Provider-initiated activities are activities conducted by a provider at the request of the patient or as a matter of a course of treatment, and occur when meeting with the patient as part of the professional relationship between the provider and patient. Provider-initiated activities do not activities conducted at the request of the MA organization or pursuant to the network participation agreement between the MA organization and the provider. Provider-initiated activities that meet this definition fall outside of the definition of marketing as outlined in §§422.2260.
Permissible 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 www.medicare.gov) including in areas where care is delivered
- Providing the names of MA organizations with which they contract or participate or both
- Answering questions or discussing the merits of an MA plan or plans, including cost sharing and benefit information, including 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 Offices, CMS’ website at www.medicare.gov, or 1-800-MEDICARE
- Referring patients to MA plan marketing materials available in common areas
- Providing information and assistance in applying for the LIS
- Announcing new or continuing affiliations with MA organizations, once a contractual agreement is signed; announcements may be made through any means of distribution