14
Contact information provided for raffles or drawings may only be used for that purpose.
50.3
– Personal/Individual Marketing Appointments
42 CFR §§ 422.2268(b)(3-5),(11), 423.2268(b)(3-5) and (11)
SOA parameters (and documentation) are required for all one-on-one appointments, regardless of
venue (e.g., home, telephone). During these appointments, discussions may only concern
previously agreed upon plan products documented in the SOA, and may only market health-
related products, and not, for example, annuities or life insurance. Individuals may not
solicit/accept enrollment applications for a January 1 effective date until October 15 of the
preceding calendar year, unless the beneficiary is entitled under another enrollment period.
60 –Activities in a Healthcare Setting
Section 1851(j)(1)(D), 42 CFR §§ 422.2268(a)(1),(2), and (5); 422.2268(b)(7) and (9),
423.2268(a)(1),(2), and (5), 423.2268(b)(7) and (9)
To maintain appropriate beneficiary safeguards while not impeding the provider/patient
relationship, CMS distinguishes between provider-initiated activities and plan-initiated activities
in a healthcare setting.
60.1
– Provider-Initiated Activities
42 CFR §§ 422.2260, 423.2260
Provider-initiated activities are those conducted by a healthcare professional, including
pharmacists, at the request of the patient or as a matter of a course of treatment, when meeting
with the patient as part of the professional relationship between healthcare provider and patient.
Provider-initiated activities do not include those conducted at the request of the Plan/Part D
sponsor or pursuant to the network participation agreement between the Plan/Part D sponsor and
the provider. Provider-initiated activities fall outside of the definition of marketing as outlined in
§§422.2260 and 423.2260.
Permissible contracted provider-initiated activities include:
Distributing unaltered, printed materials created by CMS, such as reports from Medicare
Plan Finder, the “Medicare & You” handbook, or “Medicare Options Compare” (from
https://www.medicare.gov) including in areas where care is delivered;
Providing the names of Plans/Part D sponsors with which they contract and/or participate;
Answering questions or discussing the merits of a plan or plans, including cost sharing
and benefit information (these discussions may occur in areas where care is delivered);
Referring patients to other sources of information, such as State Health Insurance
Assistance Program (SHIP) representatives, plan marketing representatives, State
Medicaid Office, local Social Security Office, CMS’ website at
https://www.medicare.gov, or 1-800-MEDICARE;
Referring patients to Plan marketing materials available in common areas; and
Providing information and assistance in applying for the LIS.
60.2
– Plan-Initiated Provider Activities in the Healthcare Setting
42 CFR §§ 422.2260, 422.2268(b)(7), 423.2260, 423.2268(b)(7)