Presentation on theme: "Becoming an Indiana Navigator and Certified Application Counselor"— Presentation transcript:
1 Becoming an Indiana Navigator and Certified Application Counselor
2 Learning ObjectivesIntroduce and explain the functions of consumer assistantsDefine Application Organizations, federal Navigators, Indiana Navigators, and Certified Application CounselorsDiscuss certification and certification renewal procedures for Application Organizations, federal Navigators, Indiana Navigators, and Certified Application CounselorsReview conflicts of interests, privacy, security and confidentiality standards, and state enforcement actions for consumer assistantsExamine tips for assisting population subtypes
3 Introduction to Consumer Assistants With the launch of the Patient Protection and Affordable Care Act (PPACA), Consumer Assistants such as Indiana Navigators and Certified Application Counselors (CACs) were introduced and designed to serve as unbiased, informed resources for consumers seeking health coverage.The ACA established basic training guidelines for assisters to follow regarding addressing the needs of underserved and vulnerable populations, eligibility and enrollment procedures, the range of public programs and qualified health plan (QHP) options available, and proper handling of tax data and personal information
4 Introduction to Consumer Assistants Types of consumer assistants include:Federal and State NavigatorsIn-person assistants (state-based Marketplaces)Certified Application Counselors (CACs)Authorized representativesPresumptive eligibility assessorsInsurance brokers, producers and agentsOthers named and defined by state
5 Introduction to Consumer Assistants Possible Types of Eligible NavigatorsCommunity and consumer-focused nonprofit groupsTrade, industry and professional associationsCommercial fishing industry organizations, ranching and farming organizationsChambers of commerceUnionsResource partners of the Small Business AdministrationLicensed agents and brokersOther public or private entities that meet the requirements
6 Application Organizations (AOs) An AO is an organization such as a community health center or FQHC that has employees and/or volunteers assisting consumers with applications for Marketplace-based health plans, insurance affordability programs and state-based health coverage programs like HIP and Hoosier HealthwiseOrganizations meeting the definition of "application organization" under Indiana Code must be registered with the Indiana Department of InsuranceHospitals that only perform presumptive eligibility (PE) are not required to register as AOs
7 Application Organizations (AO) Initial Application Initial Application Process:Complete the New Application for Application Organization Registration.Pay the online filing fee of $50 for Indiana business entity and the processing fee of $14.40 for a total of $64.40.Multi-location organizations registering as AOs must submit to IDOI the: (1) name, (2) address, (3) telephone, (4) , (5) website (if applicable), and (5) contact person; for each physical location of the Application Organization. Applicants may check the status of their application online at: www.sircon.com/login.html. (Only one application is needed for an entity with multiple locations.)Review the Conflict of Interest Policy, then complete and submit the Conflict of Interest Disclosure Form and Privacy and Security Agreement.Submit all documents to
8 Application Organizations (AO) Renewal Application Annual Renewal Process:AOs have a 30-day grace period following the expiration date to complete all steps.Complete the Renewal Application for Application Organization Registration.Pay the nonrefundable online filing fee of $50 for Indiana business entity and the processing fee of $14.40 for a total of $64.40Multi-location organizations registering as AOs must submit to IDOI the: (1) name, (2) address, (3) telephone, (4) , (5) website (if applicable), and (5) contact person; for each physical location of the Application Organization.Review the Conflict of Interest Policy and submit the Conflict of Interest Disclosure Form and Privacy and Security Agreement
9 Federal NavigatorsFederal Navigators are selected and funded by the federal government to serve in federally-facilitated (FFM) or Partnership Marketplace states for one year (minimum)The first round of federal Navigator fund recipients were announced by CMS on August 15, 2013The second round will be announced September 8, 20142013 Indiana Recipients:ASPIN: $897,150Plus One Enterprises, LTD, LLC: $130,875Health and Hospital Corporation of Marion County: $590,895United Way Worldwide: $424,586Federal Navigators in Indiana are also required to become Indiana Navigators
10 Indiana NavigatorsCertified to help consumers complete applications for health coverage including Medicaid and QHPs, and insurance affordability programs like Premium Tax Credits (PTCs) and Cost-Sharing Reductions (CSRs) in IndianaIndividuals who must be certified as Indiana Navigators include, but are not limited to:Federally-funded NavigatorsFederally-designated Certified Application Counselors (CACs)Medicaid Enrollment Center staff/volunteers helping with health coverage applicationsStaff/volunteers of other organizations helping with health coverage applications
11 Indiana Navigator Responsibilities Consumer outreach and educationAssessing the level and type of consumer needAssisting with eligibility assessmentAssisting with enrollmentChecking consumer enrollment statusIndiana Navigators DO NOT advise on plan selection.Only health insurance producers licensed in Indiana are authorized to do so
12 Indiana Navigator Certification Steps 1-2 Complete Pre-Certification Training from an IDOI-approved Pre-Certification Training Provider. The cost may vary based on the training source.Download and review the Training Content Manual, Score Report and Subject Matter Content Outline.A recommended provider is through IndianaNavigators.org which offers a free* online training program certified by the IDOI.After the 1st module there is a *$4.95 certificate upload fee to access the 1st quiz and advance through the remaining 4 modules.Submit online the New Application for Individual Indiana Navigator CertificationPay the non-refundable online application fee ($50 for Indiana residents; $100 for non-residents) and $15 processing fee.
13 Indiana Navigator Certification Steps 3-5 Review the Conflict of Interest Disclosure Policy and the signed Conflict of Interest Statement and Disclosure Form, Privacy & Security AgreementComplete a criminal background check ($7-$17 for Indiana Residents)Schedule, pay for ($84.75), and pass the Indiana Navigator Certification ExaminationA passing score is 70% or 42 questions correct out of 60 with 90 minutes to complete.all application materials to:All Navigators receive a unique ID number upon successful completion of all steps. A certificate may be requested using the above address.
14 Maintaining & Renewing Indiana Navigator Certification 60 days prior to the renewal deadline, Indiana Navigators will receive a notice to renew no later than the last day of the anniversary month of the original certification date; the following steps must be completed:Complete 2 hours of continuing education through an IDOI-approved Navigator CE provider annuallyComplete shorter application and pay $64.40 for filing and processing feesReview the Conflict of Interest Policy and sign and submit new Conflict of Interest Disclosure Form and Privacy and Security Agreement
15 Reporting Requirements for Indiana Navigators Inform Indiana Department of Insurance (IDOI) within 30 days of information changes such as:Legal nameAddressCriminal historyConflicts of interestDelinquent state tax and/or child support paymentsSecurity breaches or improper disclosure of consumer’s personally information no later than 5 days following the discovery
16 Conflicts of Interest Policy for Navigators Conflicts of interest include personal or business interests that may influence the advice and assistance the Indiana Navigator or AO provides to a consumerThese conflicts may be financial or non-financial, direct or indirect and include:Financial Conflict of InterestReceiving direct or indirect financial compensation or incentive for the enrollment of an individual into a particular health coverage planE.g. receiving $5 from No Name Insurance Company for enrolling a consumer in one of their plansCompensation that is not in connection with the enrollment of a consumer is generally not a prohibited conflict of interest
17 Conflicts of Interest Policy for Navigators 2. Loyalty Conflict of InterestHaving a direct or indirect relationship, through business or family, an interest or relationship with a third party that prohibits or inhibits the individual or organization from exercising independent judgment in the best interest of consumerChanges in potential or actual conflicts of interest must be reported to IDOI within 30 days of the change.
18 Privacy, Security and Confidentiality Standards Indiana Navigators and AOs have access to some very personal information such as income, Social Security number, birthdate and addressDue to the sensitivity of this information, Navigators and AO must agree to maintain the confidentiality of and protect any information provided by the consumer in the process of applying for and enrolling in a qualified health plan (QHP) or public health insurance program like HIP.
19 Privacy, Security and Confidentiality Standards When sharing the consumer’s personal information with an authorized individual, only provide the minimum amount of personal information neededDo not leave a computer screen displaying personal information unattendedProtect the consumer’s personal information against an reasonably anticipated uses or disclosures that are not permitted or required by law Per Ind. Code § , consumer personal information must be securely destroyed or disposed of in a way that will make the information unusablePer Ind. Code § , if the Indiana Navigator and/or Application Organization becomes aware of a security breach or improper disclosure of personal information, the consumer must be informed
20 Prohibited Actions of Indiana Navigators Prohibited HistoryProhibited Actions of Indiana NavigatorsHold/held an insurance producer license, navigator certificate, AO registration that has been denied, suspended, or revokedProvide inaccurate, misleading, incomplete or materially untrue information on applicationConviction of a felony or other crime determined by FSSA and IDOIObtain or attempt to obtain a license, certification or registration through misrepresentation or fraudAdmission or conviction of unfair trade practice or fraud [in the business of insurance]Violate: an insurance law/regulation, subpoena or order of the commissioner, rule of the marketplace operating in Indiana, rule adopted under Indiana Code (d) and/or PPACAIntentionally misrepresent the terms of an actual or proposed insurance contract or application for insuranceUse fraudulent, coercive or dishonest practices or demonstrate incompetence or untrustworthiness in acting as an Indiana Navigator or Application OrganizationCheat on a certification examinationReceive consideration for a health insurance issuer in connection with enrollment of an individual into a health insurance plan
21 Ethical Standards for Consumer Assistants DO:DO NOT :Be honest regarding personal bias or conflict of interestMake up or guess an answer to a questionGive complete and accurate informationAsk anyone for more information than absolutely necessaryAdmit when one does not know the answerJoke about sensitive physical, social or cultural differenceProtect the personal information of the people being assistedUse derogatory or profane language toward or about a consumerBe sensitive to different culturesUse professional languageEmpower consumer to make educated choices
22 State Enforcement Actions for Navigators IDOI reviews and approves all Indiana Navigator and AO application materialsThe state monitors Indiana Navigators and AOs and the quality of applications through complaints and internal trackingIf there is a consistent problem with a given Indiana Navigator or AO, the state may utilize an enforcement action such as:ReprimandCivil penaltyProbationSuspensionRevocationPermanent revocation, and/orCease and desist order
23 Certified Application Counselors (CACs) CAC organizations (usually the AO) apply to and are designated by the Marketplace (CMS)The organization is responsible for assigning CAC numbers and training their staff and volunteers as individual CACsThe federal government provides the training and certification materials but does not provide any funding for itParticipation is optionalCACs may not impose fees for assistancePrimary ResponsibilitiesAssist with Marketplace applicationsFacilitate enrollment of eligible individuals in QHPs and insurance affordability programsDisclose any conflicts of interests and comply with privacy and security agreementsAct in the best interest of the consumerAbide by federal standards
24 Certified Application Counselors (CACs) To be come certified as CACs, applicants must:Complete Marketplace-approved training and pass all examinations.Disclose to the designated CAC organization or to the Marketplace and potential applicants any potential conflicts of interestComply with privacy and security standards and data security standards.Agree to act in the best interest of the consumers assisted.Provide information in a manner that is accessible to individuals with disabilities.Enter into an agreement with the designated CAC organization regarding compliance with federal standards.
25 Addressing Consumer Needs Need or ConcernResource(s)The Affordable Care ActFederal Marketplace call centerHealth plan detailsHealth plan summary of benefits, Employer’s Human Resources of Benefits ManagerPlan recommendationsIDOI—research “Find agent/broker”Plan qualityFederal Marketplace researching, “Consumer Experience”Complaints about a Consumer AssistantIDOIComplaints about Health Insurance Plan1st : Contact health insurance company2nd: If unable to resolve the issue with health insurance company, contact IDOI
26 Serving Different Cultures and Languages It is important to have the skills to provide assistance to those of all racial, ethnic and cultural groups in your given service area.In Indiana, there are more than 100 languages spoken, so it is helpful to know what resources are available for translation.As of 2010, there are 262,198 speaking Spanish, 35,439 speaking German, 16,473 speaking Chinese, 16,120 speaking Pennsylvania Dutch and 14,063 speaking French in Indiana.The call center ( ) offers immediate assistance in English and Spanish with a language line for other options.
27 Serving Persons With Disabilities In Indiana, it is most likely that consumer assistants will work with individuals that have a type of disabilityYou should:Ensure consumer education materials, websites, etc. are accessible to allProvide assistance in a location & in a manner physically accessibleEnsure authorized representatives are able to assist with decisionsBe able to refer people with disabilities to local, state, and federal support servicesBe able to work with individuals regardless of age, disability, or cultureType of disabilityPrevalence in Indiana in 2011Hearing disability2.2%Visual disability3.7%Cognitive disability5.2%Ambulatory disability7.4%Self-care disability2.5%Independent living disability5.7%TOTAL DISABILITY PREVALENCE13.1%
28 Helpful Resources for Consumer Assistants Centers for Medicare and Medicaid (CMS) Call Center;Open 24 hours a day, 7 days a weekOffers general consumer assistance in English and Spanish and utilizes a language lineSmall Business (SHOP) HelplineAvailable Monday-Friday 9 a.m. to 7 p.m. ESTIndiana Division of Disability and Rehabilitative Services (DDRS)Provides Medicaid disability eligibility informationHoosier Healthwise Enrollment Centers (HHW);Indiana Department of Insurance (IDOI)or ;Family and Social Services Administration– Division of Family Resources (DFR), ;Open Monday-Friday 8 a.m. to 4:30 p.m. ESTProvides Medicaid, Hoosier Healthwise (HHW), and Healthy Indiana Plan (HIP) information and assistance