2027 Proposed CMS Regulations
The CMS released the 2027 proposed regulations for Medicare Advantage and Part D before the Thanksgiving break. Below is a summary of some of the proposed regulations that would impact our industry for the 2027 Annual Enrollment Period (AEP).
Third-Party Marketing Organizations (TPMOs)
- Segmentation & Accountability: CMS is considering ways to hold “bad actors” accountable without burdening compliant TPMOs. They seek input on aligning incentives for agents/brokers and handling good-faith errors
- Disclaimer Changes: TPMOs must read disclaimers before discussing benefits (not within the first minute). State Health Insurance Programs (SHIPs) will be removed from the disclaimer text
- Call Recording Retention: Proposed reduction from 10 years to 6 years for marketing/sales call recordings, with alternatives like 3 years or transcripts under consideration
Marketing & Communications
- Educational vs. Marketing Events: Eliminate the 12-hour delay—marketing events can follow educational events immediately, with a clear transition notice
Scope of Appointment (SOA)
- Remove the 48-hour waiting period between SOA completion and marketing appointment
- Require written SOA for in-person appointments; electronic/audio acceptable for remote
- Clarify that BRCs, voicemails, and online forms count as SOAs
Advertising Language
- Lift prohibition on superlatives, but statements must remain accurate and non-misleading
Enrollment & Special Enrollment Periods (SEPs)
- Provider Terminations SEP: Enrollees affected by any provider termination (not just significant changes) can request SEP without CMS determination
- CMS Approval for Certain SEPs: Codify that some SEPs (e.g., sanctions, contract violations) require CMS approval via CMS-operated mechanisms (like 1-800-MEDICARE)
Other Programmatic Changes
- Mid-Year Supplemental Benefits Notice: CMS proposes rescinding this requirement due to high utilization and administrative burden
- Star Ratings & Quality Measures: Updates to measures under §§ 422.164 and 423.184
- Requests for Information: Growth of C-SNPs/I-SNPs and dually eligible individuals
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