The new initiative sets out responsibilities that go beyond existing guidelines and make clear that health plans are committed to giving Medicare beneficiaries peace of mind. AHIP plans will work with the Centers for Medicare & Medicaid Services (CMS) to implement new steps on training, retraining and monitoring to ensure compliance, including requiring beneficiary attestation on enrollment applications and other steps to confirm that beneficiaries understand the plan they have chosen.

In addition, plans will strengthen mechanisms to promptly and effectively address non-compliance, including working with the National Association of Insurance Commissioners (NAIC), CMS, beneficiary groups and broker organizations to urge that new uniform processes and criteria be adopted to report serious broker, agent or plan employee misconduct in these areas.

Karen Ignagni, President and CEO of AHIP, said that while the vast majority of brokers, agents and plan marketing staff adhere to the highest ethical standards, these principles build on the current protections to ensure beneficiaries have greater peace of mind when considering Medicare coverage choices.

"When considering choices regarding their personal health care, seniors and individuals with disabilities deserve to know that they can trust the information they receive," said Ignagni. "The principles coupled with tough enforcement are designed to allow beneficiaries to focus on their Medicare choices without worrying about the integrity of the information provided."

The principles state that plan sponsors should specify the qualifications that brokers and agents and plan marketing staff must meet to market Medicare Advantage plans, clearly communicate these qualifications and consistently apply them, including:

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Performing background checks, including verification of required state licensure;
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Checking applicable databases for documentation of prior serious misconduct;
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Requiring brokers and agents and plan marketing staff to obtain threshold test scores on plan-specific training that provides detailed information about the plan types and benefits offered by the plan sponsor; and
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Obtaining documentation substantiating that threshold test scores have been achieved on core training that meets CMS standards.

The principles further state that MA plans will:

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Verify beneficiaries' intent to enroll and understanding of the plans they are electing, including conducting oversight such as post-enrollment outbound calls from the plan sponsor to the beneficiary or his/her legal representative for face-to-face enrollments or systematic monitoring of recorded telephonic enrollments;
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Track and analyze individual broker and agent and plan marketing staff performance with respect to beneficiary satisfaction, rapid disenrollments and complaints;
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Rapidly investigate complaints and take immediate and decisive action when complaints are verified;
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Adopt compensation arrangements that comply with the CMS Marketing Guidelines, including withholding or withdrawing payment for rapid disenrollments; and
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Make available to physicians, hospitals and other providers detailed information about plan structure, benefits, rules and payment terms. -http://www.ahip.org/