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New Federal ACA Rules Ban Some State Standards for Navigators

Final rules issued Friday May 16, by the Centers for Medicare and Medicaid Services (CMS), in the U.S. Department of Health and Human Services (HHS), significantly lower standards for health insurance navigators, putting consumers at increased risk...
May 28, 2014

 

Final rules issued Friday May 16, by the Centers for Medicare and Medicaid Services (CMS), in the U.S. Department of Health and Human Services (HHS), significantly lower standards for health insurance navigators, putting consumers at increased risk. They would permit unlicensed navigators to perform some of the functions of licensed insurance agents and brokers, while prohibiting the states from requiring that they obtain an agent or broker license.

“The Obama administration is attempting to gut the prudent actions taken by many states to ensure that healthcare consumers do not become victims,” said PIA National Executive Vice President & CEO Mike Becker in a statement. “These new rules are an attempt by the federal government to significantly lower professional standards for healthcare navigators by preempting more stringent state requirements.”

The new rules prohibit states from creating standards that “prevent the application of the provisions of Title I of the Affordable Care Act (ACA).” The rule does not overturn all State laws concerning navigators; local laws that require registration or passing fingerprinting and background checks are allowed to go forward, provided that its implementation is consistent with Federal standards. The new rule does, however, drop the prohibition against requiring errors and omissions insurance.

“These new rules specify that navigators cannot be prevented from offering consumers advice, while at the same time prohibiting states from requiring navigators to hold an agent or broker license,” said PIA National Director of Federal Affairs Jon Gentile. “By so doing, these rules attempt to declare that unlicensed navigators can perform the functions and duties of licensed insurance agents and brokers without being duly licensed, and that the states are powerless to do anything about it.”

What It Means to Agents: PIA supports the adoption of strict standards governing navigators. PIA believes that a navigator’s role should be carefully defined and overseen by the states, and that navigators should not be allowed to engage in activities that include selling, soliciting or negotiating insurance. PIA encourages states to challenge this attempt at preemption.

The final rule on Exchange and Insurance Market Standards for 2015 and beyond, released by the Centers for Medicare and Medicaid Services (CMS), was accompanied by a fact sheet and a set of Frequently Asked Questions.

Statement by PIA Regarding HHS Navigator Rules (5/19/14)
PIA Position Paper on Healthcare Navigators

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