Rule to Govern Conduct of HIX Consumer Assistance Personnel

The Centers for Medicare and Medicaid Services has issued a proposed rule to govern the conduct of “Navigators” and other personnel called “non-Navigators” who will assist consumers in comparing and selecting health benefits coverage via state insurance exchanges.

Navigators are entities that will receive grants from exchanges to provide information to consumers about health insurance, the exchange, qualified health plans, affordability programs such as premium tax credits, and Medicaid and the Children’s Health Insurance Program. They also will provide referrals to consumer assistance programs and health insurance ombudsmen for enrollees with grievances or questions. “Navigators will not make eligibility determinations and will not select qualified health plans for consumers or enroll applicants in QHPs, but will help consumers through the eligibility and enrollment process,” according to the rule.

“These proposed standards would help ensure that Navigators and non-Navigator 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,” the proposed rule states.

The rule also would clarify that entities with relationships to issuers of stop loss insurance are not eligible to become Navigators, and that the eligibility criteria also applies to non-Navigators.

The proposed rule, being published April 5 in the Federal Register, is available here.