Navigator, broker roles sealed in final CMS ruling
Originally published by Gillian Roberts on http://eba.benefitnews.com
July 15, 2013
The U.S. Department of Health and Human Services remains steadfast in its plan to hire navigators to assist and guide people through their options on the exchanges. It will also maintain a relationship with brokers and agents to provide their own recommendations to people considering or entering exchanges.
The Centers for Medicare and Medicaid Services late Friday released a final rule the navigator program, confirming that the role of navigators will be assistance-oriented and stating, as the group has on numerous occasions, that brokers and agents can be navigators if they choose to do so, but otherwise remain separate from navigators.
“We expect that agents and brokers will continue to play an important role in educating consumers about their health coverage options and, unlike navigators and non-navigator assistance personnel, will also be able to sell consumers health insurance coverage,” according to the ruling.
If brokers and agents do choose to become a navigator, “they would not be permitted to receive any direct or indirect consideration from a health insurance or stop-loss insurance issuer in connection with the enrollment of any individuals or employees in QHPs or non-QHPs,” the ruling states.
In April, Gary Cohen, director of CMS’s Center for Consumer Information and Insurance Oversight, elaborated on this sentiment to EBA: “They are not making recommendations, they’re not selling,” he said of navigators. “Some things are the same; they will [both] provide education and inform people about options available to them. But I think you go to an agent because you want to ask the agent sort of the bottom-line question, ‘What do you think I should do?’ And if a navigator is asked that question they’re going to say, ‘I can’t tell you what to do.’”
“NAIFA remains concerned that consumers will be confused about the limitations of navigators,” Robert Smith, president of the National Association of Insurance and Financial Advisors, said in a statement today. “Brokers do much more than sell insurance … Brokers explain critical differences in plan options and coverage. This may involve substantial research and fact-finding about the client’s needs.”
The federal government and states that are operating their own exchanges are expected to release a training portal for both navigators and brokers/agents who plan to aide people on the exchanges. A marketplace timeline provided by CCIIO for the rollout of the Affordable Care Act says that this training will be complete by August. However, CMS officials said Monday that the training portal will be developed now that the navigator ruling is final. They did not comment on timing.
The final rule also establishes that certified application counselors are “another type of assistance personnel available to provide information to consumers and facilitate their enrollment in QHPs and insurance affordability programs,” the rule states.
The National Association of Health Underwriters said this morning that they are still evaluating the full regulation, which is 145 pages. At the NAHU conference last month brokers told EBA that they understood navigators were a reality but are confident that their role, advising people on their options, will remain invaluable.