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  • Proposed Rule Outlines Navigator Standards

    The Centers for Medicare and Medicaid Services (CMS) released a proposed rule yesterday outlining standards that "navigators" in federally facilitated and state partnership exchanges, also known as marketplaces, must meet.

    Navigators are entities or individuals that will provide accurate and unbiased information to consumers about the exchanges, qualified health plans, and public programs including Medicaid and the Children's Health Insurance Program. For those who are not familiar with health insurance, have limited English literacy, or are living with disabilities, navigators will help ensure that they understand their health coverage options.

    The proposed standards would help ensure that navigators and other assistance personnel will be fair and impartial and will be appropriately trained, and that they will provide services and information in a manner that is accessible.

    CMS also proposes 2 amendments to the existing regulation for navigators that would apply to all navigators in exchanges, clarifying that any navigator licensing, certification, or other standards prescribed by the state or exchange must not prevent the application of the provisions in the Affordable Care Act. The proposal also seeks to make entities with relationships to issuers of stop loss insurance (policies that protect companies against catastrophic claims) ineligible to become navigators, including those who are compensated directly or indirectly by issuers of stop loss insurance in connection with enrollment in qualified health plans or non-qualified health plans. The same ineligibility criteria that apply to navigators would also apply to non-navigator assistance personnel providing services in any federally-facilitated exchanges, including in state consumer partnership exchanges, and to federally funded non-navigator assistance personnel in state-based exchanges.

    In addition to navigators, consumers will have access to assistance through services such as a call center, which will be operated by the Department of Health and Human Services, for obtaining referrals to the appropriate state or federal agencies, in-person assistance personnel, certified application counselors, and agents and brokers. 

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