Confused about the October 8, 2021, Centers for FMO & Medicaid Services’ (CMS) advisory regarding the marketing of FMO Advantage (MA) and associated prescription drug (MAPD) plans? Here are a few key points to help demystify the latest update and help you comply with the rules for your lead-generation activities.

1. Marketing vs. Communications – What is CMS’s end game?
To put it simply, CMS wants to ensure that any promotional content being used to attract consumers to MA
or MAPD products isn’t misleading or confusing. This, however, isn’t a new rule. What is new, though, is the additional scrutiny CMS is placing on what it views as “marketing.” CMS defines “marketing” as any promotional content (including websites, video, ads, email, social media and other mediums) – regardless of whether or not it mentions a specific plan – that includes information or messages on:

  • Plan premiums
  • Cost sharing
  • Benefit information

2. What Is the Process for Regulating Lead Generation?
The Health Plan Management System (HPMS) is CMS’s primary tool for reviewing and approving MA and MAPD marketing content. Any content that meets the criteria as described above must be submitted through HPMS and receive a Standardized Material Identification (SMID) code to indicate approval.

3. Who’s Responsible for Submitting Content for Approval?
FDRs (first-tier, downstream or related entities, such as YourFMO) and carriers have traditionally managed efforts in acquiring HPMS approval for MA and MAPD marketing content. However, lead-generation vendors or other organizations that produce marketing content for other parties must also acquire HPMS approval for their materials.

Although the FDR is responsible for submission and approval directly with CMS via HPMS, the FDR could include an agent, agency or lead source vendor in our business.

What does that mean? Ultimately, you are responsible for ensuring your marketing materials are compliant. Failure of a third-party vendor to gain HPMS approval will not absolve YourFMO, its affiliates or agents from penalties stemming from the use of unapproved marketing messages. CMS compliance for our marketing content is our responsibility.

4. What Do I Need to Do to Ensure Compliance?
First, carefully review all MA and MAPD marketing content that you are using for lead generation. This includes any materials being leveraged with lead vendors NOT on our list of vendors who have proven diligent about acquiring HPMS approval.

5. Which Third-Party Lead Companies Are CMS Compliant?
YourFMO has identified several companies that have proven diligent about acquiring HPMS approval.

These include:

  • Policy Scout
  • Apollo Interactive
  • Datalot
  • DMS
  • Inside Response
  • Call Trader
  • Everquote

6. Penalties – What Are the Consequences for Non-Compliance?
Sanctions may range in severity from cease-and-desist orders to fines to license suspension. Regardless, our main concern – and intent – is 100% CMS compliance. We believe that it is our collective responsibility to maintain the highest level of compliance with these regulations, and we fully support every effort to provide consumers with the most honest and transparent information possible.