42 C.F.R. § 438.104 Marketing activities.
Title 42 - Public Health
(a) Terminology. As used in this section, the following terms have the indicated meanings: Cold-call marketing means any unsolicited personal contact by the MCO, PIHP, PAHP, or PCCM with a potential enrollee for the purpose of marketing as defined in this paragraph. Marketing means any communication, from an MCO, PIHP, PAHP, or PCCM to a Medicaid recipient who is not enrolled in that entity, that can reasonably be interpreted as intended to influence the recipient to enroll in that particular MCO's, PIHP's, PAHP's, or PCCM's Medicaid product, or either to not enroll in, or to disenroll from, another MCO's, PIHP's, PAHP's, or PCCM's Medicaid product. Marketing materials means materials that— (1) Are produced in any medium, by or on behalf of an MCO, PIHP, PAHP, or PCCM; and (2) Can reasonably be interpreted as intended to market to potential enrollees. MCO, PIHP, PAHP, or PCCM include any of the entity's employees, affiliated providers, agents, or contractors. (b) Contract requirements. Each contract with an MCO, PIHP, PAHP, or PCCM must comply with the following requirements: (1) Provide that the entity— (i) Does not distribute any marketing materials without first obtaining State approval; (ii) Distributes the materials to its entire service area as indicated in the contract; (iii) Complies with the information requirements of §438.10 to ensure that, before enrolling, the recipient receives, from the entity or the State, the accurate oral and written information he or she needs to make an informed decision on whether to enroll; (iv) Does not seek to influence enrollment in conjunction with the sale or offering of any private insurance; and (v) Does not, directly or indirectly, engage in door-to-door, telephone, or other cold-call marketing activities. (2) Specify the methods by which the entity assures the State agency that marketing, including plans and materials, is accurate and does not mislead, confuse, or defraud the recipients or the State agency. Statements that will be considered inaccurate, false, or misleading include, but are not limited to, any assertion or statement (whether written or oral) that— (i) The recipient must enroll in the MCO, PIHP, PAHP, or PCCM in order to obtain benefits or in order to not lose benefits; or (ii) The MCO, PIHP, PAHP, or PCCM is endorsed by CMS, the Federal or State government, or similar entity. (c) State agency review. In reviewing the marketing materials submitted by the entity, the State must consult with the Medical Care Advisory Committee established under §431.12 of this chapter or an advisory committee with similar membership.
Title 42: Public Health
PART 438—MANAGED CARE
Subpart C—Enrollee Rights and Protections
§ 438.104 Marketing activities.
