Do I need a scope of appointment for an existing client?
Asked by: Maryjane Lubowitz | Last update: July 23, 2025Score: 5/5 (31 votes)
When must a scope of appointment be obtained?
Per the CMS Final Rule 2024 (opens in a new window), all Scope of Appointment forms must be gathered at least 48 hours before the appointment — and this time limit should be taken literally.
What are the exceptions to the 48 hour scope of appointment rule?
Exceptions to the 48-Hour Rule
SOAs that are completed during the last four days of a valid election period (AEP, ICEP, IEP, SEP, MA OEP, etc.) for the beneficiary. Unscheduled in person meetings (walk-ins) initiated by the beneficiary, including inbound calls.
What are the requirements for CMS scope of appointment?
A completed Scope of Appointment should be submitted to the carrier with each MAPD or PDP enrollment application. This includes all applications keyed in electronically or submitted through any electronic means. CMS requires agents to keep the SOA for the current year plus 10 years.
What are the rules for scope of appointment in 2024?
CMS 2024 Final Rule: 48-hour window
The 48-hour SOA rule has returned. The guidelines require a minimum 48-hour window between a Scope of Appointment form being completed and an appointment taking place with exceptions for beneficiary initiated walk-ins and the end of a valid enrollment period.
Scope of Appointment | Why does Medicare require it?
When must the scope of appointment be obtained from the consumer?
The scope of appointment must be obtained from the consumer before the start of a marketing appointment. This is a necessary step to ensure that the consumer is fully aware of the topics that will be discussed during the meeting, whether it's in-person or telephonic.
Can you do a verbal scope of appointment?
What Is the Scope of Appointment (SOA)? The SOA is an agreement you sign before discussing specific Medicare plan options with an agent. For telephonic sales, agents will read the agreement to you and ask for verbal consent. In-person or virtual meetings may require you to complete the form on paper or electronically.
What are the three types of SNP plans?
- Chronic Condition SNP (C-SNP)
- Dual Eligible SNP (D-SNP)
- Institutional SNP (I-SNP)
In which of the following settings is a scope of appointment form not required to be collected?
An unscheduled meeting with a beneficiary who arrives at an agent's office without an appointment and requests information is the only scenario listed in which a Scope of Appointment form is NOT required to be collected.
What is the scope of appointment for ACA?
The Scope of Appointment is a document that outlines the specific topics and types of information that a Medicare sales agent or broker intends to discuss with a Medicare beneficiary during a face-to-face or telephone appointment.
In which of these situations must a scope of appointment form be collected at least 48 hours prior to the interaction between the agent and the beneficiary?
If a sales agent is approached by a beneficiary at a sales/marketing event and the beneficiary indicates that they want to be enrolled into a plan, the agent must collect a valid SOA and can schedule a personal sales/marketing appointment to occur at least 48 hours after obtaining the SOA.
What is the new 48 hour rule for Medicare?
Agents must obtain a scope of appointment no less than 48 hours prior to presenting and enrolling a beneficiary into a plan. SOAs are considered valid until used in the presentation of a plan, or for 12 months from the signature date, whichever comes first.
What is the 48 hour documentation rule for CMS?
Compliance Tips: Medicare has clearly stated that “reasonable” means 24 to 48 hours. Understand that anything beyond 48 hours could be considered unreasonable. Providers should comply with this requirement and complete documentation in a timely manner.
What is the 48 hour rule for scope of appointment?
The rule, in a nutshell
Simply put, you must get a signed Scope of Appointment at least 48 hours before your appointment. And, that is a literal 48 hours. If you collect a signed Scope at noon on Tuesday, you can't have an appointment any earlier than noon on Thursday.
When a paper scope of appointment form is used, it must be completed.?
The form should be completed by the beneficiary and returned prior to the appointment. If this is not feasible (i.e. because the beneficiary scheduled the appointment on the same day), the agent may get the beneficiary to sign the form at the beginning of the appointment.
How does a cancellation differ from a disenrollment?
Cancellation and disenrollment in health insurance differ mainly in who initiates the termination. Cancellation is initiated by the insurer due to non-payment or breaches of contract, while disenrollment is a voluntary action taken by the policyholder typically during an open enrollment period.
In which setting is a scope of appointment not required?
The setting in which a Scope of Appointment form is not required to be collected is A formal marketing event that a beneficiary did not pre-register to attend.
When should a scope of appointment be submitted?
At least 48 hours prior to meeting with a potential enrollee into any MA or Part D plan (unless one of two narrow 48-hour exceptions applies, see below), the plan or its sales representative must agree upon and record the scope of appointment with the beneficiary.
What is the scope of appointment rules for 2025?
Medicare scope of appointment rules. The Medicare SOA rules 2025 are put in place by CMS. The SOA (scope of appointment) is a form clients/potential clients as well as agents must complete before meeting to discuss Medicare plans. The SOA is mandatory when discussing either Medicare Advantage or PDP plans.
What is the difference between ISNP and DSNP?
Remember that D-SNPs are for those who are eligible for both Medicare and Medicaid, I-SNPs are for those living in a long-term care facility, and C-SNPs are for those with severe or disabling health conditions. That's why a Medicare Advantage Plan is so convenient.
Why do doctors not like Medicare Advantage plans?
Across the country, provider grumbling about claim denials and onerous preapproval requirements by Advantage plans is crescendoing. Some hospitals and physician practices are so fed up they're refusing to accept the plans — even big ones like those offered by UnitedHealthcare and Humana.
What are the 3 major types of plans?
There are three major types of planning, which include operational, tactical and strategic planning. A fourth type of planning, known as contingency planning, is an alternative course of action, which can be implemented if and when an original plan fails to produce the anticipated result.
How to fill out a scope of appointment?
- The beneficiary's name and contact information.
- The date of the appointment.
- The agent's or broker's name and contact information.
- A list of the specific topics or products the agents can cover during the appointment.
When must the scope of appointment be obtained for an in-person or telephonic sales presentation?
When must the scope of appointment be obtained for an in-person or telephonic sales presentation? Agents must obtain a scope of appointment no less than 48 hours prior to presenting and enrolling a beneficiary into a plan.
What is the CMS final rule 2024 scope of appointment?
Here are the changes to this year's scope of appointment rules: 48-Hour waiting period reimplemented. SOAs are required before meeting with a beneficiary to have any discussions that may lead to a sale. Agents must now wait a full 48 hours to conduct a personal marketing appointment.