Study Hall Call:Integrated Marketing Materials

Medicare‐Medicaid Coordination Office

July 11, 2013

• Demonstration Marketing Principles• What is Marketing?• MMP Integrated Marketing Materials• Major Areas of Focus in MMP Marketing Guidance

• Marketing Surveillance Activities• Questions?

Overview

2

Demonstration Marketing Principles

3

• Marketing requirements determined jointly by CMS and state– Standards to be at least as stringent as those for Part D and Medicare Advantage plans under the Medicare Marketing Guidelines (MMG)

– Part D marketing requirements unchanged under the demonstration

• Developed based on MMG, MOU, and three‐way contract

• State‐specific marketing guidance focuses only on differences relative to the MMG for that state’s Medicare‐Medicaid Plans (MMPs)

• Medicare Marketing  Guidelines (Chapter 3 of Medicare Managed Care Manual and Chapter 2 of the Prescription Drug Benefit Manual)

• MOU• Three‐way contract• Demonstration‐specific marketing guidance for each state• Demonstration‐specific model materials and codes for each state• Annual plan Call Letters• Health Plan Management System (HPMS) memoranda• HPMS Users Guide• CMS training

Sources for MMP Marketing Guidance

4

• Marketing has a broad definition under the MMG.  It includes: – Marketing to prospective enrollees– Communications with current enrollees

• Marketing materials are any materials targeted to Medicare beneficiaries that:– Promote the plan– Inform beneficiaries that they may enroll, or remain enrolled in, a plan– Explain the benefits of enrollment in a plan or explain plan rules that 

apply to enrollees– Explain how services are covered under the plan, including conditions 

that apply to such coverage

Medicare Marketing GuidelinesMarketing Definition

5

Examples (see Section 20 of the MMG):• Privacy notices• OMB forms• Press releases that don’t include any plan‐specific information (e.g., 

benefits, premiums, co‐pays)• Member newsletters, unless sections are used to enroll, disenroll, 

and communicate benefits with members • Ad‐hoc enrollee communications, which are informational and 

targeted to current enrollees, are customized or limited to a subset of enrollees, apply to a specific situation or cover member‐specific claims processing or other operational issues, and which do not include information about the plan’s benefit structure

Materials Not Subject to Marketing Review

6

• State‐specific models developed for:– Annual Notice of Change– Member Handbook (Evidence of Coverage)– Summary of Benefits (SB)– Comprehensive formulary– Provider and pharmacy directory– Single ID card – Enrollment/disenrollment forms and notices (if plans are delegated these 

functions)– Welcome letter for passively enrolled individuals

• Models to be further customized by each state• Part D model materials available 

– Transition letter, Part D explanation of benefits, excluded provider letter

MMP Integrated Marketing Models

7

Major Areas of Focus in State‐Specific Marketing Guidance

8

• Start date for marketing activity for the following contract year– MMPs permitted to begin marketing no sooner than 90 days 

prior to effective date of enrollment for a contract year

• Translation requirements• Required materials and timelines for receipt for new and continuing enrollees

• Marketing multiple lines of business• Plan type name in marketing materials

• Marketing material disclaimers• MMG disclaimers modified• Use of incentives, rewards, and nominal gifts• Use of agents/brokers and one‐on‐one appointments with prospective enrollees

• Customer service call center requirements and use of alternative technology on weekends and holidays

Major Areas of Focus in State‐Specific Marketing Guidance (cont.)

9

Materials for Beneficiaries Provided at the Time of Enrollment

10

• For passively enrolled individuals, 30 days prior to enrollment:– Welcome letter– Formulary– Combined Provider/Pharmacy Directory– Summary of Benefits– ID Card– Member Handbook (EOC)

• For opt‐in enrollees, within 10 days of CMS confirmation of enrollment:– Formulary– Combined Provider/Pharmacy Directory– ID Card– Member Handbook (EOC)

Materials for Beneficiaries Provided at the Time of Enrollment (cont.)

11

Materials for Beneficiaries after Enrollment

12

• Annual requirements:– Formulary– Member Handbook (Annual Notice of Change and Evidence of Coverage) or ANOC and SB – by September 30

– Member Handbook (EOC) – by December 31 (if Member Handbook/EOC not sent by September 30)

• ID Card ‐ as requested• Provider/Pharmacy Directory – every three years (plus change pages as needed)

• MMPs included in current Medicare surveillance activities

• State‐specific surveillance plans to be created with state input

• Additional focus on compliance with demonstration marketing requirements and marketplace trends

• Demonstration surveillance will include:– Targeted observations– Analysis of provider marketing materials and practices– Clipping service to review advertisements in the marketplace– Analysis of communications to limited English proficient enrollees– Analysis of marketplace trends and plan compliance with requirements

• Investigation of complaints received

Surveillance Activities in MMP Service Areas

13

• Demonstration oversight by Contract Management Team (CMT)– Medicare representative from regional office – Medicaid representative from regional office – State representative

• Structure of CMT will vary by state • State and CMS marketing reviewers (MR) members of CMT

Marketing Review Team

14

Marketing Review Process

15

• Marketing review types:– Prospective reviews– Retrospective reviews (for File & Use materials)

• States decide categories of materials to review prospectively, which results in:– Joint reviews; or– One‐sided reviews (CMS only or state only)– File & Use submissions (no prospective review)

Marketing Review Process

16

• Marketing materials must be reviewed timely• Concurrent reviews with state for dual‐review materials

• Some materials may have one‐sided reviews:– CMS‐only: Part D appeals/grievance notices (MA and CA)

– State‐only:  Advertising materials (MA)

• Process described in Marketing Review SOP

HPMS Submission Process

17

• All marketing submitted in HPMS– HPMS Users Guide‐Monitoring/Marketing/Documentation

• HPMS category codes set up based on state review preferences 

• When MMP enters category code in HPMS the screen indicates if one‐sided or joint review

• HPMS Marketing Review Timeframes:– File & Use – MMP must submit at least 5 calendar days prior to use; no prospective review

– 10‐day review ‐Models without modification– 45‐day review ‐ Non‐model materials or models used with modification 

HPMS Marketing Review Timeframes

18

• Approved• Disapproved• Withdrawn• MMPs must resubmit previously disapproved documents:– Must correct any errors or changes– Indicate changes in comments

Material Dispositions in HPMS

19

Additional Resources for More Information

20

• Financial Alignment Initiative Web Page:– http://www.cms.gov/Medicare‐Medicaid‐Coordination/Medicare‐and‐Medicaid‐Coordination/Medicare‐Medicaid‐Coordination‐Office/FinancialModelstoSupportStatesEffortsinCareCoordination.html

– Includes information on translation requirements, model materials, marketing guidance for each state, and plan marketing training slides

• Medicare Marketing Guidelines:– http://www.cms.gov/Medicare/Health‐Plans/ManagedCareMarketing/FinalPartCMarketingGuidelines.html

• Part D Marketing Model Documents:– http://www.cms.gov/Medicare/Prescription‐Drug‐Coverage/PrescriptionDrugCovContra/Part‐D‐Model‐Marketing‐Materials.html

Additional Resources for More Information (cont.)

21

Questions?

22

• Send general MMG marketing questions to marketing@cms.hhs.gov

• States should send demonstration‐specific marketing questions to MMCO at: CMS_FADPlanSelection@cms.hhs.gov

• Plans should send demonstration‐specific marketing questions to MMCO at:  MMCOCapsModel@cms.hhs.gov

• Send HPMS process/system access questions to HPMS help desk at: HPMS@cms.hhs.gov

23

Duals ICRC Marketing Study HallMassachusetts Experience

7/11/13

Derek TymonOne Care Contract Manager, MassHealthMedicare/Medicaid Program

2424

Background • In August 2012, the Massachusetts Executive Office of Health

and Human Services (EOHHS) signed the Demonstration to Integrate Care for Dual Eligible Beneficiaries MOU with CMS.

• The Massachusetts Medicaid program operates under the name “MassHealth.” The duals initiative is called the One Care Program.

• MassHealth issued and completed a competitive procurement to select One Care Plans. Selections were announced, and rate and contract language negotiations are near completion.

• The Readiness Review process began in Fall 2012 and will be finalized prior to the 10/1/13 contract start date.

• Now engaged in significant implementation readiness review and working with CMS to develop marketing materials review protocols, state-specific marketing codes and templates.

2525

Starting the Process and Materials Development

Participants

• MassHealth Policy Unit – maintains primary relationship with CMS and responsible for program design and development

• MassHealth Providers and Plans Unit – responsible for implementation and ongoing program management of One Care and other Medicaid managed care programs

• CMS – regional and central offices

• CMS provided marketing material templates for MassHealth's review and input

• Templates included: List of Covered Drugs, Summary of Benefits, and Provider Directory

• Collaborative and iterative process to address MassHealth specific needs and requirements while ensuring compliance with CMS requirements

2626

Marketing Code Development Simultaneous to the materials development, CMS and MassHealthreviewed an initial list of MMP marketing codes and made changes as appropriate to reflect MassHealth specific needs.

Examples of Questions Considered:

• Which material do we want to review? (were there materials coded as “file and use” that MassHealth would prefer to review and approve prior to use?)

• What is a reasonable timeframe for review? (10 days with a model, 45 days?)

• Were their categories listed for all required MMP documents?

Frames of Reference:

• Current MassHealth MCO marketing review policy

• CMS Medicare Marketing Guidelines

2727

Marketing Code Outcome Examples• Advertising such as Newspaper, Radio, and Billboards

• MassHealth chose to review these items to be in-line with current MassHealth MCO requirements (State-Only Review)

• Part D Appeals and Grievance Form• MassHealth deferred to CMS expertise regarding review of Part-D

services (CMS-Only Review)

• Non-Part D Claims/Org Determinations/Appeals/Grievances • MassHealth and CMS agreed on the creation of new codes for non-

Part D services (Dual-Review)

• Direct Mail Pieces• While CMS allowed the use of Direct Mail, MassHealth had

previously forbid it in its MCO program. Further discussion let to the allowance of Direct Mail in the MMP program (State-Only Review)

2828

Building Interagency CommunicationApproach

• Identified Key Contract and primary reviewers for MassHealth and CMS Boston Regional Office

• Face-to-Face “meet and greet” between the MassHealth marketing review team and the CMS Boston Regional Office marketing review team

• Side-by-side walkthrough/review of the HPMS system

• Side-by-side “test” of the submitted material review process

• Development of MassHealth/CMS protocol for how Dual-Review materials are processed through respective agencies and HPMS determinations are made

2929

Outward Facing CommunicationApproach

• MassHealth and CMS marketing review teams participated in an One Care meeting with selected Plans to jointly introduce the team and the review process

• Bi-directional key contact identification

• Ad-Hoc emails to all One Care Plans with updated information regarding material review process or clarifications in marketing codes/rules

• Periodic check-in calls with each One Care Plan

3030

Ongoing ProcessApproach

• Weekly Check-in calls between the MassHealth and CMS review teams

• Frequent ad-hoc communication as issues arise

• Treat the MassHealth/CMS material approval protocol as a “living” document, flexible to change and always open to process improvement

3131

Results to Date • All Massachusetts MMP’s have submitted marketing

materials

• 10-day and 45-day review deadlines have all been meet

• Plans have raised important questions to MassHealth and CMS that have resulted in ongoing changes and improvement to process

• MassHealth and CMS coordination has led to a smooth Dual-Review process