27-June-2016

New marketing guidance released by the Centers for Medicare and Medicaid Services (CMS) doesn’t contain any “game changers,” but health plans should take note of new requirements regarding agent-broker compensation and provider endorsements, Mike Adelberg, senior director for FaegreBD Consulting, told Medicare Advantage News.

The guidance specified that health plans must establish agent-broker compensation, including “payment amounts for initial and renewal compensation,” before October 1 each year, and the commission-bands for those amounts must be fixed for the ensuing year. The update also stipulated that “a contracted or employed physician or health care provider cannot provide an endorsement or testimonials.” CMS has also directed preferred provider organizations (PPOs) to add disclaimers to marketing materials saying that out-of-network providers “are under no obligation to treat” plan members, “except in emergency situations.”

The new marketing rules stated that provider and pharmacy directories are not subject to marketing review, which suggests that the agency will continue to oversee matters concerning network adequacy separately, Adelberg said.

“The exclusion of provider and pharmacy directories from marketing review does not mean that CMS is lightening its attention,” Adelberg said. “Quite the opposite, this clarifies that CMS will conduct oversight of these materials through other means.”

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