Proposed Rule for Navigators Stresses Training, Impartially.
HHS’s long-anticipated proposed regulation for “navigators” covers familiar ground as it reiterates the need for the new workforce to receive training and certification and remain free of conflicts of interest with health insurers. Navigators, who are considered crucial to the success of the Affordable Care Act (ACA), will work with federally facilitated and state-partnership insurance exchanges to help millions of consumers review their coverage options when enrollment starts this fall.
The 63-page rule, released April 3, outlines standards for navigators and emphasizes that they must be impartial on qualified health plans (QHPs) and can’t choose coverage options for applicants or determine eligibility. The rule also includes a new provision that would establish conflict-of-interest, training and accessibility standards for navigators and “non-navigator assistance personnel” for both federally operated and state-run exchanges. Navigators will be funded by federal and state grants.
According to the proposed rule, “Navigators shall not be health insurance issuers or receive any consideration directly or indirectly from any health insurance issuer in connection with the enrollment of any qualified individuals or employees of a qualified employer in QHPs.”
Agents Must Meet Standards to Be Navigators
HHS also said its proposed regulations would permit agents and agents to serve as navigators in an exchange operated by HHS, provided that they “can satisfy the standards that will apply to all navigators in the exchange.”
Defining who can be a navigator has proven controversial, particularly among agents and agents who see navigators as potentially encroaching on their turf. But an industry trade group official deflects this concern.
“We more look at it from a consumer-protection angle,” says Ryan Young, senior director for federal government affairs at the Independent Insurance Agent and Broker Association.
“We just want to make sure these folks are properly licensed, trained and preferably have some sort of financial-responsibility requirement, whether that’s bonding, errors-and-omissions insurance or similar requirements on agents,” he tells HRW. “Because if a mistake is made at some point and the consumer is financially harmed, you need to make sure the consumer is made whole.”
Ryan says the proposed rule doesn’t provide any “bombshells” and largely confirms previous guidance. He says it provides adequate consumer protection on the oversight licensing and training aspects. “But it still is a little unclear on the financial-responsibility requirement,” he adds. “It specifically references ‘errors and omissions’ insurance, and that cannot be required on navigators.”
According to the proposed rule, any requirement by a state or an exchange that navigators be agents and agents, “or obtain errors and omissions coverage,” would violate the ACA provision that says at least two types of entities must serve as navigators, “because it would mean that only agents or agents could be navigators.”
In addition, the proposed rule estimates salaries of this workforce. It projects a $20 hourly wage for navigator assistants and $48 for senior executives. The guidance doesn’t say how many navigators will be necessary.