Half of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan. This massive growth, which equates to doubling his number of MA enrollments since 2010, is due to the large number of insurance agents and brokers, field marketing organizations, and prospects who identify beneficiaries and help them select and enroll in insurance plans. Driven in part by an extensive network of customer generators. Regulators have focused on some areas of the industry due to marketing strategies that can mislead or confuse Medicare beneficiaries.
To address some of these practices, the Centers for Medicare and Medicaid Services (CMS) released a final rule on April 4 that significantly expands the sharing and selling capabilities of third-party marketing organizations (TPMOs), including lead generators. We have set some restrictions. Medicare connects to insurance companies, brokers, and other his TPMOs. TPMOs are organizations and individuals, including agents and brokers, who are compensated to perform lead generation, marketing, sales, and enrollment-related functions on behalf of MA Plans. A TPMO includes first tier, downstream or related entities (FDRs) to the MA plan, but may also include entities for which he or she may not be considered an FDR under existing rules.
Starting October 1, 2024, new rules will require TPMOs to require explicit consent from a beneficiary before sharing a beneficiary's data with another TPMO for the purpose of marketing or enrolling the beneficiary in an MA or Part D plan. You will be required to obtain written consent. Consent must be obtained separately for each TPMO receiving beneficiary data through clear and conspicuous disclosure. This regulation requires that beneficiaries have a clear opportunity to choose to receive follow-up from a particular organization. Blanket consent to redisclose contact information is no longer sufficient. The rule also prohibits TPMOs from conditioning beneficiaries' access to information about beneficiaries who have consented to the sale or sharing of their contact information. According to CMS, beneficiaries expect their information to be used only by entities with which they have direct contact, and the “one-on-one” consent requirement is designed to respect that expectation. It is said that there is
This rule supplements existing privacy regulations, including the Health Insurance Portability and Accountability Act (HIPAA). Her TPMO, which is a HIPAA-covered entity or a business associate of a covered entity, must comply with the HIPAA Privacy Rule, including restrictions on sharing protected health information (PHI) with telemarketers. there is. For example, her TPMO, which is a business associate of MA Plan, must use PHI only to communicate on behalf of MA Plan and cannot use it to sell the TPMO's products or services.
TPMOs may also be required to comply with regulations promulgated by the Telephone Consumer Protection Act (TCPA) and the Federal Communications Commission (FCC). Under the TCPA, texters and callers are prohibited from robocalls or robotexts (including calls made using artificial intelligence) sent using autodialers, artificial voices, or prerecorded voice messages. If you wish to engage in telemarketing via telephone calls), you must obtain prior express written consent with specific, clear and conspicuous disclosures. The TCPA amendments, effective January 27, 2025, will also require text message senders and callers to obtain “one-to-one” consent for each merchant and will not be able to transfer consent to other merchants. It cannot be sold or sold.1 CMS' new rules are modeled after these FCC rules “to make it easier and less difficult for TPMOs to comply with both rules, where applicable.” However, unlike the FCC rules, the new CMS rules apply to manual calls. Manual calls require prior explicit written consent by the beneficiary to share data with another of his TPMOs. Therefore, TPMOs should be careful when calling Medicare leads using both autodialing and manual dialing.
1 Federal Communications Commission, FC-23-107: Second Report and Order, Second Supplemental Notice of Proposed Rulemaking in CG Docket NOS. 02-278 and 21-402, and Waiver Order of CG Docket no. 17-59, p. 12, 21, https://docs.fcc.gov/public/attachments/FCC-23-107A1.pdf (December 18, 2023).
