On April 5, 2013, CMS published a proposed rule that would establish standards for “Navigators” in federally-facilitated and state partnership Affordable Insurance Exchanges under the ACA. Under prior CMS regulations, Exchanges must award grants to Navigators to provide impartial information to consumers about health insurance, the Exchange, Qualified Health Plans (QHPs), various insurance affordability programs, and grievance procedures, among other functions. Navigators will not make eligibility determinations, select QHPs for consumers, or enroll applicants into QHPs, but they will help consumers through the eligibility and enrollment process. The April 5 proposed rule would establish conflict-of-interest, training and certification, and meaningful access standards applicable to Navigators (and certain other non-Navigator assistance personnel funded through federal Exchange Establishment grants). The proposed rule also would amend existing Exchange regulations to clarify certain licensing and certification requirements and to specify that entities with relationships to issuers of stop loss insurance are ineligible to become Navigators. Comments will be accepted until May 6, 2013.
Home Regulatory Developments Centers for Medicare & Medicaid Services Regulations CMS Proposes Rules for Health Insurance Exchange “Navigators”