What level of oversight should organizations sponsoring Medicare health plans expect regarding the conduct of their contracted representatives?

• A. Organizations sponsoring Medicare health plans will monitor contracted representatives to ensure compliance with all applicable federal law and guidance and plan policies; state licensure laws are not preempted.
• B. Independent monitoring by state agencies only.
• C. No monitoring is required if the representative is new.
• D. Monitoring applies only to products marketed outside Medicare plans.

Answer: (A)

Organizations sponsoring Medicare health plans must actively oversee the contracted representatives to ensure they comply with all applicable federal laws and CMS guidance, plus the sponsor’s own policies. This oversight isn’t limited to anything handed off to state agencies; the sponsor has ongoing responsibility to train, monitor, and take corrective action if a representative’s conduct or marketing materials violate rules. Importantly, state licensure requirements still apply and are not wiped out by federal oversight, so reps must maintain proper licensing in addition to following federal and plan rules.

This is why the best approach is for the sponsor to have a comprehensive monitoring program that covers federally required conduct, plan policies, and licensing, rather than relying solely on state agencies, exempting new representatives, or restricting monitoring to products outside Medicare.