMOs
• Permission to contact no longer being open-ended and capped at 6-months
• Door-to-Door contact is prohibited even with a business reply card (BRC) unless there is an established appointment
• Call recordings for only sales, marketing, and enrollment calls - this one is positive as the language was too broad and some carriers said all calls must be recorded
• Pre-Enrollment Check Lists (PECL) must be read verbatim at the beginning of all telephonic enrollments to discuss the effects on their current plan, doctor networks, pharmacy info, etc.

This opens the door to all new potential violations. What can agents do? They can make sure they are documenting their appointments properly with the intent of recalling details of the appointment months later.

One method I have seen agents and agencies take is to have their own version of the PECL mentioned above so they (the agents) can make sure all necessary information was conveyed at the appointment. These were not CMS or carrier-approved, but more personal documentation that once started to get used became just part of the appointment and provided the necessary data to have on hand should there be a question about that appointment months later.

Starting proper documentation in your CRM now can help you pivot any new regulations and properly defend yourself from any potential violations.

Added bonus! Your clients may also notice this and appreciate how you are looking out for them putting you in an even more positive light!

NEXT STEPS:

Create your own checklist to use at appointments. You can use them in the beginning, as a checklist to be done throughout the appointment, or at the end. The more you document, the more you will be ready to defend!