Reform Alert - News from the Blues' Office of National Health Reform

HHS issues proposed rule on standards for navigators and non-navigator assistance personnel

Update: July 25, 2013 — CMS announces agent/broker webinar

April 11, 2013

On April 3, 2013 the Department of Health and Human Services (HHS) issued a Proposed Rule on Standards for Navigators and Non-Navigator Assistance Personnel. Comments are due May 5, 2013.

Under the Affordable Care Act, Navigators and Non-Navigator Assistance Personnel will assist consumers with traversing the Marketplace website and understanding health insurance issues.

The proposed rule creates conflict-of-interest, training and certification and meaningful access standards for Navigators and Non-Navigator assistance personnel in a federally-facilitated Marketplace (FFE) or state partnership Marketplace. The standards also apply to Non-Navigator assistance personnel (formerly known as in-person assisters) in state-based Marketplaces that are funded through federal Marketplace grants.

Non-Navigator assistance personnel will not be available on an FFE, but developed by states with Consumer Assistance Partnerships. Separate guidance is being developed for certified application counselors, a third type of consumer assistance personnel.

The proposed rule clarifies that any Navigator licensing, certification, or other standards prescribed by the state or Marketplace must not conflict with the provisions of Title I of the ACA.

The proposed rule adds a provision that Navigators cannot be issuers of stop-loss insurance.

Navigators and non-Navigator assistance personnel must:

  • Submit to the Marketplace a written attestation that they do not have any of the prohibited conflicts of interest;
  • Submit to the Marketplace a written plan for remaining free of conflicts of interest; and
  • Provide information to consumers about the full range of qualified health plan (QHP) options and insurance affordability programs for which they are eligible.

The Centers for Medicare and Medicaid Services (CMS) notes that some conflicts of interest will not bar a Navigator or non-Navigator assistance personnel from serving; however, the information should still be disclosed to the Marketplace and to consumers. Navigators are federally funded and directly linked to the Marketplace itself. They cannot be contracted directly with health care insurers for conflict of interest purposes. Thus, under the proposed rule, Navigator and non-Navigator entities, including staff, must disclose to the Marketplace and to each consumer who receives application assistance the following:

  • Any lines of insurance business, not covered by the participation restrictions and prohibitions in current Marketplace regulations, the entity intends to sell while carrying out consumer assistance functions;
  • Any existing employment relationships, or any former employment relationships within the last 5 years, with any health insurance issuers or issuers of stop-loss insurance or their respective subsidiaries, including any existing employment relationships between a spouse or domestic partner;
  • Any existing or anticipated financial, business, or contractual relationships with health insurance issuers or issuers of stop loss

In addition, consumer assistance entities and their staffs must develop and maintain knowledge about the racial, ethnic, and cultural groups in their service area and languages spoken; provide consumer assistance in the consumer’s preferred language at no cost to the consumer; provide notice to consumers with Limited English Proficiency about their right to receive language assistance; and receive ongoing training on culturally and linguistic appropriate service delivery.

Consumer assistance entities and their staffs must also comply with standards related to persons with disabilities, which include ensuring accessibility of information; providing auxiliary aids and services for at no cost; acquiring sufficient knowledge to refer people with disabilities to appropriate local, state, and federal support services; and being able to work with all individuals regardless of age, disability, or culture.

Where can I find more information?
For more information, read Standards for Navigators and Non-Navigator Assistance Personnel.

The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.