Final Regulations on Navigators, In-Person Assisters and Certified Application Counselors

By Tricia Brooks, Georgetown University Center for Children and Families

It was another hot summer Friday for regulations with the release of the final rule on navigator and non-navigator assisters (aka in-person assisters) and Exchange-based certified application counselors (CAC). (Don’t our friends at CMS know that we like to take weekends off?) All in all, the proposed rules for navigators were finalized with minimal changes while there were a few notable changes in the requirements for the new health insurance marketplace to have certified application counselors.

Navigator and non-navigator assister regulations were finalized with minimum changes. The final rule lists these specific revisions:

1)   Disclosures of non-prohibited conflicts of interest must be in plain language.

2)   Non-navigator assisters must comply with the requirement to provide information in a fair, accurate and impartial manner (as navigators are required).

3)   Accessibility supports (both language and disability-related) must be available either “when requested or when necessary to ensure effective communication.”

4)   Notices to individuals with limited English proficiency must be in the consumer’s preferred languages.

5)   Authorized representatives are not limited to those considered “legally” authorized (such as legal guardians). In other words, consumers can pick an authorized representative of their choice.

All exchanges are required to have a “certified application counselor program.”

What’s different from the proposed rule is that the Exchange may either choose to certify CAC’s directly or to designate organizations to certify their own staff and volunteers (or do both). Another change is that exchanges are NOT required to but may certify Medicaid and CHIP application counselors. And I was personally pleased to see that CACs will be required to provide information on the “full range of QHPs and insurance affordability programs.”

The federally-facilitated exchange (FFE) will operate its CAC program by designating entities not certifying CACs directly, and all CAC entities (as well as navigators and non-navigator assisters) will be listed its website as a resource to consumers. CAC entities in states with an FFE will be limited to community health centers, hospitals, health care providers of all types including Indian health providers, and social service agencies that assist with other public programs that are either non-federal governmental entities or 501(c) nonprofits. Additional guidance is expected from CCIIO on the details of the federal CAC program in states with a federal or partnership exchange and how it will designate CAC entities.

There are key differences between CACs and Navigator or non-Navigator Assisters. The final rule is clear that CACs are not required to conduct public outreach. CACs also are not subject to the same detailed conflict of interest standards, eligibility requirements and prerequisites and CLAS and disability access standards. (I’ll dig more into these differences in a future blog.)

Many clarifications in the preamble will be important as the regulations are implemented and enforced. You’ll find lots of interesting information in the preamble as the final rule reviewed and responded to comments received on the proposed regulations. While the regulatory language may have changed only minimally, there are very important clarifications in the preamble that will guide implementation and enforcement.

Importantly, this rule is clear that state training and certification or licensing standards must not interfere with assisters of all types fulfilling their duties. Legislation in a number of states appears to do just that, particularly as it relates to assisting consumers through the full application and enrollment process. The preamble describes facilitating enrollment in a QHP as “providing fair, impartial, and accurate information that assists consumers with submitting the eligibility application, clarifying the distinctions among QHPs, and helping qualified individuals make informed decisions during the health plan selection process.” The rule acknowledged concerns about potentially conflicting legislation and stated that CMS is monitoring relevant state legislation and will work with states to help ensure that state legislation does not conflict.

In the coming weeks, I’ll be diving into the details and nuances of the final rule, particularly those all-important clarifications in the preamble. So stay tuned for more.

Editor’s Note: This blog originally appeared on Georgetown University’s Center for Children and Families’ Say Ahhh! Blog

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The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.