By Shelley Segal, CEO

As most of the final Centers for Medicare & Medicaid Service (CMS) regulations[1] are effective January 1, 2023, now is a great time to make sure all of the new requirements are implemented, or will be implemented on time, especially the new Third-Party Marketing Organization (TPMO) regulations.

Medicare Advantage Organizations (MAOs) and Prescription Drug Plans (PDPs), also known as “Sponsors”, that contract with a TPMO either directly or indirectly through a First Tier, Downstream or Related Entity (FDR), are accountable for ensuring that the TPMO adheres to all requirements which apply to the Sponsor. The new regulation now includes entities that are not FDRs but provide services to a Sponsor or a Sponsor’s FDR. {42 CFR (§§ 422.2260 and 423.2260, 422.2267 and 423.2267, 422.2274 and 423.2274}

Therefore, Sponsors are now accountable for all compliance actions performed by entities (as listed below in rows 1, 2, 3, and 4). For marketing, these actions include Communications, Marketing, Lead Generations, and telephonic enrollment recordings.

[1] [CMS-4192-F, CMS–1744–F, and CMS–3401–F]

Sponsors must update or create new Policies & Procedures (P&Ps) documenting their oversight requirements. These documents need to include how the oversight will be completed and documented for TPMOs, brokers and agents that are a first tier or downstream entity, as well as other entities that provide services. For instance:

• How does the organization identify who provides services to your delegated entities?
• Who is conducting telephonic enrollment calls?
• Does the delegated entity require a contract for all entities providing services?
• Does the organization know how and from where it (or its FDR) obtains leads?
• Where are the telephonic enrollment recordings retained?
• And who audits and/or monitors the TPMO’s, brokers, agents, and other entities (sales call centers, lead generations)?

Segal Medicare Experts (SME) is here to help with your specific needs. Now is the perfect time, as your 2023 marketing materials are currently being created. Do your TPMOs and other entities know all of the CMS marketing requirements?

Let SME create, implement and audit these requirements so your organization will be ready by 1/1/2023, and ready for the next CMS audit.

We are here for you, and ready to help! Call or email us today.

Segal Medicare Experts

SME@SMEteam.org 

OR 562.334.7980

segalmedicareexperts.com