1

The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Conflict of Interest: Identification, Remedy, and Removal

State Health Insurance Assistance Program (SHIP), Senior Medicare Patrol (SMP) Program, and Medicare Improvements for Patients and Providers Act (MIPPA) Program 

Overview

As the Medicare population grows, the networks serving them continue to feel conflicting pressures as they seek to serve as many individuals as possible, adhere 

to federal funding and policy requirements, and identify innovative funding streams. Organizations that house the SHIP, SMP, and MIPPA programs must be 

especially conscientious in navigating these pressures, as their Team Members are tasked with providing unbiased, objective information to Medicare-eligible 

individuals on their health insurance options. 

This document provides technical assistance to SHIP/SMP/MIPPA programs and their partner Community-Based Organizations (CBOs) on how to avoid actual 

and perceived Conflicts of Interest (COI) and mitigate risk. The Administration for Community Living’s (ACL) Office of Healthcare Information and Counseling’s 

(OHIC) intention in preparing this resource is not to be prescriptive, as we know that each state and scenario is different, but instead to provide identification 

and remedy or removal strategies to help support grantees' risk mitigation efforts. Nor is this document intended to discourage grantees or CBOs from forming 

new partnerships or contracts when appropriate. The purpose of this document and related technical assistance is to support grantees in identifying and 

mitigating risks in administering their SHIP/SMP/MIPPA programs. Responsibility for managing conflict of interest risk falls on the SHIP/SMP/MIPPA grantee, not 

upon ACL. All information provided within this resource impacts not only the direct SHIP/SMP/MIPPA grantees, but also each entity receiving sub-awarded or 

pass through funding. 

In considering the appointment of an individual as a SHIP/SMP/MIPPA Team Member or pursuing a new relationship with a partner entity, it is best practice for 

the organization or employing agency to: 

(i) Take reasonable steps to avoid employing or appointing an individual who has an unremedied conflict of interest or who has a member of the 

immediate family with an unremedied conflict of interest; 

(ii) Take reasonable steps to avoid assigning an individual to perform duties which would constitute an unremedied conflict of interest; 

(iii) Establish a process for periodic review and identification of conflicts; 

(iv) Establish proactive policies and contract language that protect the federal programs’ interests; and

(v) Take steps to remove or remedy known conflicts immediately.

As potentially problematic scenarios arise, it is important that you seek to understand the situation, educate all involved, and formulate a mitigation plan along 

with your ACL OHIC project officer and either the SHIP Technical Assistance (TA) Center or SMP Resource Center. Whether potential conflicts of interest are 

actual or perceived, it is essential that grantees pursue solutions that preserve the integrity and unbiased nature of the SHIP/SMP/MIPPA programs. Even the 

appearance of a COI should be avoided at all costs. Many situations will not fit neatly into one of the scenarios included within this document. When in doubt, 

contact your ACL OHIC project officer, the SHIP TA Center, or SMP Resource Center for technical assistance on how to proceed. In accordance with the Conflict 

of Interest Decision Tree, risk mitigation plans should be established along with a state's assigned ACL OHIC Project Officer and kept up-to-date and on file.

Technical Assistance requests can be sent to OHIC@ACL.hhs.gov.
2

The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Conflict of Interest Identification, Remedy, & Removal

* Indicates additional information included in 'Terminology' section of resource.

Conflict of Interest Conflict 

Type

Conflict 

Entity

Example Steps Toward Identification/ 

Best Practices to Avoid This Type of COI

Examples of Remedy or Removal 

Implementation of one or more remedy tactic(s) 

below will lessen but may not eliminate conflict or 

risk. Consult with ACL Project Office to ensure 

adequate mitigation steps are under way.

LoyaltyCommitmentControlIndiv./ GroupOrg./ Agency

1

Licensed insurance 

agent/broker acting as 

SHIP*/SMP*/MIPPA*

Team Member*.

X X X X

Mary (SHIP Team 

Member) maintains 

her licensure as a 

Generic Insurance 

Company agent for 

her side job that she 

works on nights and 

weekends. She never 

uses SHIP hours to do 

Generic Insurance 

Company work and 

vice versa.

▪ Is individual an active SHIP/SMP 

Team Member?

▪ Is individual a licensed insurance 

agent/broker? Is individual actively 

working in the relevant insurance 

industry? If not, how long ago did 

individual discontinue this work?

Best Practice (BP): SHIP/SMP/MIPPA

screens for insurance agent licensure 

prior to accepting new Team 

Members.

BP: SHIP/SMP/MIPPA rescreens at 

regular intervals in accordance with 

their VRPM policies and procedures.

No individual may be a licensed insurance 

agent and a SHIP/SMP/MIPPA Team Member 

at the same time. This is a violation of the SHIP 

Statute (see Addendum C).

At least one of the following tactics must be 

implemented in order to remove the conflict 

and proof of all actions must be documented: 

1. Removal of insurance license before 

SHIP/SMP/MIPPA Team Member acceptance.

2. Removal or prohibition of Team Member 

status as the SHIP/SMP/MIPPA cannot ensure 

the Team Member will be able to perform their 

program duties in an unbiased manner. 

2

SHIP/SMP/MIPPA Team 

Member is a 

former/retired 

insurance agent/ 

broker.

X X

Janet just applied to 

become a new SHIP 

Team Member and 

she recently retired 

from a career as an 

insurance agent. 

▪ Is individual an active 

SHIP/SMP/MIPPA Team Member?

▪ How long ago did individual 

discontinue work as insurance agent/ 

broker?

▪ Can individual confidently confirm 

that they are able to remain unbiased 

in their SHIP/SMP/MIPPA duties?

▪ Could there be unknown biases?

BP: SHIP/SMP/MIPPA provides new 

Team Members mentoring and 

shadowing and all Team Members 

regular periodic monitoring to 

monitor for bias and training needs. 

At least one of the following tactics must be 

implemented in order to remove the conflict 

and proof of all actions must be documented:

1. Removal of Team Member as the 

SHIP/SMP/MIPPA cannot ensure the Team 

Member will be able to perform their program 

duties in an unbiased manner. 

2. Focused training of Team Member to ensure 

adherence to expectations/ requirements 

related to bias.
3

The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Conflict of Interest Conflict 

Type

Conflict 

Entity

Example Steps Toward Identification/ 

Best Practices to Avoid This Type of COI

Examples of Remedy or Removal 

Implementation of one or more remedy tactic(s) 

below will lessen but may not eliminate conflict or 

risk. Consult with ACL Project Office to ensure 

adequate mitigation steps are under way.

LoyaltyCommitmentControlIndiv./ GroupOrg./ Agency

3

SHIP/SMP/MIPPA Team 

Member has 

immediate family 

member* with financial 

connection to 

plan/health 

system/provider group.

X X

Anne is a new SHIP 

Team Member whose 

husband is a Generic 

Insurance Company 

(GIC) agent selling 

Medicare Advantage 

plans.

▪ Is individual an active 

SHIP/SMP/MIPPA Team Member?

▪ Does individual's immediate family 

member have any possible financial 

gain/loss/personal investment 

related to insurance plan/health 

system/provider group?

BP: SHIP/SMP/MIPPA screens for COI 

within immediate family prior to 

accepting new Team Members.

BP: SHIP/SMP/MIPPA rescreens at 

regular annual intervals in 

accordance with their VRPM policies 

and procedures.

If a financial conflict is identified, the 

SHIP/SMP/MIPPA must take steps to ensure 

that the program work can be provided free of 

any bias. At least one of the following tactics 

must be implemented in order to remove 

conflict and proof of all actions must be 

documented:

1. Removal of Team Member as the

SHIP/SMP/MIPPA cannot ensure the Team 

Member will be able to perform their program 

duties in an unbiased manner. 

2. Focused training of Team Member to ensure 

adherence to expectations/ requirements 

related to bias.
4

The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Conflict of Interest Conflict 

Type

Conflict 

Entity

Example Steps Toward Identification/ 

Best Practices to Avoid This Type of COI

Examples of Remedy or Removal 

Implementation of one or more remedy tactic(s) 

below will lessen but may not eliminate conflict or 

risk. Consult with ACL Project Office to ensure 

adequate mitigation steps are under way.

LoyaltyCommitmentControlIndiv./ GroupOrg./ Agency

4

CBO* combining 

staffing for 

SHIP/SMP/MIPPA and 

business acumen*

activities (i.e. Team 

Members expected to 

spend time on activities 

that support both 

programs)

X X X X

Townville Area Agency 

on Aging (TAAA)

maintains 3 staff 

members who work 20 

hours per week 

providing case 

management services 

for a contract TAAA 

holds with Generic 

Insurance Company. 

TAAA requires these 

same three staff 

members to provide 

SHIP services with the 

other 20 hours of their 

time.

▪ Does CBO employ active 

SHIP/SMP/MIPPA Team Member(s)? 

▪ Does CBO expect SHIP/SMP/MIPPA

Team Member(s) to spend a portion 

of their total FTEs on business 

acumen-related activities?

▪ Are the business acumen activities 

supported by funding from a health 

insurance plan/s? 

▪ What funding source(s) support 

these positions (SHIP/SMP/MIPPA

and/or plan funds)?

▪ What funding sources are used to 

support the supervisors/chain of 

command?

BP: organizations housing both 

SHIP/SMP/MIPPA and business 

acumen activities prepare and 

implement annual 

firewall/delineation of activities plan

including proof of FTE billing and 

submit as ACL documentation.

This is a conflict if the business acumen work is 

supported by a health insurance plan. At least 

one of the following tactics must be 

implemented in order to remove conflict and 

proof of all actions must be documented:

1. Mandatory: Ensure no SHIP/SMP/MIPPA

Team Member is ever in position which is 

partially or fully supported by plan 

contract/funds.

2. Requirement that firewalls* be put in place

between SHIP/SMP/MIPPA work and plan 

contracted work. 

3. Prohibit cross-training and expectations 

between SHIP/SMP/MIPPA work and any work 

with the plans.

4. More frequent/thorough federal/ state 

monitoring of work plan/ budget when business 

acumen activities crossover with 

SHIP/SMP/MIPPA work. 

Note: Agency does not need to be excluded 

from SHIP/SMP/MIPPA as long as appropriate 

firewalls and/or remedy/removal strategies are 

put in place when health insurance plans are 

involved in the business acumen activities.
5

The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Conflict of Interest Conflict 

Type

Conflict 

Entity

Example Steps Toward Identification/ 

Best Practices to Avoid This Type of COI

Examples of Remedy or Removal 

Implementation of one or more remedy tactic(s) 

below will lessen but may not eliminate conflict or 

risk. Consult with ACL Project Office to ensure 

adequate mitigation steps are under way.

LoyaltyCommitmentControlIndiv./ GroupOrg./ Agency

5

CBO houses 

SHIP/SMP/MIPPA

program and has 

contract with insurance

plan ("shared front 

door")

X X X X

Townville Area Agency 

on Aging (TAAA) is an 

active SHIP site and 

also holds a contract 

with Generic Insurance 

Company (GIC) to 

provide care 

management services 

for their insured 

individuals in TAAA's 

service area. SHIP 

activities and GIC

contract activities are 

not structurally 

delineated via staffing, 

leadership, and 

financial firewalls.

▪ Does CBO provide SHIP/SMP/MIPPA

services?

▪ Does CBO have signed contract with 

insurance plan?

▪ Does CBO have staff working on 

SHIP/SMP/MIPPA and contract work 

reporting through the same chain of 

command? 

BP: Establish proactive policies and 

contract language that protect 

federal programs’ interests.

BP: organizations housing both 

SHIP/SMP/MIPPA and business 

acumen activities prepare and 

implement annual 

firewall/delineation of activities plan

including proof of FTE billing and 

submit as ACL documentation.

At minimum, the first two of the following 

tactics must be implemented in order to 

remove conflict and proof of all actions must be 

documented: 

1. (Mandatory) Firewall(s) must be put in place 

between SHIP/SMP/MIPPA work and the 

contracted plan.

2. (Mandatory) Ensure no SHIP/SMP/MIPPA

Team Member is ever in position which is 

partially or fully supported by plan 

contract/funds/activities.

3. Include carefully written/strategic contract 

language.

4. Identify strict strategic time commitment 

expectations to limit possibility of double billing 

time.

5. Limit cross-training and expectations 

between SHIP/SMP/MIPPA work and any work 

with the plans.

6. Develop a media/outreach/communication 

plan that clearly delineates services provided by 

SHIP/SMP/MIPPA from the work conducted 

under the plan contract to reduce risk of the 

appearance of a conflict. 

7. More frequent/thorough federal/ state 

monitoring of work plan/ budget. 
6

The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Conflict of Interest Conflict 

Type

Conflict 

Entity

Example Steps Toward Identification/ 

Best Practices to Avoid This Type of COI

Examples of Remedy or Removal 

Implementation of one or more remedy tactic(s) 

below will lessen but may not eliminate conflict or 

risk. Consult with ACL Project Office to ensure 

adequate mitigation steps are under way.

LoyaltyCommitmentControlIndiv./ GroupOrg./ Agency

6

CBO has contract with 

health system or 

provider group.

X X X X

Townville Area Agency 

on Aging holds a 

contract with 

Townville Regional 

Hospital System to 

provide case 

management for 

insured local 

individuals. 

▪ Does CBO provide SHIP/SMP/MIPPA

services?

▪ Does CBO have signed contract with 

health system or provider group?

▪ Is the health system branded or 

contracted with any single insurance 

company? 

BP: Establish proactive policies and 

contract language that protect 

federal programs’ interests

This is a conflict if the health system is branded 

with or also has a contract with a single 

insurance company. If this is the case, the 

conflict must be handled as explained in item 

#5, and at least one of the following tactics 

must be implemented in order to remove 

conflict and proof of all actions must be 

documented:

1. If agency houses both activities and creates 

general resources, SHIP/SMP Team Members 

are not involved in soliciting or creating 

materials beyond providing SHIP/SMP-specific 

information.

2. If agency houses both activities and creates 

general resources, SHIP/SMP/MIPPA may be 

listed, but not featured or highlighted more 

than other programs included in materials.

Online materials including plan branding must 

be posted on non-SHIP/SMP/MIPPA-specific 

pages.
7

The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Conflict of Interest Conflict 

Type

Conflict 

Entity

Example Steps Toward Identification/ 

Best Practices to Avoid This Type of COI

Examples of Remedy or Removal 

Implementation of one or more remedy tactic(s) 

below will lessen but may not eliminate conflict or 

risk. Consult with ACL Project Office to ensure 

adequate mitigation steps are under way.

LoyaltyCommitmentControlIndiv./ GroupOrg./ Agency

7

SHIP/SMP/MIPPA Team 

Member receiving 

compensation or other 

benefits from plan 

(outside of their role 

within the 

program/agency) or 

showing favoritism.

X X X

Alex (Local insurance 

agent) encourages 

Alice (SHIP Team 

Member) to 

recommend Generic 

Insurance Company as 

the best local plan 

because it clearly 

provides the best 

possible benefit 

offering.

Minnie (SHIP Team 

Member) believes she 

is remaining unbiased 

but also receives $200 

per enrollment from 

Generic Insurance 

Company.

▪ Is individual an active

SHIP/SMP/MIPPA Team Member?

▪ What exactly is the plan asking for?

▪ Is plan offering benefit (financial or 

non-financial) to Team Member for 

enrollment in or referrals to their 

plan?

BP: Establish a process for periodic 

review and identification of conflicts.

BP: SHIP/SMP/MIPPA screens Team 

Members at regular annual intervals 

to ensure that staff are not receiving 

benefits.

At least one of the following tactics must be 

implemented in order to remove conflict and 

proof of all actions must be documented:

1. Removal of Team Member as the 

SHIP/SMP/MIPPA cannot ensure the Team 

Member will be able to perform their program 

duties in an unbiased manner. 

2. Retraining of Team Member to clearly 

articulate and ensure adherence to 

expectations/requirements.

3. Guidance provided to plan to clearly 

articulate SHIP/SMP/MIPPA Team Member 

expectations/requirements.

4. If COI exists higher within agency, involved 

agency staff and/or board members required to 

excuse themselves from voting/discussion/ 

participation as needed when the conflict 

arises.
8

The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Conflict of Interest Conflict 

Type

Conflict 

Entity

Example Steps Toward Identification/ 

Best Practices to Avoid This Type of COI

Examples of Remedy or Removal 

Implementation of one or more remedy tactic(s) 

below will lessen but may not eliminate conflict or 

risk. Consult with ACL Project Office to ensure 

adequate mitigation steps are under way.

LoyaltyCommitmentControlIndiv./ GroupOrg./ Agency

8

SHIP/SMP/MIPPA

material/ 

advertisement/media/e

vent cobranded* with 

plan.

X X X

Townville Area Agency 

on Aging (TAAA) (who 

also houses SHIP) 

disseminates local 

Open Enrollment 

reminder flyer which 

includes brand images 

for both TAAA and 

Generic Insurance 

Company. 

▪ Does material/advertisement/ 

media/event include 

SHIP/SMP/MIPPA branding?

▪ Does material/advertisement/ 

media/event include plan branding?

▪ Source of funding for material(s) 

plays no role in allowability.

BP: SHIP/SMP/MIPPA materials 

include only SHIP/SMP branding.

At least one of the following tactics must be 

implemented in order to remove conflict and 

proof of all actions must be documented:

1. Cancellation of material/ 

advertisement/event.

2. SHIP/SMP/MIPPA removal of participation.

9

SHIP/SMP/MIPPA

material/advertisement

/media/event

sponsored* by plan.

X X X

Townville Area Agency 

on Aging plans a local 

SHIP event during 

Open Enrollment 

which includes lunch 

provided for attendees 

through funding by 

Generic Insurance 

Company.

▪ Is event intended to provide 

outreach, counseling, or education to 

Medicare beneficiaries as part of 

SHIP/SMP/MIPPA program activities?

▪ Is material/ advertisement/ 

media/event financially supported (in 

part or full) by plan?

BP: SHIP/SMP/MIPPA events do not 

utilize funds received directly or 

indirectly from plan in any way.

At least one of the following tactics must be 

implemented in order to remove conflict and

proof of all actions must be documented:

1. Identify alternative source of sponsorship for 

event.

2. Procure equivalent sponsorship from all 

available plans to support event therefore 

eliminating the conflict of appearing to favor or 

promote one agency or plan over another.

3. Cancellation (or SHIP/SMP/MIPPA removal of 

participation) of event if no alternatives are 

possible.
9

The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Conflict of Interest Conflict 

Type

Conflict 

Entity

Example Steps Toward Identification/ 

Best Practices to Avoid This Type of COI

Examples of Remedy or Removal 

Implementation of one or more remedy tactic(s) 

below will lessen but may not eliminate conflict or 

risk. Consult with ACL Project Office to ensure 

adequate mitigation steps are under way.

LoyaltyCommitmentControlIndiv./ GroupOrg./ Agency

10

SHIP/SMP/MIPPA

participates in a plan 

organized and 

sponsored event.

X X X X

SHIP/SMP/MIPPA

attends a local event 

that is sponsored 

solely by Generic 

Insurance Company.

▪ Is this a large, community-organized 

event?

▪ Is plan one of multiple sponsors, as 

opposed to the sole sponsor?

▪ Will SHIP/SMP/MIPPA presence at 

event be perceived as bias toward 

plan? 

▪ Will SHIP/SMP/MIPPA absence at 

this large community event 

detrimentally impact their ability to 

serve community?

BP: SHIP/SMP/MIPPA should only 

attend plan event if this is a large 

community-organized event and plan 

is not the sole sponsor.

At least one of the following tactics must be 

implemented in order to remove conflict and

proof of all actions must be documented:

1. SHIP/SMP/MIPPA does not participate in 

event.

2. SHIP/SMP/MIPPA educates plan on need for 

diverse sponsorship, resulting in change of 

event’s financial backing.

11

SHIP/SMP/MIPPA event 

includes plan as 

exhibitor*.

X X

Townville Area Agency 

on Aging plans a local 

SHIP event during 

Open Enrollment 

which includes 20 

vender tables, 8 of 

whom are locally 

offered insurance 

companies. Venders 

will provide 

educational materials 

about their offerings.

▪ Is event intended to provide 

outreach, counseling, or education to 

Medicare beneficiaries as part of 

SHIP/SMP/MIPPA program activities?

▪ Is exhibitor a licensed, locallyavailable plan?

▪ What is the purpose of the plan 

inclusion (education or marketing)? 

BP: SHIP/SMP/MIPPA event does not 

include plan as exhibitor unless all 

plans available in the area are invited 

to participate.

BP: SHIP/SMP/MIPPA event includes 

variety of exhibitors, including 

multiple locally-available plans.

At least one of the following tactics must be 

implemented in order to remove conflict and 

proof of all actions must be documented:

1. SHIP/SMP/MIPPA program should make 

every possible effort to eliminate perceived 

favoritism or loyalty to one plan over another. 

2. Ensure presence of variety of exhibitors, 

including multiple locally-available plans.

3. Ensure any plan participation is education 

based rather than marketing focused. 
10

The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Conflict of Interest Conflict 

Type

Conflict 

Entity

Example Steps Toward Identification/ 

Best Practices to Avoid This Type of COI

Examples of Remedy or Removal 

Implementation of one or more remedy tactic(s) 

below will lessen but may not eliminate conflict or 

risk. Consult with ACL Project Office to ensure 

adequate mitigation steps are under way.

LoyaltyCommitmentControlIndiv./ GroupOrg./ Agency

12

Insurance agent serving 

as primary trainer for 

SHIP/SMP/MIPPA Team 

Members.

X X X

Sally (local Generic 

Insurance Company 

agent) provides 

excellent Medicare 

101 trainings so 

Townville Area Agency 

on Aging sends new 

SHIP Team Members 

to Sally's trainings in 

order to save money 

and maintain healthy 

working relationship.

▪ Is trainer a licensed insurance 

agent?

▪ What is the purpose of the training? 

General Medicare knowledge or plan 

specific information? 

▪ Is training attended by 

SHIP/SMP/MIPPA Team Members as 

part of mandatory training?

▪ Are all available plans providing 

equivalent training to 

SHIP/SMP/MIPPA Team Members?

Agents cannot be used as the primary means of 

Medicare content training for SHIP/SMP/MIPPA

Team Members. At minimum, the first two 

following tactics must be implemented in order 

to remove conflict and proof of all actions must 

be documented: 

1. (Mandatory) Removal of associated 

individuals from SHIP/SMP/MIPPA trainer 

status. 

2. (Mandatory) Retraining of impacted Team 

Member(s) to ensure full, unbiased 

understanding of appropriate materials and 

ensure adherence to expectations and 

requirements.

3. Ensure organization's relationship with 

Agent/Plan is clearly severed or restructured to 

ensure elimination of this conflict.

4. Provide guidance to plan to clearly articulate 

SHIP/SMP/MIPPA Team Member 

expectations/requirements.

5. If warranted/appropriate, leverage all 

available plans to benefit from their offerings in 

controlled situations to provide plan specific 

information to Team Members.
11

The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Conflict of Interest Conflict 

Type

Conflict 

Entity

Example Steps Toward Identification/ 

Best Practices to Avoid This Type of COI

Examples of Remedy or Removal 

Implementation of one or more remedy tactic(s) 

below will lessen but may not eliminate conflict or 

risk. Consult with ACL Project Office to ensure 

adequate mitigation steps are under way.

LoyaltyCommitmentControlIndiv./ GroupOrg./ Agency

13

Insurance agent 

providing training to 

general public 

regarding 

SHIP/SMP/MIPPA.

X X

Tim (local Generic 

Insurance Company 

agent) provides indepth training on 

Medicare to the 

general public and 

includes reference and 

explanation of 

SHIP/SMP/MIPPA in 

his materials or 

presentation.

▪ Are licensed agents representing 

themselves as SHIP/SMP/MIPPA 

Team Members?

As long as the insurance agent is not 

representing him/herself as a SHIP/SMP/MIPPA

Team Member this activity is outside the 

bounds of the grant/agency purview. If,

however, the agent is representing him/herself 

as SHIP/SMP/MIPPA, the program agency can: 

1. Provide agent with this document and any 

supplementary materials to educate them on 

Conflict of Interest and related bias indicating 

that they cannot/will not be accepted as a 

SHIP/SMP/MIPPA Team Member.

2. Take legal action against the agent for 

misrepresenting him/herself as part of the 

SHIP/SMP/MIPPA team. 

14 SHIP/SMP/MIPPA Team 

Members training 

agents/brokers/plan 

representatives

X X X Brenda (SHIP Team 

Member) provides indepth Medicare 

training for new SHIP 

Team Members. There 

is one open seat in the 

room so John (local 

Generic Insurance 

Company agent) is 

allowed to attend. 

There is no perceived 

additional cost to his 

attendance and he 

makes all of his own 

copies of materials.

▪ What is the purpose of the training 

and/or the agent/broker/plan's intent 

in attending?

▪ Is agent's attendance 

of/participation in training taking 

space that could be filled by a 

SHIP/SMP/MIPPA Team Member?

▪ Is agent's attendance 

of/participation in training utilizing 

SHIP/SMP/MIPPA trainer's time (and 

therefore grant-funded hours)

At least one of the following tactics must be 

implemented in order to remove conflict and 

proof of all actions must be documented:

1. SHIP/SMP/MIPPA programs are not intended 

to be the main source of Medicare 

knowledge/information for 

agents/brokers/plans, however, it is allowable 

for SHIP/SMP/MIPPA to provide training for 

agents/brokers occasionally if they participate 

in a public event. These entities should be using 

available CMS materials for this content. 

2. SHIP/SMP/MIPPA must ensure that 

attendees of public events understand that 

attendance does not deem them 

"SHIP/SMP/MIPPA" trained or officially part of 

the program, nor, can they use this training in 

any self-promotion/advertising activities.
12

The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Addendum A: Conflict of Interest Terminology

Abbreviation/Term Definition/Supporting Details

Area Agency on Aging (AAA)

A public or private non-profit agency designated by the state to address the needs and concerns of all older 

persons at the regional and local levels. AAAs coordinate and offer services that help older adults and individuals 

with disabilities remain in their homes - if that is their preference - aided by services and supports to make 

independent living a viable option. AAAs often provide SHIP/SMP/MIPPA services, as well as other programs 

serving older adults and individuals with disabilities, to a geographic area.

Administration for Community 

Living (ACL)

The Administration for Community Living was created around the fundamental principle that older adults and 

people of all ages with disabilities should be able to live where they choose, with the people they choose, and with 

the ability to participate fully in their communities. By funding services and supports provided by networks of 

community-based organizations, and with investments in research, education, and innovation, ACL helps make 

this principle a reality for millions of Americans. ACL provides and administers funding to SHIP/SMP/MIPPA

programs nationally, as well as, funding to states, AAAs, and Centers for Independent Living to provide direct 

services. ACL also administers funding to be used toward business acumen-related activities.

Business Acumen

Business acumen refers to the critical skills that aging and disability organizations must possess in order to 

enhance the effectiveness, efficiency, and sustainability of the services they provide. These skills include: building 

relationships with health care providers, insurers, and other payers; pricing and billing for services; negotiating 

contracts; describing the value (both financial and quality of life) of services; and data management (including 

interoperable data systems and reporting to payers). 

The goal is to help states and community-based organizations develop innovative business models and tap into 

new revenue streams that enable them to market their services, compete in a changing marketplace, ensure 

funding for services, and help payers to achieve quality goals and cost savings.

Community-Based Organization 

(CBO)

Local organizations that offer community living services and supports to advance the health, well-being, 

independence, and community participation of older adults and people with disabilities. Frequently receive 

funding from state aging and/or insurance agencies to support SHIP/SMP/MIPPA programs.

Cobranding Marketing of a product or service under two or more brand names.

Conflict of Interest (COI)

[def]: a conflict between the private interests and the official responsibilities of a person in a position of trust

[def2]: a situation in which a person is in a position to derive personal benefit from actions or decisions made in 

their official capacity.

[def3]: a conflict between competing duties.

https://www.merriam-webster.com/dictionary/conflict%20of%20interest

Conflict Entity Individual/Group Conflict Entity: COI relates to individual's actions. Responsibility for this type of conflict falls upon 

the individual and the organization to mitigate.
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Updated July 2020

Organization/Agency Conflict Entity: COI relates to organization or agency's actions/allowances. Responsibility for 

this type of conflict falls upon the organization to mitigate. These are an organization's responsibility to 

remedy/remove, not an individual's. If an individual finds him/herself in this situation, this resource can be used as 

supporting documentation in communication with organization about mitigating risk.

Exhibitor Presence at an outreach/enrollment/educational event with intention of disseminating information about own 

entity.

Firewall

A combination of strict physical, organizational, and electronic procedures and security measures that separate 

two competing priorities housed within one organization. Successful firewalls include a number of formalized

policies related to separation of financial, staffing, communication routing, legal, and other aspects of business. 

Immediate Family Member Pertaining to conflicts of interest, means a member of the household or a relative with whom there is a close 

personal or significant financial relationship.

Medicare Improvements for 

Patients and Providers Act 

(MIPPA)

The Medicare Improvement for Patients and Providers (MIPPA) program provides grants to states and tribes to 

help older adults, individuals with disabilities, and their caregivers apply for special assistance through Medicare. 

MIPPA provides valuable support at the state and community levels for organizations involved in reaching and 

providing assistance to people who may be eligible for the Low-Income Subsidy program (LIS), Medicare Savings 

Program (MSP), and the Medicare Part D Prescription Drug Program. This initiative includes special efforts to 

target rural areas and Native American elders.

Subaward Requirements

Per the HHS Grants Policy Statement (HHS GPS), the terms and conditions in the HHS GPS apply directly to the 

recipient of HHS funds. The recipient is accountable for the performance of the project, program, or activity; the 

appropriate expenditure of funds under the award by all parties; and all other obligations of the recipient, as cited 

in the NoA. In general, the requirements that apply to the recipient, including public policy requirements, also 

apply to subrecipients and contractors under grants, unless an exception is specified.

State Health Insurance Assistance 

Program (SHIP)

The SHIP mission is to empower, educate, and assist Medicare-eligible individuals, their families, and caregivers 

through objective outreach, counseling, and training, to make informed health insurance decisions that optimize 

access to care and benefits. The SHIP vision is to be the known and trusted community resource for Medicare 

information.

SHIPs conduct outreach by providing presentations, distributing information, conducting enrollment events, and 

participating in health fairs, senior fairs, and other community events. SHIP outreach helps to inform groups and 

individuals about Medicare benefits, coverage rules, written notices and forms, appeal rights and procedures, and 

more.

SHIPs provide free, in-depth, unbiased, one-on-one health insurance counseling and assistance to Medicare 

beneficiaries, their families, and caregivers. SHIPs assist people in obtaining coverage through options such as 
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The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Original Medicare (Parts A & B), Medicare Advantage (Part C), Medicare Prescription Drug Coverage (Part D), and 

Medicare Supplement (Medigap). SHIPs also assist beneficiaries with limited income to apply for programs, such 

as Medicaid, Medicare Savings Program and Extra Help/Low Income Subsidy, which help pay for or reduce 

healthcare costs.

SHIPs recruit and train both volunteer and in-kind counselors to provide program services. SHIP counselors are 

highly trained and certified to help Medicare beneficiaries, their families, and caregivers with:

 Informing about Medicare Advantage, Medicare Prescription Drug coverage, and Medigap plan 

comparison or enrollments;

 Explaining how supplemental insurance options (e.g. insurance plans for retirees) work with Medicare;

 Providing information on long-term care insurance; and

 Referring beneficiaries to agencies such as the Social Security Administration and State Medicaid offices 

for additional assistance.

Senior Medicare Patrol (SMP) 

Program

The SMP mission is to empower and assist Medicare beneficiaries, their families, and caregivers, to prevent, 

detect, and report suspected healthcare fraud, errors, and abuse through outreach, counseling, and education. 

SMPs work to resolve beneficiary complaints of potential healthcare fraud in collaboration with state and federal 

partners, including the U. S. Department of Health & Human Services Office of the Inspector General, Centers for 

Medicare & Medicaid Services, state Medicaid fraud control units, and state Attorney Generals.

SMPs recruit and train retired professionals and other volunteers to recognize and report instances or patterns of 

healthcare fraud. These activities support ACL’s goals of promoting increased choice and greater independence 

among older adults and individuals with disabilities. SMP activities also serve to enhance the financial, emotional, 

physical, and mental well-being of older adults, thereby increasing their capacity to maintain security in retirement 

and make better financial and healthcare choices.

Sponsor Entity financially supporting an event.

Team Member Includes any individual who works directly on the SHIP/SMP/MIPPA programs. This person may be paid through 

SHIP/SMP/MIPPA grant funds, through in-kind funding, or be a true volunteer for the program.

Three Dimensions of Conflict 

(Conflict Type)

Conflicts of Loyalty: These involve issues of judgment and objectivity. These are the typical situations almost 

everyone understands—financial and employment considerations. A Team Member’s ability to be fair might be 

questioned if the Team Member or their family is also a past or current agent. 
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Conflicts of Commitment: These are issues of time and attention. Toward which goals or obligations does one 

direct one’s efforts—i.e., one’s time and energies? Concerns about the adequacy of resources come into play 

because pressures to do more occur when available resources are limited. In regional or local programs, Team 

Member who assume several other workplace responsibilities in addition to their Team Member responsibilities 

may experience conflicts of commitment.

Conflicts of Control: These are issues of independence. Do other interests, priorities, or obligations of the agency 

that houses the program materially interfere with the Team Member’s ability to advocate for the best interest of 

the beneficiary? Do administrative or political forces interfere with the professional judgment of the Team 

Member? Is the Team Member able to act responsibly without fear of retaliation by superiors or those with 

influence/organizational control?

Volunteer Risk and Program 

Management (VRPM)

Volunteer policies, developed by ACL, designed to establish and organize the structure of the operation of 

volunteer programs within SHIP and SMP. Additional resources can be found here 

(https://www.smpresource.org/Content/Resources-for-SMPs/Volunteer-Risk-and-Program-ManagementVRPM.aspx).
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The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Addendum B: Related policies as they currently appear in VRPM

ACL OHIC also plans to prepare interim additions to Volunteer Risk & Program Management (VRPM) policies and procedures to help support the 

recommendations made within the document. A workgroup will be formed to help identify needed updates to the VRPM document in full and updates will be 

available in 2021. An on-going workgroup will also be formed to brainstorm possible remedy recommendations for problematic COI situations. Please keep in 

mind, as COI issues continue to evolve, this will remain a working document with period updates released as needed. 

For reference, below are the current VRPM policies that relate to COI: 

3.35: Conflict of Interest [Required]

 Policy: No person who has a conflict of interest in connection with the work they will do at the SMP/SHIP, whether personal, philosophical, or financial 

may serve as a volunteer. Volunteers do not promote any personal or business interest while undertaking their SMP/SHIP assignment. One example of 

persons with an inherent conflict of interest is anyone who receives compensation for enrolling beneficiaries in a specific insurance plan or plans. 

 Rationale: Given the sensitive nature of SMP/SHIP work, the need for objectivity, and the ever-present possibility of fraud and abuse, even inside the 

SMP/SHIP, the screening of volunteers must be done carefully to avoid a conflict of interest or a perceived conflict of interest.

 Suggested Procedures: SMP/SHIP volunteers sign a conflict of interest statement and agree to immediately notify their designated supervisor if any 

potential conflict arises during performance of their duties. All possible conflicts of interest are immediately reported by volunteers to their supervisor.

SMP/SHIP can attempt to resolve conflicts of interest through, for example, changes of volunteer duties or changes of volunteer role. If a conflict of 

interest cannot be resolved, the volunteer may be relieved of duty.

3.101: Acceptance of honoraria [Required]

 Policy: Honoraria offered to SMP/SHIP volunteers are respectfully and tactfully declined, citing, as needed, this policy as the basis for their action. 

Honoraria which is given to the SMP/SHIP program may be accepted by the volunteer on behalf of the SMP/SHIP.

 Rationale: It is not appropriate for SMP/SHIP volunteers to benefit materially from their work duties.

 Definition: SMP/SHIP volunteers perform work functions (e.g., speeches, presentations, training, etc.) which may, from time to time, attract honoraria. 

Exempted from this policy are one-time speaker’s gifts that can reasonably be regarded as small or token and where the nominal value received by any 

one person is under $15.00.

3.105 Financial transactions with clients [Required]

 Policy: SMP/SHIP volunteers do not enter into financial transactions with beneficiaries, their family members or caregivers, either lending or borrowing 

in either direction. 

 Suggested Procedure: If clients are in immediate financial need, the coordinator of volunteers is notified and referral is made to appropriate community 

services.
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The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

3.100 Acceptance of gifts [Required]

 Policy: SMP/SHIP volunteers do not accept gifts from beneficiaries, their families, caregivers, or other representatives. Any such offerings are respectfully 

and tactfully declined, citing, as needed, this policy as the basis for their action. 

 Rationale: Acceptance of personal gifts by SMP/SHIP volunteers is prohibited to prevent, and prevent the perception of, exploitation of SMP/SHIP 

beneficiaries and their families and caregivers and to protect both the reputation of the SMP/SHIP and its volunteers from accusations of favoritism or 

personal gain. The work of SMP/SHIP volunteers often engenders gratitude among beneficiaries. It is understandable that some SMP/SHIP clients and 

those who care for them wish to express their thankfulness through gifts to the people who have been so helpful; however, the SMP/SHIP provides 

services to beneficiaries without compensation. 

 Definition: For this policy, gift is broadly defined to include any payment, distribution, transfer, loan, advance, deposit, gift or other rendering of money, 

property, services or anything else of value, whether tangible or intangible. Gifts include but are not limited to material goods, money in any form, 

valuables, jewelry, wedding gifts, tickets to sporting events and entertainment, and travel. Meals provided during events are not considered gifts for the 

purposes of this policy.
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The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Addendum C: SHIP Statute

The SHIP statute provides the justification, overview, and expectations for the State Health Insurance Program. The statute is also the base for which the entire 

program has been developed and managed. The full statute, Section 4360 – Health Insurance Information, Counseling, and Assistance Grants of 42 USC 1395b4, can be found here: https://www.ssa.gov/OP_Home/comp2/F101-508.html. The portion of the statute relevant to conflicts of interest has been excerpted 

and highlighted below (42 USC 1395b-4, Section 4360 (b) (2)): 

(2) As part of an application for a grant under this section, a State shall submit a plan for a State-wide health insurance information, counseling, and 

assistance program. Such program shall—

(A) establish or improve upon a health insurance information, counseling, and assistance program that provides counseling and assistance to 

eligible individuals in need of health insurance information, including—

(i) information that may assist individuals in obtaining benefits and filing claims under titles XVIII and XIX of the Social Security Act;

(ii) policy comparison information for medicare supplemental policies (as described in section 1882(g)(1) of the Social Security Act) and 

information that may assist individuals in filing claims under medicare supplemental policies;

(iii) information regarding long-term care insurance; and

(iv) information regarding other types of health insurance benefits that the Secretary determines to be appropriate;

(B) in conjunction with the health insurance information, counseling, and assistance program described in subparagraph (A), establish a system of 

referral to appropriate Federal or State departments or agencies for assistance with problems related to health insurance coverage (including legal 

problems), as determined by the Secretary;

(C) provide for a sufficient number of staff positions (including volunteer positions) necessary to provide the services of the health insurance 

information, counseling, and assistance program;

(D) provide assurances that staff members (including volunteer staff members) of the health insurance information, counseling, and assistance 

program have no conflict of interest in providing the counseling described in subparagraph (A);

(E) provide for the collection and dissemination of timely and accurate health care information to staff members;

(F) provide for training programs for staff members (including volunteer staff members);

(G) provide for the coordination of the exchange of health insurance information between the staff of departments and agencies of the State 

government and the staff of the health insurance information, counseling, and assistance program;

(H) make recommendations concerning consumer issues and complaints related to the provision of health care to agencies and departments of 

the State government and the Federal Government responsible for providing or regulating health insurance;

(I) establish an outreach program to provide the health insurance information and counseling described in subparagraph (A) and the referrals 

described in subparagraph (B) to eligible individuals; and

(J) demonstrate to the satisfaction of the Secretary, an ability to provide the counseling and assistance required under this section
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The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

Updated July 2020

Contact Information:

ACL:

OHIC@acl.hhs.gov

SHIP TA Center/SMP Resource Center:

OHICResourceCenters@nei3a.org

*Include your ACL Project Officer on 

correspondence.

Addendum D: COI Decision Tree

*This decision tree was prepared for use by ACL SHIP/SMP/MIPPA grantees. Though this document includes best practices that may be helpful for others, 

guidance for other groups may differ slightly. 

Is this a Conflict of 

Interest (COI)?

Yes

Contact SHIP or SMP 

Center & ACL PO for 

technical assistance

Prepare risk mitigation 

plan with support from 

SHIP or SMP Center 

and ACL PO

Ensure adequate steps 

have been taken to 

remedy and/or 

remove COI

Keep record of all 

steps taken to remedy 

and/or remove COI

Not Sure

Contact SHIP or SMP 

Center for technical 

assistance and triage

No

Continue to monitor 

activities and consult 

with ACL’s up-to-date 

COI guidance in order to 

identify actual and/or 

perceived COIs