Becoming an Indiana Navigator and Certified Application Counselor

Learning Objectives

I. Introduce and explain the functions of consumer assistants

II. Define Application Organizations, federal Navigators, Indiana Navigators, and Certified Application Counselors

III. Discuss certification and certification renewal procedures for Application Organizations, federal Navigators, Indiana Navigators, and Certified Application Counselors

IV. Review conflicts of interests, privacy, security and confidentiality standards, and state enforcement actions for consumer assistants

V. Examine tips for assisting population subtypes

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

Types of consumer assistants include:– Federal and State Navigators

– In-person assistants (state-based Marketplaces)

– Certified Application Counselors (CACs)

– Authorized representatives

– Presumptive eligibility assessors

– Insurance brokers, producers and agents

– Others named and defined by state

Introduction to Consumer Assistants

Possible Types of Eligible Navigators Community and consumer-focused nonprofit groups Trade, industry and professional associations Commercial fishing industry organizations, ranching and farming organizations Chambers of commerce Unions Resource partners of the Small Business Administration Licensed agents and brokers Other public or private entities that meet the requirements

Introduction to Consumer Assistants

• 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 Healthwise – Organizations meeting the definition of

"application organization" under Indiana Code 27-19-2-3 must be registered with the Indiana Department of Insurance

– Hospitals that only perform presumptive eligibility (PE) are not required to register as AOs

Application Organizations (AOs)

Initial Application Process: 1. Complete the New Application for Application Organization Registration.

1. Pay the online filing fee of $50 for Indiana business entity and the processing fee of $14.40 for a total of $64.40.

2.Multi-location organizations registering as AOs must submit to IDOI the: (1) name, (2) address, (3) telephone, (4) email, (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.)

3.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 Navigator@idoi.in.gov

Application Organizations (AO) Initial Application

Annual Renewal Process:

•AOs have a 30-day grace period following the expiration date to complete all steps. 1.Complete the Renewal Application for Application Organization Registration.

2.Pay the nonrefundable online filing fee of $50 for Indiana business entity and the processing fee of $14.40 for a total of $64.40

3.Multi-location organizations registering as AOs must submit to IDOI the: (1) name, (2) address, (3) telephone, (4) email, (5) website (if applicable), and (5) contact person; for each physical location of the Application Organization.

4.Review the Conflict of Interest Policy and submit the Conflict of Interest Disclosure Form and Privacy and Security Agreement

Application Organizations (AO) Renewal Application

Federal Navigators

• Federal 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, 2013

• The second round will be announced September 8, 2014 2013 Indiana Recipients: –ASPIN: $897,150

–Plus One Enterprises, LTD, LLC: $130,875

–Health and Hospital Corporation of Marion County: $590,895

–United Way Worldwide: $424,586

• Federal Navigators in Indiana are also required to become Indiana Navigators

• Certified 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 Indiana

• Individuals who must be certified as Indiana Navigators include, but are not limited to:– Federally-funded Navigators– Federally-designated Certified Application Counselors (CACs)– Medicaid Enrollment Center staff/volunteers helping with health

coverage applications– Staff/volunteers of other organizations helping with health coverage

applications

Indiana Navigators

Indiana Navigator Responsibilities

• Consumer outreach and education• Assessing the level and type of

consumer need• Assisting with eligibility assessment• Assisting with enrollment• Checking consumer enrollment status• Indiana Navigators DO NOT advise

on plan selection. – Only health insurance producers licensed

in Indiana are authorized to do so

1. 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.

2. Submit online the New Application for Individual Indiana Navigator Certification

– Pay the non-refundable online application fee ($50 for Indiana residents; $100 for non-residents) and $15 processing fee.

Indiana Navigator Certification Steps 1-2

3. Review the Conflict of Interest Disclosure Policy and email the signed Conflict of Interest Statement and Disclosure Form, Privacy & Security Agreement

4. Complete a criminal background check ($7-$17 for Indiana Residents)

5. Schedule, pay for ($84.75), and pass the Indiana Navigator Certification Examination• A passing score is 70% or 42 questions correct out of 60 with 90 minutes to

complete.

• Email all application materials to: Navigator@idoi.in.gov • All Navigators receive a unique ID number upon successful completion of all

steps. A certificate may be requested using the above email address.

Indiana Navigator Certification Steps 3-5

• 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:

1. Complete 2 hours of continuing education through an IDOI-approved Navigator CE provider annually

2. Complete shorter application and pay $64.40 for filing and processing fees

3. Review the Conflict of Interest Policy and sign and submit new Conflict of Interest Disclosure Form and Privacy and Security Agreement

Maintaining & Renewing Indiana Navigator Certification

Reporting Requirements for Indiana Navigators

Inform Indiana Department of Insurance (IDOI) within 30 days of information changes such as:

• Legal name• Address • Criminal history• Conflicts of interest • Delinquent state tax and/or child support

payments • Security breaches or improper disclosure of consumer’s personally

information no later than 5 days following the discovery

• Conflicts of interest include personal or business interests that may influence the advice and assistance the Indiana Navigator or AO provides to a consumer

• These conflicts may be financial or non-financial, direct or indirect and include:

1. Financial Conflict of Interest • Receiving direct or indirect financial compensation or incentive for

the enrollment of an individual into a particular health coverage plan

• E.g. receiving $5 from No Name Insurance Company for enrolling a consumer in one of their plans

• Compensation that is not in connection with the enrollment of a consumer is generally not a prohibited conflict of interest

Conflicts of Interest Policy for Navigators

Conflicts of Interest Policy for Navigators

2. Loyalty Conflict of Interest Having 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 consumer

Changes in potential or actual conflicts of interest must be reported to IDOI within 30 days of the

change.

Privacy, Security and Confidentiality Standards

• Indiana Navigators and AOs have access to some very personal information such as income, Social Security number, birthdate and address

• Due 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.

Privacy, Security and Confidentiality Standards

• When sharing the consumer’s personal information with an authorized individual, only provide the minimum amount of personal information needed

• Do not leave a computer screen displaying personal information unattended

• Protect the consumer’s personal information against an reasonably anticipated uses or disclosures that are not permitted or required by law Per Ind. Code §24-4.9-3.5, consumer personal information must be securely destroyed or disposed of in a way that will make the information unusable

• Per Ind. Code §24-4.9-3, 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

Prohibited History Prohibited Actions of Indiana NavigatorsHold/held an insurance producer license, navigator certificate, AO registration that has been denied, suspended, or revoked

Provide inaccurate, misleading, incomplete or materially untrue information on application

Conviction of a felony or other crime determined by FSSA and IDOI

Obtain or attempt to obtain a license, certification or registration through misrepresentation or fraud

Admission 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 27-19-3-3(d) and/or PPACA

Intentionally misrepresent the terms of an actual or proposed insurance contract or application for insurance

Use fraudulent, coercive or dishonest practices or demonstrate incompetence or untrustworthiness in acting as an Indiana Navigator or Application Organization

Cheat on a certification examination

Receive consideration for a health insurance issuer in connection with enrollment of an individual into a health insurance plan

DO: DO NOT :Be honest regarding personal bias or conflict of interest

Make up or guess an answer to a question

Give complete and accurate information

Ask anyone for more information than absolutely necessary

Admit when one does not know the answer

Joke about sensitive physical, social or cultural difference

Protect the personal information of the people being assisted

Use derogatory or profane language toward or about a consumer

Be sensitive to different cultures

Use professional language

Empower consumer to make educated choices

Ethical Standards for Consumer Assistants

• IDOI reviews and approves all Indiana Navigator and AO application materials

• The state monitors Indiana Navigators and AOs and the quality of applications through complaints and internal tracking

• If there is a consistent problem with a given Indiana Navigator or AO, the state may utilize an enforcement action such as:– Reprimand

– Civil penalty

– Probation

– Suspension

– Revocation

– Permanent revocation, and/or

– Cease and desist order

State Enforcement Actions for Navigators

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 CACs

• The federal government provides the training and certification materials but does not provide any funding for it

• Participation is optional

• CACs may not impose fees for assistance

Primary Responsibilities•Assist with Marketplace applications •Facilitate enrollment of eligible individuals in QHPs and insurance affordability programs•Disclose any conflicts of interests and comply with privacy and security agreements •Act in the best interest of the consumer •Abide by federal standards

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 interest•Comply 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.

Need or Concern Resource(s)

The Affordable Care Act Federal Marketplace call center

Health plan details Health plan summary of benefits, Employer’s Human Resources of Benefits Manager

Plan recommendations IDOI—research “Find agent/broker”

Plan quality Federal Marketplace researching, “Consumer Experience”

Complaints about a Consumer Assistant IDOI

Complaints about Health Insurance Plan 1st : Contact health insurance company 2nd: If unable to resolve the issue with health insurance company, contact IDOI

Addressing Consumer Needs

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 (1-800-318-2596) offers immediate assistance in English and Spanish with a language line for other options.

Serving Persons With Disabilities

Type of disability Prevalence in Indiana in 2011Hearing disability 2.2%Visual disability 3.7%

Cognitive disability 5.2%Ambulatory disability 7.4%

Self-care disability 2.5%Independent living disability 5.7%

TOTAL DISABILITY PREVALENCE 13.1%

• In Indiana, it is most likely that consumer assistants will work with individuals that have a type of disability

• You should:• Ensure consumer education materials, websites, etc. are accessible to all• Provide assistance in a location & in a manner physically accessible• Ensure authorized representatives are able to assist with decisions• Be able to refer people with disabilities to local, state, and federal support

services• Be able to work with individuals regardless of age, disability, or culture

Centers for Medicare and Medicaid (CMS) Call Center 1-800-318-2596; www.healthcare.gov Open 24 hours a day, 7 days a week Offers general consumer assistance in English and Spanish and utilizes a language line

Small Business (SHOP) Helpline1-800-706-7893Available Monday-Friday 9 a.m. to 7 p.m. EST

Indiana Division of Disability and Rehabilitative Services (DDRS) 1-800-545-7763

Provides Medicaid disability eligibility information

Hoosier Healthwise Enrollment Centers (HHW) 1-800-889-9949; http://www.in.gov/fssa/3030.htm Indiana Department of Insurance (IDOI) 1-800-622-4461 or 317-232-2385; http://www.in.gov/idoi/ Family and Social Services Administration– Division of Family Resources (DFR) 317-232-4704, 1-800-403-0864; http://www.in.gov/fssa/2407.htm

Open Monday-Friday 8 a.m. to 4:30 p.m. ESTProvides Medicaid, Hoosier Healthwise (HHW), and Healthy Indiana Plan (HIP) information and assistance

Helpful Resources for Consumer Assistants