Avoiding CTMs: How to Stay Compliant This AEP

AEP is fast-paced, but that doesn’t mean you can cut corners. It’s essential to stay on top of compliance to build long-term trust with clients and protect yourself and your business.

Our tips will help you avoid the dreaded CTM (Compliance Tracking Module) reports and ensure a smooth, complaint free enrollment period.

Why Does Compliance Even Matter?

CMS is paying attention to everything – what you say during appointments, how you market yourself, what you say in marketing materials, how you collect leads, and if you’re keeping records. Not being compliant can result in fines, loss of contracts with carriers, damage to your reputation, increased oversight, and even revocation of your license.

Agents who prioritize compliance are likely to have no issues and have a thriving business this AEP season.

Quick Reminders

Before we get into compliance, let’s remind you of a few things that could help you avoid common customer complaints and compliance issues all together.

1. Know your plans inside and out – be an expert at your offerings
2. Clear Communication – overshare! don’t miss any details!
3. Discuss ALL Plan Benefits – highlight all the benefits of a plan when talking to a client.
   • For example, if a plan offers DVH, transportation services, food cards, or spending cards, inform your clients!

Try to remember these – they really do help!

Remain Compliant with these Guidelines

TPMO

Agents are considered “TPMOs” (third-party marketing organizations) by CMS. When marketing Medicare Advantage or Prescription Drug Plans, agents have to follow a set of guidelines.

TPMO guidelines include:

• Making a list of all the contractors, subcontractors, and vendors you used for marketing, lead generation, sales, and enrollment.

• Record all sales, enrollment, and marketing calls with clients.

• Use the appropriate TPMO disclaimer when communicating via phone, email, website, through print materials, or other marketing platforms.

There are two potential TPMO disclaimers you will use.

For those of you who DO NOT offer all available plans in your service area:

“We do not offer every plan available in your area. Currently, we represent [insert number of organizations] organizations that offer [insert number of plans] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.”

For those of you who DO offer all available plans in your service area:

“Currently, we represent [insert number of organizations] organizations that offer [insert number of plans] products in your area. You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.”

We recommend visiting Medicare.gov or a local State Health Insurance Program (SHIP) for comprehensive information on disclaimer options.

Call Recording

CMS requires agents to record all their marketing, sales, and enrollment calls with Medicare clients at any time of year. As a Tidewater partner, it’s easy for you to record AEP calls using IntegrityCONNECT. This (completely free!) platform is your compliant solution for recording all of your marketing and enrollment calls.

With IntegrityCONNECT, you can:

• Seamlessly record all your inbound and outbound client calls.
• Easily link calls to both new and existing client contact records.
• Store recordings automatically and securely for the full 10-year period required.
• Download calls anytime, from wherever you are working.

*You do not need to record in person conversations with clients*

*Plans that fall under this rule include, Medicare Advantage Part D, Medicare Advantage, and Part D Prescription Drug products for TPMO sales call recording.*

Permission to Contact

A Permission to Contact (PTC) is another CMS requirement agents need to be aware of. This is the necessary step that allows you to initiate contact with potential clients and market Medicare products to them.

So, how do you obtain a client’s PTC if they have to be the ones to initiate contact?

Here are a few things you can do:

• Send out business reply cards (BRCs).
• Contact a beneficiary after they request a return call from the BRC.
• Contact a beneficiary after they fill out an online contact form (like from your website).
• Contact a beneficiary through email as long as you include an opt-out option.

*You cannot directly message a beneficiary through social media, text, or go door-to-door to obtain a PTC.*

Your PlanEnroll landing page collects consumer information and a PTC, making it easier to remain compliant! If you haven’t already, go ahead and activate your PlanEnroll page before AEP. Once you connect with a potential client through PlanEnroll, you can send an SOA (Scope of Appointment) through text or email from their profile.

Scope of Appointment

A Scope of Appointment is different from a PTC, but it works in conjunction with it. After you obtain a potential client’s PTC, you must sign the SOA, which is a form that outlines exactly what you’ll present to a client during your meeting. The SOA ensures that beneficiaries will not hear about any plans other than those they requested.

Key things to remember about SOAs:

• Agents must keep SOA forms for at least 10 years on file, even if the meeting didn’t end in a sale.
• SOAs will be valid for 12 months or until it is used (you will need a new one if they expire before your meeting).
• You can use the same SOA in follow-up discussions with clients.
• You must obtain an SOA for in-person and virtual meetings.
• You must wait 48 hours between obtaining an SOA from a client appointment unless the beneficiary is 4 days or less from the end of a valid enrollment period, or the client was a walk-in and did not have a scheduled meeting with you already.

Marketing

As of October 1st, agents were allowed to start marketing plans to potential clients. CMS distinguishes rules between non-marketing and marketing materials for Medicare Advantage and Part D. Knowing the difference between the two is crucial to remain compliant, so let’s look at how they differ:

Non-marketing materials:

• Content is general, non-specific information.

• Intent is to provide general information to potential clients.

• They are not subject to CMS review.

Marketing materials:

• Content includes plan specific information (including benefits, premiums, and plan comparisons).
• Intent is to influence beneficiaries to enroll, change, or keep their current plans.
• They are subject to CMS review.

*If marketing a printed advertisement (think letters, cards, flyers) where a plan specific benefit is features, the carrier name must be featured*

Remember these tips when marketing:

• Your goal is to educate, not to persuade customers about which plans/carriers you may be drawn to.
• You must inform beneficiaries about all plans available to them.
• Don’t ever use the word “free” even if a plan includes an additional coverage option or premium that is $0.

Events

Agents are allowed to host events throughout the year. These events can be educational, sales-related, or individual appointments with clients. CMS outlines all the guidelines for these events here.

When hosting educational events, here are a few things to remember:

• Give out educational materials.
• Answer questions by attendees.
• Hand out your business cards so potential clients can reach out to you first.
• Do not collect SOAs or enrollment forms.
• Do not give out plan-specific materials.
• Do not schedule future appointments with attendees.

When hosting sales events or individual appointments, here are a few things to remember:

• Use the TPMO disclaimer.
• Name all the plan types you’ll cover before you start talking.
• Schedule follow-up meetings with attendees.
• Collect SOAs (if at an individual appointment, you must have this prior to the meeting).
• Hand out your business cards.
• Do not compare carriers’ plans.
• Do not request or accept referrals.

Quick Tips to Remain Compliant

We just threw a lot of information at you, but remaining compliant is very important and your responsibility as an agent. We’ve compiled a short list of quick tips that wrap up what we talked about and can help:

• Record all required calls.
• Secure a Scope of Appointment (SOA) at least 48 hours before a client meeting.
• You can market before AEP begins, but you cannot enroll a client until October 15th.
• You must use a TPMO disclaimer.
• Be knowledgeable about CMS marketing rules.
• Educate clients, don’t just seek to enroll.

Extra Resources

For additional information, please refer to CMS.gov to find the full Medicare Communications and Marketing guidelines outlined. You can also view the MA and Part D Communication requirements on the Federal Reserve website. Please refer here for compliance guidance for MA, VBID, and SSBCI products and benefits as well.

The Tidewater team is always available to answer any compliance questions. Contact us anytime for help or guidance.

*This post is for agent use only and did not include all necessary CMS guidelines agents must follow. Please refer to CMS.gov or contact us for a full list of guidelines you must follow.*