Managed Care

Universal Scope of Appointment

  • 1.  Universal Scope of Appointment

    Posted 11-04-2015 05:10 PM

    Hello,

    Im looking for the CMS guidance that states a sales agent can use the Universal CMS approved Scope of Appointment form if they do not have a plan specific copy. 

    I've read in several webpages that this is acceptable but cannot find the actual guidelines.

    Thank You,

    Wanda Amador

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    Wanda Amador AAS
    Medicare Specialist
    Community Care Alliance of Illinois
    Chicago,IL
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    2019 HCCA Compliance Institute


  • 2.  RE: Universal Scope of Appointment

    Posted 11-04-2015 05:15 PM

    Wanda,

     

    The guidance is in Section 70.9.3 of the Medicare Marketing Guidelines, which are posted on the CMS website at: https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/FinalPartCMarketingGuidelines.html

     

    No standard form is required; as long as the below requirements are met:

     

    70.9.3 – Scope of Appointment

    42 CFR 422.2262, 422.2268(g) and (h), 423.2262, 423.2268 (g) and (h)

     

    SOA documentation is subject to the following requirements:

    • The documentation may be in writing, in the form of a signed agreement by the beneficiary, or a recorded oral agreement. Any technology (e.g., conference calls, fax machines, designated recording line, pre-paid envelopes, and email) can be used to document the scope of appointment.

    • Date of appointment

    • Beneficiary contact information (e.g., name, address, telephone number)

     

    Documentation of beneficiary or appointed/authorized representative agreement

    • The product type(s) (e.g., MA, PDP, MMP) the beneficiary has agreed to discuss during the scheduled appointment

    • Agent information (e.g., name and contact information)

    • An explanation why the SOA was not documented 48 hours prior to the appointment, if applicable

    • A statement clarifying that:

    - beneficiaries are not obligated to enroll in a plan

    - current or future Medicare enrollment status will not be impacted

    - that the beneficiary is not automatically enrolled in the plan(s) discussed

     

     

     

    Annie Hsu ShiehSenior Compliance CounselCentral Health Plan of California 1540 Bridgegate Drive, Diamond Bar, CA 91765Phone (626) 388-2390 ext. 2885Fax (626) 388-2367ahsu@centralhealthplan.com

     

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    2019 HCCA Compliance Institute