Cigna: What CMS' Final Rule Means to You - UPDATED

The Centers for Medicare and Medicaid Services (CMS) publish edits 2023 Final Rule this past spring. The Final Rule announces changes that have been made to existing marketing and communication requirements for both Medicare Advantage and Part D plans. These changes strengthen the oversight of third-party marketing organizations (TPMO) and include new consumer protections.

The 2023 Final Rule is to be applied to all marketing and communications that occur beginning with Contract Year 2023. This means that any marketing occurring October 1, 2022 and later, as well as any communications that are distributed for 2023, regardless of when they are distributed, are impacted by the new 2023 Final Rule.

Impacts to Third Party Marketing Organizations (TPMOs)

Several of the new requirements apply to Third Party Marketing Organizations (TPMOs) which CMS has defined as:

• Organizations and individuals who are compensated to perform lead generation, marketing, sales and enrollment-related functions as part of the chain of enrollment (the steps taken by a beneficiary from becoming aware of a Medicare plan or plans to make an enrollment decision). TPMOs may be FDRs or other business that provide services to customers including a MA/Part D plan or an MA/Part D plan’s first tier, downstream or related entity(FDR). TPMO also include independent agents/brokers.

The Final Rule expands plan oversight requirements of TPMOs. As a result, contracts and written agreements between TPMO and Cigna or between the TPMO and the plan’s FDR will need to be updated to include certain requirements. Cigna plans to address this by updating our Rules of Engagement (ROE) document and redistributing it by the end of September. 

The Final Rule includes additional oversight activities, requiring that you:

•  Disclose to Cigna any subcontracted relationships used for marketing, lead generation, and enrollment.
•  Record all calls with beneficiaries in their entirety, including the enrollment process, and pre and post sale calls. This requirement applies to both, virtual and telephonic engagements. Please note, Face-to-Face beneficiary engagements are not required to be recorded.
• Provide Cigna with monthly reports of staff disciplinary actions and violations associated with beneficiary interaction.
• Provide new disclosure requirements when conducting lead generating activities, as applicable.

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Key Takeaways

Cigna would like to remind you of the need to provide the following disclaimer, when applicable, including in marketing materials that you may be creating now for AEP 2023:

• “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”

The disclaimer is required to be communicated as follows:

•  Included on all materials that meet the definition of “marketing” including website, print and television.
• Conveyed verbally, electronically or written, depending on how the TPMO is interacting with the beneficiary.
•  If the TPMO is providing information to the customer verbally, the disclaimer must be stated within the first minute of the call.

To ensure AEP and compliance readiness, prior to AEP, Cigna will provide additional guidance related to the disclosure information you are to provide to them as a result of the new requirements. They also ask that youvensure all TPMOs that you contract with directly in support of Cigna lead generation, marketing, sales, and enrollment are aware of and adhere to the new requirements.

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UPDATE 9/30/2022

Previously Cigna mentioned that they would provide additional guidance relating to the disclosure information that you must provide to Cigna as a result of the new requirements. Please read below for the steps that we are taking to comply with these new requirements, and what will be required of you.

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Disclose any subcontracted relationships to Cigna

• What? All sales agencies contracted with Cigna are required to send a file of all their TPMO relationships to Cigna.
• How? We created a template that you will be required to complete and send to the CARL team (CARL@cigna.com)by October 15. On an ongoing basis, you will be required to send an updated file as changes occur. Log in to Producers' University to access the template.
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Disclose compliance violations to Cigna.

• What? All sales agencies contracted with Cigna must report the following for their employees, plus any TPMO subcontracted relationships:  All staff disciplinary actions that apply to Cigna beneficiary interactions with plan; All violations of any requirements that apply to Cigna beneficiary interactions with a plan.
• How? We created a template that you will be required to complete and send to the CARL team (CARL@cigna.com)by the last day of each month starting in October. Log in to Producers' University access the template.

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‍Record all calls with beneficiaries in their entirety.

• What? Call recording must include the enrollment process and pre/post sale calls. This requirement applies to both virtual and telephonic engagements. Virtual engagements include enrollments performed on video platforms (i.e. Skype).Face-to-face beneficiary engagements are not required to be recorded.
• How? Agents can use an approved recording program or Connecture DRX to record beneficiary calls. If using ConnectureDRX, please watch this instructional video to learn how to record calls using this program.