Client Alert: CMS Updates Marketing Guidelines And Formalizes Call Center Requirements For Part D Plan Sponsors

On July 25, 2006, the Centers for Medicare and Medicaid Services (CMS) revised its Medicare Marketing Guidelines for organizations offering Medicare Advantage health coverage. The revised guidelines represent CMS’ current, official position on marketing policies and operational instructions for Medicare Advantage plans, Medicare Advantage Prescription Drug Plans (MA-PDs), Prescription Drug plans (PDPs) and 1876 Cost Plans regarding the communications that such plans may make to their current and prospective enrollees. One notable addition to the Medicare Marketing Guidelines—upon which this article will focus—is the inclusion of operating requirements for call centers maintained by MA-PDs and PDPs (collectively, Part D Plan Sponsors).

The imposition of specific call center requirements upon Part D Plan Sponsors is not a completely new concept. The initial participants in the Medicare prescription drug benefit program agreed to maintain a toll-free customer service call center operating within certain parameters as part of the application process with CMS. CMS guidance issued earlier this year for new organizations applying for Medicare prescription drug program participation in 2007 augmented the call center requirements currently applicable to Part D Plan Sponsors. With the release of the revised Medicare Marketing Guidelines, all Part D Plan Sponsors—both new applicants and existing program participants—will become subject to explicit call center operating requirements later this year. CMS’ adoption of these call center requirements and its early enforcement action against Part D Plan Sponsors that began offering prescription drug coverage in January of this year evidence CMS’ commitment to maintaining the value of Medicare Advantage prescription drug benefits by ensuring that Medicare beneficiaries enrolled in such benefit plans have a high level of customer satisfaction. more...