Yesterday the Obama Administration released the much-awaited draft regulations on navigators and non-navigator assistance personnel. The regulations propose to codify much of what was already outlined through previous unofficial guidance documents published by the Administration and provide few notable surprises.
Navigator programs were created by the Patient Protection and Affordable Care Act (PPACA) to empower certain groups, such as unions and nonprofits, to raise public awareness regarding the existence of exchanges, as well as providing referrals for enrollees and to “facilitate enrollment” in qualified health plans.
More recently, the Administration has established additional new programs for “non-navigator assistance personnel,” such as in-person assisters and application filers. They are similar to navigators, except they can be funded by grants from the federal government.
This move was in reaction to the initial anticipated lack of funding for navigators, since the law specifies that navigators must be funded through exchange operations. The regulations released yesterday apply to these non-navigator assistance personnel as well.
Since passage of the PPACA, the Big “I” has viewed this as a consumer protection issue, and has pressed the Administration to ensure that navigators or similar entities will be properly licensed, trained and certified.
The regulations confirm the Administration’s previous guidance that creates a training and certification process for navigators at the federal level, and also allows states broad authority—no matter if the exchange is state-based or federal—to require further licensing and training.
Much of the specifics in the rules address conflict-of-interest standards and training requirements. With regard to training, the proposal would require a prospective navigator to complete a federally approved program of up to 30 hours of training, pass a federal examination and complete continuing education. Navigators would be required to receive training in at least 15 specific subjects, including basic concepts of health insurance, the health plans offered by the exchanges, eligibility and enrollment rules, the tax implications of enrollment decisions, and privacy and security standards.
Health agents and brokers are barred from being navigators, along with any other individual or entity receiving payment from a health insurance issuer. Notably, the new regulations allow producers to become navigators if they sell only non-health products such as auto, life and homeowners policies.
The regulations offer more information than was previously known on these entities, but still leave many gaps.
In addition, the Big “I” has made it clear to the Administration that independent insurance agents and brokers are anxiously awaiting further details on exactly how producers will function within the exchanges. With the initial enrollment scheduled for Oct. 1, 2013, time is running short.
Ryan Young is Big “I” senior director of federal government affairs.