The rule applies to navigators in states with federally facilitated exchanges and state partnership exchanges. It also applies to any in-person assisters that are funded by federal exchange establishment grants in states with state-based exchanges partnership exchanges. It does not apply, however, to navigators in state-based exchange states, although these states are welcome to adopt them.
After the proposed rule was released in early April, agent and brokers groups demanded more extensive training be require of navigators, non-navigator assistance personnel and certified application counselors—the three new groups designated by CMS to provide such help—over concerns that wouldn't be prepared enough, might give incorrect information, and also might have conflicts-of-interests.
Agents and brokers are concerned about getting displaced in their traditional role of helping individuals and businesses buy health insurance, though state exchanges generally plan to allow agents and brokers to sell exchange plans.
Meanwhile, organizations that would actually hire navigators and other staff to assist people in signing up for coverage contended the agents' about training were overblown and that a bigger concern was getting sufficient funding for such assistance programs. The funding concern is not addressed in the final rule.
The rule also states that appropriate conflict-of-interest standards are in place to prevent fraud, since all assistance personnel must go through state or federal training and certification, as well as appropriate checks completed.
The final rule also makes clear who cannot become navigators, assistance personnel, or counselors. “In all exchange models, entities ineligible to become navigators include health insurance issuers and their subsidiaries, issuers of stop loss insurance and their subsidiaries, associations that include members of or that lobby on behalf of the insurance industry, and entities that receive any consideration directly or indirectly from any health insurance issuer or issuer of stop loss insurance in connection with the enrollment of any individuals or employees in a QHP or non-QHP insurance product.”
But associations such as chambers of commerce are permitted to have a non-navigator assistance program.
Agents and brokers are permitted to continue to help people individuals enroll individuals and groups with health coverage, including through an exchange, but will be compensated by insurance companies, as allowed by state laws, just as they always have.
Follow Jonathan Block on Twitter: @MHjblock