The Centers for Medicare and Medicaid Services last week proposed new regulations that considerably toughen marketing and operations oversight on insurers offering Medicare Advantage and prescription programs under Part D of Medicare.
The proposal would also impose stringent standards on the conduct of agents selling Medicare Advantage programs and subject them to state oversight. It would also give the agency the authority to fine an insurer up to $25,000 per beneficiary if an agent is found to violate the new rules.
The CMS also wants to revise procedures affecting how carriers handle low-income prescription drug plan members, or other special needs plans.
Regarding marketing, the proposal would require that insurers using independent agents to sell MA and prescription drug programs under Medicare use state-licensed agents for such marketing. And, it would require MA organizations to report to states “in a manner consistent with state appointment laws” that they are using with those agents.
The proposed regulations would also bar door-to-door marketing and cold-calling.
And, going beyond an agreement that members of America’s Health Insurance Plans proposed in March with members of the Senate Finance Committee, the regulations tighten guidelines on broker/agent commissions that insurers can pay to independent agents.
In comments to reporters, Kerry Weems, acting administrator of CMS, said the proposed rules “build on CMS’ experience” in administering the MA and Part D programs since 2006 and “strengthens” their authority.
Most of this has already been put into place through operational guidance, and Weems said “hopefully the rule will be in place” and finalized in time for the open enrollment period this year that begins Oct. 1.