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HHS Releases Final Rule on Healthcare Navigators

The U.S. Department of Health and Human Services (HHS) released the long anticipated Final Rule on healthcare navigators last week...
July 23, 2013

The U.S. Department of Health and Human Services (HHS) released the long anticipated Final Rule on healthcare navigators last week. The document is very similar to the previously released Proposed Rule from April. The document covers an array of topics, including public comments, conflict-of interest claims and fraud potential. It also notes that should a licensed insurance agent wish to become a navigator, the agent must be licensed/certified as a navigator; an insurance license is not by itself sufficient to serve as a navigator.

PIA has long voiced concerns about a lack of controls surrounding potential fraud or abuse by navigators. The Final Rule confirms that navigators will have access to personally identifiable information (PII), but it fails to establish proper safeguards. Instead, HHS says that it “does not expect” navigators to retain the PII, and notes that navigators “generally” will not have access to such information when the consumer is not present. It adds that should fraud occur, HHS will take appropriate action, although it fails to say what that action would be or what enforcement authority would be exercised.

What It Means to Agents: Despite issuing its Final Rule, HHS has yet to address all of PIA’s concerns regarding healthcare navigators.

HHS Final Rule on Navigators (Federal Register 7/17/13)

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