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BULLETIN

July 13, 2013


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[Official Guidance]

Text of CMS Announcement: Policies Finalized to Ensure Navigators Will Help Consumers Enroll in the Health Insurance Marketplace
"[CMS] took the next step in moving toward implementation by finalizing a proposed rule [on Friday, July 12] outlining the standards for Navigators, the in-person assisters in Federally-facilitated and State Partnership Marketplaces. State-based Marketplaces have the option of using this guidance or developing their own. The rule identifies training, conflict of interest standards, and standards for serving people with limited English proficiency and people with disabilities. Navigators and similar in-person assisters will provide unbiased information to consumers about health insurance, the new Health Insurance Marketplaces, qualified health plans, and public programs including Medicaid and the Children's Health Insurance Program.... CMS will ensure that all consumers who need Marketplace customer service can receive it from trained professionals." (Center for Consumer Information & Insurance Oversight, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)

[Official Guidance]

Text of Final CMS Regs: Standards for Navigators and Non-Navigator Assistance Personnel, Consumer Assistance Tools and Programs of an Exchange, and Certified Application Counselors
146 pages. "This final rule addresses various requirements applicable to Navigators and non-Navigator assistance personnel in Federally-facilitated Exchanges, including State Partnership Exchanges, and to non-Navigator assistance personnel in State Exchanges that are funded through federal Exchange Establishment grants. It finalizes the requirement that Exchanges must have a certified application counselor program. It creates conflict-of-interest, training and certification, and meaningful access standards; clarifies that any licensing, certification, or other standards prescribed by a state or Exchange must not prevent application of the provisions of title I of the [ACA]; adds entities with relationships to issuers of stop loss insurance to the list of entities that are ineligible to become Navigators; and clarifies that the same ineligibility criteria that apply to Navigators apply to certain non-Navigator assistance personnel. The final rule also directs that each Exchange designate organizations which will then certify their staff members and volunteers to be application counselors that assist consumers and facilitate enrollment in qualified health plans and insurance affordability programs, and provides standards for that designation.... State Exchanges will not be required to use the standards being finalized ... for their Navigators, or for non-Navigator assistance programs not funded through section 1311(a) Exchange Establishment grants.... State Exchanges may find the federal standards to be useful models, and we encourage them to draw upon these standards as they develop and disseminate conflict of interest and training standards for Navigators ... or when establishing standards for any non-Navigator assistance program that is established by the State Exchange and is not funded by federal 1311(a) Exchange." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)

[Official Guidance]

CMS Guidance on the Certified Application Counselor Program (PDF)
"All Exchanges must have a certified application counselor program. This guidance establishes the process for the Federally Facilitated Marketplaces, including State Partnership Marketplaces (jointly, FFMs or the Marketplaces), to designate organizations to certify their staff and volunteers to participate in the certified application counselor program, and the process to withdraw such designation from these organizations. State-based Marketplaces are welcome to follow this guidance in designating (and withdrawing designation of) organizations, but are also permitted to establish their own processes for their certified application counselor program.... [T]he application that the entity submits to the [Federally Funded Marketplace (FFM)] for the purpose of becoming designated as a certified application counselor organization will be posted on the CMS website ... Interested organizations may submit their completed application online.... Organizations that the FFM designates must enter into a written agreement with the FFM, in a form and manner prescribed by the FFM." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)

[Official Guidance]

Sample Application to to Be a Certified Application Counselor Organization (PDF)
"This application is only a sample to help you prepare for the kind of information an interested organization will need to provide. An online application will be available at the end of July 2013 for organizations who want to become Marketplace-designated organizations that can certify application counselors. These groups might include community health centers or other health care providers, hospitals, or social service agencies." (Center for Consumer Information & Insurance Oversight, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)


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