2023-07115.pdf

* 28. Section 422.2263 is amended by adding paragraphs (b)(8) through (10) to read as follows:  422.2263 General marketing requirements. * * * * * (b) * * * (8) Advertise benefits that are not available to beneficiaries in the service area(s) where the marketing appears, unless the advertisement is in local media that serves the service area(s) where the benefits are available and reaching beneficiaries who reside in other service areas is unavoidable. (9) Market any products or plans, benefits, or costs, unless the MA organization or marketing name(s) as listed in HPMS of the entities offering the referenced products or plans, benefits, or costs are identified in the marketing material. (i) MA organization or marketing names must be in 12-point font in print and may not be in the form of a disclaimer or fine print. (ii) For television, online, or social media, the MA organization or marketing name(s) must be either read at the same pace as the phone number or must be displayed throughout the entire advertisement in a font size equivalent to the advertised phone number, contact information, or benefits. (iii) For radio or other voice-based advertisements, MA organization or marketing names must be read at the same pace as the advertised phone numbers or other contact information. (10) MA organizations may not include information about savings available to potential enrollees that are based on a comparison of typical expenses borne by uninsured individuals, unpaid costs of dually eligible beneficiaries, or other unrealized costs of a Medicare beneficiary. * * * * * 29. Section 422.2264 is amended by  a. Adding paragraphs (a)(2)(i)(A) and (B); b. Revising paragraph (b)(2); c. Removing paragraph (c)(1)(ii)(C). d. Redesignating paragraphs (c)(1)(ii)(D) and (E) as paragraphs (c)(1)(ii)(C) and (D) and revising newly redesignated (c)(1)(ii)(D); f. Revising paragraphs (c)(2)(i), (c)(3)(i), and (c)(3)(iii)(A) and (B). The additions and revisions read as follows:  422.2264 Beneficiary contact. * * * * * (a) * * * (2) * * * (i) * * * (A) Contact is unsolicited door-to- door contact unless an appointment, at the beneficiarys home at the applicable date and time, was previously scheduled. (B) [Reserved]. (b) * * * (2) If the MA organization reaches out to beneficiaries regarding plan business, as outlined in this section, the MA organization must provide notice to all beneficiaries whom the plan contacts as least once annually, in writing, of the individuals ability to opt out of future calls regarding plan business. (c) * * * (1) * * * (ii) * * * (D) Make available and receive beneficiary contact information, including Business Reply Cards, but not including Scope of Appointment forms (c) * * * (2) * * * (i) Marketing events are prohibited from taking place within 12 hours of an educational event, in the same location. The same location is defined as the entire building or adjacent buildings. * * * * * (3) * * * VerDate Sep<11>2014 21:20 Apr 11, 2023 Jkt 259001 PO 00000 Frm 00217 Fmt 4701 Sfmt 4700 E:\FR\FM\12APR2.SGM 12APR2ddrumheller on DSK120RN23PROD with RULES222336 Federal Register / Vol. 88, No. 70 / Wednesday, April 12, 2023 / Rules and Regulations (i) At least 48 hours prior to the scheduled personal marketing, the MA plan (or agent or broker, as applicable) must agree upon and record the Scope of Appointment with the beneficiary(ies), except for: (A) SOAs that are completed during the last four days of a valid election period for the beneficiary. (B) Unscheduled in person meetings (walk-ins) initiated by the beneficiary. * * * * * (iii) * * * (A) Market any health care related product during a marketing appointment beyond the scope agreed upon by the beneficiary, and documented by the plan in a Scope of Appointment, business reply card, or request to receive additional information, which is valid for 12 months following the date of beneficiarys signature date or the date of the beneficiarys initial request for information. (B) Market additional health related lines of plan business not identified prior to an individual appointment without a separate Scope of Appointment, identifying the additional lines of business to be discussed; such Scope of Appointment is valid for 12 months following the beneficiarys signature date. * * * * * 30. Section 422.2265 is amended by revising paragraph (b)(4) to read as follows:  422.2265 websites. * * * * * (b) * * * (4) A provider directory searchable by every element required in the model provider directory, such as name, location, specialty. * * * * * 31. Section 422.2267 is amended by a. Redesignating paragraph (a)(3) as paragraph (a)(5); b. Adding new paragraphs (a)(3) and (4); c. Revising paragraph (e)(4) introductory text; d. Adding paragraph (e)(4)(viii); e. Revising paragraphs (e)(5)(ii)(A) introductory text, (e)(10) introductory text, (e)(12), (e)(30)(vi) and (e)(41). The additions and revisions read as follows:  422.2267 Required materials and content. * * * * * (a) * * * (3) Be provided to enrollees on a standing basis in any non-English language identified in paragraphs (a)(2) and (4) of this section or accessible format upon receiving a request for the materials in anon-English language or accessible format or when otherwise learning of the enrollees primary language or need for an accessible format. This requirement also applies to the individualized plans of care described in  422.101(f)(1)(ii) for special needs plan enrollees. (4) For any fully integrated dual eligible special needs plan or highly integrated dual eligible special needs plan, as defined at  422.2, or applicable integrated plan, as defined at  422.561, be translated into the language(s) required by the Medicaid translation standard as specified through their capitated Medicaid managed care contract in addition to the language(s) required by the Medicare translation standard in paragraph (a)(2) of this section. (5) * * * (e) * * * (4) Pre-Enrollment checklist (PECL). The PECL is a standardized communications material that plans must provide to prospective enrollees with the enrollment form, so that the enrollees understand important plan benefits and rules. For telephonic enrollments, the contents of the PECL must be reviewed with the prospective enrollee prior to the completion of the enrollment. It references information on the following: * * * * * (viii) Effect on current coverage. (5) * * * (ii) * * * (A) Information on the following medical benefits, starting in the top half of the first page and in the order as identified in paragraphs (A)(1) through (A)(10), including * * * * * (10) Non-renewal Notice. This is a standardized communications material through which plans must provide the information required under  422.506. * * * * * (12) Provider Termination Notice. This is a model communications material through which plans must provide the information required under  422.111(e). (i) The written Provider Termination Notice must be provided in hard copy via U.S. mail (first class postage is recommended, but not required). (ii) The written Provider Termination Notice must do all of the following: (A) Inform the enrollee that the provider will no longer be in the network and the date the provider will leave the network. (B) Include names and phone numbers of in-network providers that the enrollee may access for continued care (this information may be supplemented with information for accessing a current provider directory, including both online and direct mail options). (C) Explain how the enrollee may request a continuation of ongoing medical treatment or therapies with their current provider. (D) Provide information about the annual coordinated election period and the MA open enrollment period, as well as explain that an enrollee who is impacted by the provider termination may contact 1800MEDICARE to request assistance in identifying and switching to other coverage, or to request consideration for a special election period, as specified in  422.62(b)(26), based on the individuals unique circumstances and consistent with existing parameters for this SEP. (E) Include the MA organizations call center telephone number, TTY number, and hours and days of operation. (iii) The telephonic Provider Termination Notice specified in  422.111(e)(1)(i) must relay the same information as the written Provider Termination Notice as described in paragraph (e)(12)(ii) of this section. * * * * * (30) * * * (vi) Is excluded from the translation requirement under paragraphs (a)(2) through (4) of this section; and * * * * * (41) Third-party marketing organization disclaimer. This is standardized content. If a TPMO does not sell for all MA organizations in the service area the disclaimer consists of the statement: We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov, 1800MEDICARE, or your local State Health Insurance Program to get information on all of your options. If the TPMO sells for all MA organizations in the service area the disclaimer consists of the statement: Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. You can always contact Medicare.gov, 1800MEDICARE, or your local State Health Insurance Program for help with plan choices. The MA organization must ensure that the disclaimer is as follows: (i) Used by any TPMO, as defined under  422.2260, that sells plans on behalf of more than one MA organization. VerDate Sep<11>2014 21:20 Apr 11, 2023 Jkt 259001 PO 00000 Frm 00218 Fmt 4701 Sfmt 4700 E:\FR\FM\12APR2.SGM 12APR2ddrumheller on DSK120RN23PROD with RULES222337 Federal Register / Vol. 88, No. 70 / Wednesday, April 12, 2023 / Rules and Regulations (ii) Verbally conveyed within the first minute of a sales call. (iii) Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication. (iv) Prominently displayed on TPMO websites. (v) Included in any marketing materials, including print materials and television advertisements, developed, used or distributed by the TPMO. 32. Section 422.2272 is amended by adding paragraph (e) to read as follows:  422.2272 Licensing of marketing representatives and confirmation of marketing resources. * * * * * (e) Establish and implement an oversight plan that monitors agent and broker activities, identifies non- compliance with CMS requirements, and reports non-compliance to CMS. 33. Section 422.2274 is amended by adding paragraph (c)(12) and revising paragraph (g)(2)(ii) to read as follows:  422.2274 Agent, broker, and other third- party requirements. * * * * * (c) * * * (12) Ensure that, prior to an enrollment, CMS required questions and topics regarding beneficiary needs in a health plan choice are fully discussed. Topics include information regarding primary care providers and specialists (that is, whether or not the beneficiarys current providers are in the plans network), regarding pharmacies (that is, whether or not the beneficiarys current pharmacy is in the plans network), prescription drug coverage and costs (including whether or not the beneficiarys current prescriptions are covered), costs of health care services, premiums, benefits, and specific health care needs. * * * * * (g) * * * (2) * * * (ii) Record all marketing, sales, and enrollment calls, including the audio portion of calls via web-based technology, in their entirety. * * * * * PART 423VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT 34. The authority citation for part 423 continues to read as follows: Authority: 42 U.S.C. 1302, 1306, 1395w- 101 through 1395w-152, and 1395hh. 35. Section 423.4 is amended by adding in alphabetical order definitions for Immediate need individual, and