The new Medicare regulations that govern health and drug plan marketing are a combination of some new rules, but also codify what our company has done for years, says Cindy Polich, chief strategy officer with UnitedHealth Groups Ovations business group, which has approximately 1.5 million Medicare Advantage members and slightly more than 600 plans. We anticipated these latest regulations and already built them into our plans for 2009.
For example, UnitedHealth previously developed a comprehensive training program for brokers and sales agents that already met the new requirements, she says. The new requirements did not significantly change our established programs.
Other plans were taken aback by the short phase-in period for the new requirements. Alison Nicholson, manager for individual sales at Regence Blue Cross and Blue Shield of Oregon, which offers Medicare Advantage plans in Idaho, Oregon, Utah and Washington state and covers nearly 91,000 members, was under the impression that Jan. 1, 2009, would be the official start date, not Oct. 1 of this year. Although it was never explicitly stated by the CMS as the implementation date, Jan. 1 was the assumed start date because thats the start of the plan year, Nicholson explains.
Under this tight timeframe, Regence worked to create or update policies and procedures, create disclosure statements for some advertising templates and to train staff and agents to get ready to comply with the new rules, Nicholson says.
The requirements arent going to limit everything the plans can do. But some of the provisions have the potential to stifle relations with potential clients, Nicholson says.
Under these new restrictions, salespeople cant just set up a meeting with a client. If a personal appointment is booked over the phone, We must be on a recorded line and are required to go through all of the products well be offering in advance, so the client is aware of everything that will be discussed during the in-person meeting between salesperson and beneficiary, she says.
If a call confirming a home appointment isnt recorded, We have to get a disclosure form signed in advance by the beneficiary. If its been determined that we have not disclosed all of the types of products the beneficiary really wants to discuss, there needs to be a 48-hour cooling-off period before we can talk to the client again.
The provision is designed to discourage salespeople from potentially misrepresenting products, she says. There have been cases of unscrupulous salespeople trying to sell unrelated, more-expensive products such as long-term-care options, even though the beneficiary thinks theyve met with the plan sponsor to talk about Medicare Advantage.
While the changes are designed to protect the beneficiary, the cumbersome new process of obtaining a disclosure form may slow down the process of getting material to the beneficiaries, Nicholson says.
Another provision dictates a salesperson cant call a beneficiary or client whos in the process of disenrolling from a plan, or making direct contact with a beneficiary in the event a new plan becomes available.
This prevents us from talking to a client who may have issues that could be resolved without disenrolling, Nicholson says.
She later conceded that the agency did take some recent measures to give plans more time to prepare for these new regulations, such as clarifying statements that allow carriers to contact their own clients.
Karen Ignagni, AHIPs president and CEO, says the requirements are what Congress and the CMS intendedthey hold plans and agents accountable for what they sell to beneficiaries.
Ignagni says her association has been doing whatever we can to make sure brokers are trained and rules are followed to the letter through various training programs and guidelines.
While AHIP agrees with the thrust of the rules, Ignagni says the organization is still conferring and providing recommendations to the CMS and Congress to suggest even further refinements. She wouldnt elaborate on what the refinements were, only that AHIP was making sure all the rules work effectively.
Ignagni estimates the plans will have to spend money to comply with the marketing rules. However, some plans say theyve yet to experience major costs. In Regences case, Our costs have amounted to less than $5,000, at least in Oregon, Nicholson says.
Not all of the requirements should be a surprisesome have already been put into practice, says Paul Precht, director of policy and communications at the Medicare Rights Center, a consumer advocacy group.
For example, the prohibition on door-to-door marketing has already been in place for at least a couple of years, Precht says. None of these requirements, however, whether its a prohibition on cold-calling or other unsolicited contact, will have any teeth unless theyre enforced, he says.
To ensure that plans comply with the new requirements, the CMS said it would step up its surveillance initiatives, including tripling the number of secret shopper activities, in which Medicare officials pose as prospective enrollees and monitor sales events. In 2007, the CMS used secret shoppers at 300 events, reprimanding three companies that offer Medicare Advantage plans.
Other surveillance activities include: reviewing plans local print and broadcast advertisements; reviewing recordings of enrollment calls to ensure compliance with the new regulations; and ensuring that health and drug plans detect, report and respond to agent/broker marketing misrepresentation and other issues, according to a CMS spokesman.