CMS Compliance and Consent Documentation

We received, and many of you as well, the attached from Ambetter on 09/28/2023. This serves as a reminder that ensuring the highest standards of business quality and CMS compliance begins with each one of us. We wish to emphasize a specific aspect of CMS compliance, which is imperative for all agents to fully grasp and adhere to.

According to CMS regulations, it is mandatory to document customer consent through audio recording and maintain these records for ten years. This documentation must confirm that the consumer or their authorized representative has given consent before receiving assistance with applying for or enrolling in Marketplace coverage. Additionally, it must confirm the accuracy of their eligibility application information before submission to the Marketplace.

We want to stress that this authorization requirement applies to all enrollments, except for passive re-enrollments. In other words, if you enroll a customer today and subsequently assist them in enrolling (with the same or a different carrier) during open enrollment, you are obligated to obtain their authorization on both occasions.

Please be aware that we have also received similar communications from other carriers and CMS, reinforcing the importance of compliance in this matter. Failure to comply with these regulations may result in significant repercussions.

Your commitment to adherence to these CMS rules is crucial to maintaining our commitment to excellence and ethical business practices. If you have any questions or require further clarification on this matter, please do not hesitate to reach out to us.