Health Center Regulatory Issues

NACHC Brief Outlines Roles and Responsibilities of Exchange Consumer Assistance Programs

By: Rob Kidney

As Health Insurance Exchanges begin open enrollment in October, a key feature and a critical element to getting eligible consumers enrolled in coverage are their consumer assistance functions. By law, these include a Navigator Program, a Certified Application Counselor Program and an optional in-person assister program. NACHC’s latest State Policy Report, Navigating the Health Insurance Marketplace: Community Health Centers and Consumer Assistance Programs, describes their roles and functions, outlining the relevant federal regulations and discusses how community health centers can participate.

On April 5, 2013, CMS issued a funding opportunity announcement for the Navigator Program in Federally-Facilitated and State Partnership Exchanges. It is clear in the guidance that health centers are eligible to apply for Navigator grants in these types of Exchanges, however, State-Based Exchanges will be free to determine eligibility on their own and it is critical that health centers make the case in their state as to why they should be considered eligible entities.

The report also includes a discussion of recently proposed conflict of interest, training, certification and recertification standards that apply to Navigators and in-person assisters in Federally-Facilitated and State Partnership Exchanges and federally funded in-person assisters in State-Based Exchanges. In developing their own standards, State-Based Exchanges may wish to use these as a model, but are not required to do so. Therefore, as States move forward with regulating consumer assistance programs, health centers should seek to provide input, as appropriate.
It is important to note that CMS is seeking public comments on the proposed conflict of interest, training, certification and recertification standards. NACHC is currently reviewing them to determine whether or not to provide comments. Please contact Roger Schwartz or Susan Sumrell with any questions.

As work on Exchanges and consumer assistance programs moved ahead in your state, it might be helpful for health centers to consider the following:

• If your state is operating a State-Based Exchange, will community health centers be eligible to apply for Navigator grants? If not, why not?
• Will your State-Based or Partnership Exchange establish an In-Person assister program? Will health centers be eligible for this role?
• As your State-Based Exchange develops training, certification and conflict of interest standards, do they unnecessarily restrict your ability to participate in consumer assistance programs? For example, do they automatically assume that a conflict of interest exists for health care providers?
• Is your State considering requiring Navigators to hold a license? If so, are the requirements overly-burdensome? Do they unnecessarily prevent certain entities from participating?
• Are policymakers aware of the consumer assistance functions your health center already performs?
• What opportunities exist for stakeholder input? Is there an opportunity for a representative from your health center or state primary care association to participate in your state’s Navigator or consumer advisory committee?
• Is your health center or staff certified by your State’s Medicaid agency as an application counselor?
• What other organizations or individuals in your community might apply to become Navigators or in-person assisters? Are there identifiable gaps in the number of eligible entities? Are there opportunities for partnering?


For more information on Health Insurance Exchanges, click here.