The 2017 Centers for Medicare & Medicaid Services (CMS) Annual Election Period for beneficiaries is fast approaching. For those providers who have contracted with Blue Cross and Blue Shield of Texas (BCBSTX) to provide services to our Blue Cross Medicare Advantage (HMO)SM or Blue Cross Medicare Advantage (PPO)SM members, it’s important to keep in mind the rules established by CMS when marketing to potential new members.
You may not be planning specific marketing activities, but what if a patient asks for information or advice? Remaining neutral when assisting with enrollment decisions is essential. See below for a partial listing of additional “Dos” and “Don’ts” for contracted providers, as specified within the CMS Medicare Marketing Guidelines (MMG) for contract year 2017 (excerpted from the section on Provider-based Activities):
| DO: | DON’T: |
| Provide the names of Plans/Part D sponsors with which [you] contract and/or participate (see MMG section 70.11.2 for additional information on provider affiliation) | Accept Medicare enrollment applications |
| Provide information and assistance in applying for the LIS* | Make phone calls or direct, urge or attempt to persuade beneficiaries to enroll in a specific plan based on financial or any other interests of the provider |
| Make available and/or distribute plan marketing materials in common areas | Mail marketing materials on behalf of Plans/Part D Sponsors |
| Refer [your] patients to other sources of information, such as SHIPs** plan marketing representatives, [the] State Medicaid Office, local Social Security Office, CMS’ website at medicare.gov or 800-MEDICARE | Offer inducements (e.g., free health screenings, cash, etc.) to persuade beneficiaries to enroll in a particular plan or organization |
| Share information with patients from CMS’ website, including the ‘Medicare and You’ Handbook or ‘Medicare Options Compare’ (from medicare.gov), or other documents that were written by or previously approved by CMS | Accept compensation directly or indirectly from the plan for enrollment activities |
| Distribute materials/applications within an exam room setting |
The above list provides just a sampling of important points for your convenience. For a more in-depth review of the guidelines that are applicable to providers, please refer to the Provider Medicare Marketing Guidelines excerpt.
If you have questions about these guidelines or are planning marketing activities, please refer to the Managed Care Marketing page on CMS’ website.
*LIS refers to low-income subsidy
**SHIPs are Senior Health Insurance Assistance Programs
This material is provided for informational purposes only and is not the provision of legal advice. If you have any legal questions with respect to CMS rules or regulations, you should seek the advice of legal counsel.