Sneak Preview: CMS Proposes Flexibilities for ACA Exchange Navigator Grantees

Jerry Ashworth
February 1, 2019 at 07:09:41 ET
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(The following was excerpted from a recent article in the Federal Grants Management Handbook.) The Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule that would provide greater flexibilities for entities receiving Navigator program grants under the Patient Protection and Affordable Care Act (ACA) (Pub. L. 111-148).

ACA created the American Health Benefit Exchanges, which are marketplaces through which qualified employers can purchase health insurance coverage. Under the Navigator program established by the act, exchanges may award grants to entities (called “navigators”) to conduct public education activities to raise awareness of the availability of qualified health plans and facilitate enrollment in these plans. Program regulations require that the information made available by these entities is fair, accurate and impartial.

The ACA regulation at 45 C.F.R §155.210(e)(9) currently states that federally facilitated exchanges (FFE) — which are operated by HHS — may require or authorize a navigator receiving grant awards beginning in 2018 to provide assistance on a number of topics not specifically mentioned in the statute. These include helping users:

  • understand the process of filing exchange eligibility appeals;
  • understand and apply for exemptions from the individual shared responsibility payment that are granted through the exchange;
  • understand the exchange-related components of the premium tax credit reconciliation process;
  • understand basic concepts and rights related to health coverage and how to use their coverage; and
  • locate licensed tax advisers, tax preparers or other resources for assistance with tax preparation and tax advice related to consumer questions about the exchange application and enrollment process.

Under the proposed rule, CMS sought to provide more flexibility by amending this regulation at 45 C.F.R §155.210(e)(9) to make assistance with these topics permissible, but not required, for navigators that receive these grants in 2019.

“We believe making assistance with these topics optional for navigators would reduce regulatory burden on navigator entities and better meet consumers’ needs by allowing navigators to prioritize work according to consumer demand, community needs and organizational resources,” CMS explained. Although providing assistance would not be required, CMS emphasized that FFE navigators still would be authorized to continue to provide assistance with these topics based on an assessment of the communities needs, and to “build competency in the assistance activities in which they are engaging.” The CMS proposal also would continue to allow state-based exchanges (SBE) — which are operated by states — to determine whether to require or to authorize SBE navigators to perform these activities, if such would best meet the state’s needs and resources.

(The full version of this story has now been made available to all for a limited time here.)

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