Tomorrow is the latest red-letter day in the implementation of the Patient Protection and Affordable Care Act (PPACA). Last month the Obama Administration postponed the deadline and now states must declare whether or not they will run their own health insurance exchange by Dec. 14, 2012.
The Department of Health and Human Services released a Q-and-A document with a number of new pieces of information on implementation, including the statement that the state exchange deadline tomorrow will not be extended as well as further clarity on the regulation of so-called navigators.
The total number of states forgoing the option to run their own health insurance exchange has yet to be determined. However, the number of states with at least some level of federal involvement in their exchange is likely to push well into the 20s.
States still have until Feb. 15, 2013, to declare whether or not they will enter into a partnership with the federal government, allowing them to run particular functions of the exchange or allow HHS to step in completely and run a federally facilitated exchange (FFE).
The Q-and-A document also provides new details on the regulation of navigator programs. These programs are authorized by the PPACA and are designed to empower certain groups, such as unions, nonprofits and chambers of commerce, to perform outreach with the goal of raising public awareness of exchanges and qualified health plans, as well as performing other duties such “facilitating enrollment.”
It is this last duty that is the most worrisome because of its vagueness and potential for negative impact on consumer protection. The Big “I” and many experts believe that individuals and small businesses seeking information on which health insurance plan best fits their needs should be able to count on sound advice from a licensed health insurance agent, broker or consultant. The association also believes that it is reckless for state or federal governments to hand this trusted role over to any individual or entity with no relevant health care background, training, accountability or oversight.
Question 18 of the Q-and-A document provides some much needed guidance on this issue. The document says that states cannot impose a blanket requirement that all navigators must obtain a producer license.
However, states may impose navigator-specific requirements such as licensing and certification, even in an FFE or partnership state. These requirements would come on top of federal training and certification requirements for FFE and partnership states.
In addition, the document implies that a navigator can be required to obtain a producer license if they do anything outside of the “navigator” duties assigned by the PPACA that would require such a license.
Ryan Young is Big “I” senior director of federal government affairs.