With the release of the 2023 Medicare Communications and Marketing Guidance (MCMG), the Medicare Advantage and Part D health plan industry will be sifting through rubble and abbreviated language to identify changes in their plan’s marketing requirements. CMS' significant edits are no less than a scout troop's game of musical chairs for compliance and marketing teams across the industry: Take a chair away when the music stops, then see what fits. Rewind, repeat, to see what’s left standing at the end of the record. So... what is left?
Considering the previous MCMG was last released in its entirety in 2018 (paired with one supporting memo in 2019), health plans are not only identifying content updates but are also contending with detailed revisions in chronology and format, which makes version-to-version comparison a challenge. Toppan Merrill is working through the updated MCMG to identify changes that may impact plan decisions or influence our business activities. As your organization continues to weed through edits, here are some things to remember:
A potential risk to health plans, is the apparent removal of regulatory verbiage, as the MCMGwas shortened. With this CMS update, plans need to stay aware that language no longer appearing in the MCMG, does not necessarily mean the requirement no longer exists. The required language was likely repeated in the Code of Federal Regulations (CFR) over time, after portions were codified into law, and therefore simply removed from the MCMG to avoid duplication. While the Code of Federal Regulations (CFR) remains the authority as the online source of legalities and requirements, it’s not as easy to navigate as the handier MCMG – we hear you. This sub-regulatory guidance not only provided CFR cross-references but organized subject matter in (mostly) logical groupings using a simple numbering scheme that hadn't changed in years. Yes, we can all can adapt to only using the CFR, but CMS’ added content scramble complicates the comparison process between old and new guidelines. An important checkpoint is determining whether portions might have inadvertently disappeared between the MCMG and the CFR. Let’s face it - nobody wants a repeat of the debacle that was caused by guidance oversights between the CMS Multi-Language Insert and the Office for Civil Rights' language requirements.
Toppan Merrill is in the process of comparing the new MCMG against its prior version and the CFR, in the “where’s Waldo” pin and tuck evaluation of guidance. In the meantime, Toppan Merrill continues to listen to our clients’ needs, so we’ve reached out to CMS to see if they plan to host an industry webinar to support Q&A around the MCMG’s revision.
Thus far, CMS does not appear to have made significant changes to the MCMG impacting the ANOC and EOC documents we primarily service. Much of that guidance resides in the annual instructions following CMS’ model release, so we’ll all hear more details at that time.
Initial observations include the following:
- Appendices: CMS reduced its Appendices at the end of the guidelines from seven to five, relocating select language throughout the MCMG document. The Appendices provide lists of requirements in a convenient, easy-to-use reference. Primary impact applies to the following:
- Definitions: Reduced from 27 definitions to 6, with a handful scattered throughout the other 50 pages.
- Disclaimers: Required disclaimers from the MCMG, to 9 versus 13. Again, the absent disclaimers do not mean they’re no longer required. Plans need to confirm whether the required language has defaulted to the CFR document. A few are scattered elsewhere in the MCMG, closer to their relative subject matter.
- Summary of Benefits (SB) Instructions: SBs are a significant marketing tool for health plans, and their guidance has been updated to reflect the edits CMS previously sent via email, as well as any relevant changes to the document instructions. Now referring to this document as a “model,” the following SB changes include:
- The required order of benefits changed slightly with the embedding of past memo language
- New instructions are included for indicating when a benefit has no cost-sharing (such as $0 copays)
- Other changes to instructions and disclaimer referenced, due to the relocation of disclaimer content
- The use of Cash Equivalents as “Nominal Gifts”: CMS previously prohibited plans from distributing promotional, nominal gifts (items with a retail value of $15.00 or less per individual), in the form of cash or gift cards that could be redeemed for/converted into cash. CMS has now embraced guidance issued from the Office of Inspector General (OIG), adopting guidance which permits gifts such as a Visa gift card that does not limit the purchase to specific retail chains or locations.
As we continue to work through further edits, we welcome your questions and are interested in hearing your experiences with CMS’ changes. Contact us at email@example.com for more information on our health insurance sales and marketing communications solutions.
Summer Beach, Associate Director, Medicare Compliance Solutions at Toppan Merrill
With over 25 years in the insurance industry, Summer’s focus is Medicare-related compliance. With past roles as Regulatory Compliance Manager and Director for state, regional and national insurers, her areas of SME include CMS-regulated documents and guidelines, agent/broker and sales compliance, designing CMS-approved investigation processes, audits and Corrective Action Plans, and training with re-education formats following CMS disciplines. Summer brings expertise in policies and procedures, auditing compliance programs, and has measurably reduced plans’ member complaints to CMS through remedial initiatives. Well-versed on CMS insights, Summer identifies risks to avoid, for staying compliant. Summer’s experience supports Toppan Merrill and our clients in staying compliant with CMS and regulatory requirements.