Helaine I. Fingold, Senior Counsel in the Health Care & Life Sciences practice, in the firm’s Baltimore office, was quoted in Radar On Medicare Advantage, in “Marketing Guidelines Feature New Flexibilities for MAOs,” by Lauren Flynn Kelly.
Following is an excerpt:
In a newly named, updated and reorganized set of guidelines for Medicare Advantage and Part D plans that are gearing up to market their products during the 2019 Annual Election Period (AEP), CMS is making several changes aimed at streamlining the submission of marketing materials for review while addressing some evolving aspects of the program, such as intensifying plan-provider relationships. Industry experts tell AIS Health the modifications should largely be of help to plans, although they may want to seek more specific guidance from CMS in certain instances to ensure compliance. …
Plans, however, may want to approach that flexibility with some caution, advises Helaine Fingold, senior counsel with the Health Care and Life Sciences practice in the Baltimore office of Epstein Becker and Green. “CMS is trying to balance regulatory flexibility with its oversight responsibility. The current revision of the guidelines tilts toward the flexibility end,” says Fingold. And plans may ultimately want more detail around marketing for a couple reasons, she suggests.
“First, plans have different tolerance levels with respect to compliance risk. Some plans may be more conservative in their marketing and communication efforts absent explicit guidance in support of a particular approach and may seek such guidance from CMS,” advises Fingold.
“Second, the new guidelines will largely be interpreted by the Regional Office staff who review plans’ marketing materials,” she adds. “The different regions can vary in the strictness with which they interpret marketing guidance. Such variation could lead plans to seek policy clarification from the Central Office when Regional Offices take different approaches to particular aspects of the guidelines.”
