Managed Care Model Compliance Plan / Selective Marketing and Enrollment

Why This Topic Matters

Selective marketing and enrollment practices can create compliance exposure for managed care organizations and may trigger sanctions. Understanding the regulatory boundaries helps plans design policies that reduce discrimination risk and align with Medicare requirements.

Article Sections

1. Selective marketing and enrollment concerns

   Introduces the compliance issue of targeting enrollees based on risk and describes the broader concern with discriminatory enrollment practices in managed care settings.

2. Health-status factors and enrollment protections

   Summarizes the categories of health-related factors discussed in the article and the general protections that apply to eligible enrollees.

3. Sanctions and enforcement risk

   Describes the types of penalties and corrective actions that may apply when enrollment practices are expected to discourage or deny participation by certain individuals.

4. Examples of prohibited screening and marketing practices

   Reviews examples of activities that may indicate selective marketing, including screening-related conduct, outreach methods, and other enrollment tactics.

5. CMS guidance on nominal gifts and enrollment items

   Discusses general CMS guidance referenced in the article on nominal-value gifts and the conditions under which plan-related items may be offered.

6. Other examples of selective enrollment behavior

   Covers additional compliance concerns raised by the article, including enrollment prioritization, cost tracking, and targeted re-enrollment efforts.