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2013 Medicare Marketing Guidelines (MMG)Questions & ResponsesNovember 2, 2012Section 120 – Agent/Broker Compensation (Updated)Number Question1. Beneficiary notifications when Unqualifiedvs. Unlicensed agents submit applications:Is this notification only required when theagent is unlicensed or should thebeneficiary also be notified when the agenthasn`t completed the entire certificationprocess?ResponseBeneficiaries must be notified when anunqualified agent/broker has enrolled themin a plan. Unqualified agents/brokersinclude agents/brokers who are unlicensedor have not completed the certificationprocess.2. Do we need to submit the agent/brokerattestation?3. Regarding compensation, what are theguidelines for paying FMO`s/TMO`s.There seems to be some confusion onwhen, how, and how much over ride to paythe FMO`s/TMO`s4. Do the agents that draw base salaries areconsidered employed agents are do notfall into CMS guidance?5. Under the agent/broker compensationmodule, if you employ agents and contractwith external agents and brokers; thecorresponding amounts you submit mustapply to both or include amounts whichapply only to external agents/brokers.6. Beneficiaries that enroll in dual plans, theiragents may get compensation for both theplans. Can it exceed the FMV approved byCMS since it‟s the addition of the twoplans?The agent/broker attestation is part of theannual plan agent/broker compensationamount submission process in HPMS.TMOs typically receive two types ofcompensation: 1) compensation forenrollment and 2) compensation for otherservices. TMO compensation forenrollment must follow the compensationrules for independent agents. TMOcompensation for other services must beconsistent with local market rates for thoseservices.Agents who receive a fixed amount and sellexclusively for one plan are exempt fromthe independent agent compensation rules(like employed agents).When submitting agent/brokercompensation information in HPMS, theHigh/Low amounts entered only apply toindependent agents/brokers.Compensation paid to agents for enrollingbeneficiaries in dual plans (e.g., a cost planand a separate PDP), cannot exceed theFMV amount respectively for each plan.The Final Contract Year 2013 Medicare Marketing Guidelines 44
2013 Medicare Marketing Guidelines (MMG)Questions & ResponsesNovember 2, 2012Section 120 – Agent/Broker Compensation (Updated)Number Question7. This may be an enrollment question, butwe discussed 120.2, terminated agents.Do beneficiaries have until the date ofnotification plus 2 months to make adecision to remain in a plan or change?ResponsePlans should refer to the enrollmentguidance in Chapter 2 of the MMCM andChapter 3 of the PDM regarding beneficiarycancellation timeframes.8. New - When will 120.3 Annual Up-datesbe available?9. New - Has the 2013 agent compensationbeen released? If so, where is it? If not,when will it be released? Thanks10. New - What SEP code should be used ifan agent is terminated and the memberwishes to make a change.11. New - Are plans allowed to collect leadsthrough, for example SEP marketingactivities, prior to the AEP, for futurecontact during the AEP?12. New - Regarding agent charge backs: itseems that the guidelines are based on aCY basis. For those of us with only a D-SNP plan (and enroll using SEP), can wepay renewals and charge back on aconstant rolling year?13. New - If an agent is termed for fraud (i.e.forging signature on an enrollment form)does CMS need to be notified?This information was released via HPMS onAugust 21, 2012.Compensation rates for CY 2013 werereleased via HPMS on May 3, 2012.This situation would be considered anexceptional circumstance SEP.Plans should use the guiding principleswhen determining whether beneficiarycontact is appropriate. Note that Section70.6 states permission to be contacted isconsidered to be event-specific and maynot be treated as open-ended permissionfor future contact.No, agent/broker compensation can only bepaid on a calendar year basis, never arolling year.Plans should notify the appropriate StateAuthority when an agent is terminated.The Final Contract Year 2013 Medicare Marketing Guidelines 45
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