The Role of Third Party Assistors in New YorkYork s ’s ... · PDF fileThe Role of Third...
Transcript of The Role of Third Party Assistors in New YorkYork s ’s ... · PDF fileThe Role of Third...
The Role of Third Party Assistors in New YorksTheRoleofThirdPartyAssistorsinNewYork sExchange:OverviewofFederalRequirements
DanielleHolahan
HealthBenefitExchangeStakeholderMeetingMarch14,2012
TheBasics
UnderthePatientProtectionandAffordableCareAct(ACA):
An Exchange shall establish a Navigator programAnExchangeshallestablishaNavigatorprogram
ExchangeswouldawardNavigatorgrantstoeligibleentitiesentities
FundingfortheNavigatorprogrammustbefromExchangeoperationalfunds,notfederalfunds
2
NavigatorEligibilityEntitiesthathave,orcouldreadilyestablish,relationshipswiththoselikelytobequalifiedhealthplan(QHP)eligible(employers,employees,consumers,selfemployed)
Underfinalregulations,anExchangemustincludeanentityfrom:
Communityandconsumerfocusednonprofitsy p
And anentityfromatleastoneofthefollowing:
ChambersofCommerceLicensedagentsandbrokersTrade,industry,andprofessionalassociationsCommercialfishingindustryorganizations,ranchingandfarmingorganizations
UnionsResourcepartnersoftheSmallBusinessAdministrationO h bli i i i i di id l h h d dOtherpublicorprivateentitiesorindividualsthatmeetthestandardsoutlinedinACASection1311/Regulation155.210
3
NavigatorDutiesTheACArequiresNavigatorsto:
Maintainexpertiseineligibility,enrollment,andprogramspecificationsandconductpubliceducationactivitiestoraiseawarenessabouttheExchangep g
Provideinformationandservicesinafair,accurateandimpartialmanner.Informationmustacknowledgeotherhealthprograms
F ilit t l ti f QHPFacilitateselectionofaQHP
Providereferralstoconsumerassistanceoffice(s)forenrolleeswithgrievances,complaints,questionsabouttheirplan,coverage,oranyd t i tideterminations
Provideinformationthatisculturallyandlinguisticallyappropriatetotheneedsofthepopulationbeingservedandensureaccessibilityandusabilityf N i t t l f th ith di bilitiofNavigatortoolsforthosewithdisabilities
UnderthefinalExchangeregulations,StatesmayallowNavigatorstoassistith bli t Th ti iti ld b li ibl f f d l f diwithpubliccoveragetoo.Theseactivitieswouldbeeligibleforfederalfunding
4
NavigatorStandards
UndertheACA,
Navigators shall not: Navigatorsshallnot:Beahealthinsuranceissuer;
Beasubsidiaryofahealthissuer;
Beanassociationthatincludesmembersof,orlobbiesonbehalfof,theinsuranceindustry;or
Receive any consideration directly or indirectly from any health insuranceReceiveanyconsiderationdirectlyorindirectlyfromanyhealthinsuranceissuerinconnectionwithenrollmentofindividuals/employeesinQHPsornonQHPs
Th E h h ll bli h N i d d i l di TheExchangeshallestablishNavigatorstandards,including:Conflictofinterestprovisions
Navigator training standardsNavigatortrainingstandards
5
AgentsandBrokers
InadditiontopermittingagentsandbrokerstobeNavigators,astatemayalsochoosetopermitagentsandbrokersto:
Enrollqualifiedindividuals,employers,oremployeesintoQHPsinthe individual and SHOP exchangestheindividualandSHOPexchanges
AssistindividualsinapplyingforadvancepremiumtaxcreditsandcostsharingreductionsforQHPsg
TheExchangemayprovideinformationaboutlicensedagentsd b k it b itandbrokersonitswebsite
6
NewYorkStatePolicyQuestionsNavigatorsg
WhatshouldthecriteriabeforeligibilitytoserveasaNavigator? ShouldNavigatorsprovidehelpwithpublicprograms,inadditiontoQHPs?Sh ld N i t b th th i di id l d SHOP E h ? ShouldNavigatorsserveboththeindividualandSHOPExchanges?
WhatkindoftrainingshouldberequiredofNavigators?ShoulditbethesamefortheindividualandSHOPExchanges?
Wh t h ld N i t tifi ti l k lik ? WhatshouldNavigatorcertificationlooklike?Producers,Chambers,BusinessAssociations
Whatroleshouldproducers,chambers,businessassociationsplayinenrollingindividuals and small groups in QHPs?individualsandsmallgroupsinQHPs?
ShouldtheyserveboththeindividualandSHOPExchanges? ShouldbrokersbeNavigatorsorcontinuetheirtraditionalroleasbrokers(includingbeing reimbursed directly by carriers)?beingreimburseddirectlybycarriers)?
Compensation
Whataretheoptionsforcompensatingtheseentities?N i Navigatorgrants
BrokerscanbereimbursedbytheExchange(Navigatorgrants)ordirectlybycarriers Other? 7