CMS Rules and Regulations

Posted  by PX Team

  1. For purposes of these additional Addendum / Terms and Conditions, “CMS Rules and Regulations” means all laws, rules and regulations applicable to Medicare and Medicaid including, without limitation, the Centers for Medicare & Medicaid Services (“CMS”) rules, the 42 CFR Subpart V – Medicare Advantage Communication Requirements, the Medicare Communications and Marketing Guidelines (“MCMG”), CMS sub-regulatory requirements, all rules applicable to Dual Eligible Special Needs Plans (“D-SNPs”), all relevant state Medicaid and/or other insurance regulations/statutes, and all relevant US Department of Health and Human Services Office of Inspector General (“OIG”) and/or Office for Civil Rights (“OCR”) regulations or sub-regulatory requirements.


  1. Publisher represents and warrants that all Publisher Creatives, as well as the Services, shall at all times comply with applicable CMS Rules and Regulations. In connection with the foregoing, Publisher shall: (a) submit all Publisher Creatives to PX for prior approval; (b) submit all Publisher Creatives directly, or through third-party clients, to CMS via the Health Plan Management System (“HPMS”) and obtain Standardized material identifications (“SMIDs”) in connection with same; (c) obtain carrier opt-in for the use of the Publisher Creatives and include the appropriate carrier designation as required for routing to the appropriate carrier; (d) not utilize any Publisher Creatives that have not been approved by the CMS; and (e) upon approval of any Publisher Creatives by the CMS, provide PX with a copy of the final CMS-approved or accepted Publisher Creatives, the Standardized Material Identification (“SMID”) associated with the subject Publisher Creatives and the entity name that submitted the subject Publisher Creatives to CMS.


  1. Publisher agrees to indemnify and hold harmless PX from and against any and all damages, costs and/or losses (including attorneys’ fees and court costs, as well as direct, actual, exemplary, punitive, indirect and/or consequential damages) incurred by PX arising from or related to the Publisher Creatives, Services and/or Publisher’s breach of this Addendum. Publisher acknowledges that damages caused by the use of unapproved Publisher Creatives are difficult to calculate and ascertain. As such, the parties agree that if Publisher uses unapproved Publisher Creatives, PX may elect to impose liquidated damages in the amount of One Hundred Dollars ($100.00) per Incident (as defined below), in addition to all other remedies available to PX at law or in equity.  For purposes of this Addendum, an “Incident” means any use of unapproved Publisher Creatives to advertise Medicare and/or Medicaid insurance to any consumer via any medium and/or means, whether written, visual or auditory.  Should Publisher distribute or otherwise communicate the same unapproved Publisher Creatives to a single individual multiple times, each such instance of communication shall be considered an Incident for purposes of this Section 3.

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