Check-out this presentation - Indiana Primary Health Care Association

Becoming an Indiana
Navigator and Certified
Application Counselor
Learning Objectives
I.
II.
III.
IV.
V.
Introduce and explain the functions of consumer
assistants
Define Application Organizations, federal Navigators,
Indiana Navigators, and Certified Application Counselors
Discuss certification and certification renewal procedures
for Application Organizations, federal Navigators, Indiana
Navigators, and Certified Application Counselors
Review conflicts of interests, privacy, security and
confidentiality standards, and state enforcement actions
for consumer assistants
Examine tips for assisting population subtypes
Introduction to Consumer Assistants
• Consumer Assistants such as Indiana Navigators and Certified
Application Counselors (CACs) were introduced with the Patient
and Protection Affordable Care Act, or the ACA and designed to
serve as unbiased, informed resources for consumers seeking
health coverage application assistance.
• The ACA established basic training guidelines for assisters to follow
regarding:
 Needs of underserved and vulnerable populations
 Eligibility and enrollment procedures
 Range of public programs and qualified health plan (QHP) options
 Proper handling of tax data and personal information
Introduction to Consumer Assistants
Types of consumer assistants:
– Indiana Navigators
– Federal Navigators
– Certified Application Counselors
(CACs)
– Authorized representatives
– Presumptive eligibility assessors
– Insurance brokers, producers and
agents
Barb Hickner, Outreach and Enrollment Coordinator at
Family Health Clinic of Carroll County in Delphi, Indiana
In this module, we will focus on the main types of
consumer assistants in Indiana: Indiana Navigators,
Federal Navigators, and CACs.
Introduction to Consumer Assistants
Where are the Consumer Assistants?
 Community and consumer-focused nonprofit groups (like health
centers)
 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
Application Organizations (AOs)
Application Organizations (AOs)
• An AO is an organization such as a statefunded Community Health Center (CHC) or
Federally Qualified Health Center (FQHC)
that has employees and/or volunteers
assisting consumers with applications for
health coverage (Marketplace and statebased programs like HIP) and insurance
affordability programs like premium tax
credits (PTCs).
• Organizations meeting the definition of
"application organization" under Indiana
Code 27-19-2-3 must be registered with the
Indiana Department of Insurance (IDOI).
AO Initial Application Steps
1. Complete the New Application for Application Organization Registration.
 Pay the online filing ($50)* and processing fees ($14.40)*.
 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.)
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.
3. Review the Conflict of Interest Policy, then complete and submit the Conflict of
Interest Disclosure Form and Privacy and Security Agreement.
4. Submit all documents online at end of online application or to
[email protected]
*All fees are current as of August 11, 2015 but are subject to change.
Non-resident businesses will pay $100 for online filing.
AO Renewal Steps
AOs have a 30-day grace period following the annual expiration date to
complete the following steps:
1. Complete the Renewal Application for Application Organization Registration.
• Pay the nonrefundable online filing ($50)* and processing fees ($7.23)*.
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.
3. Review the Conflict of Interest Policy and submit the Conflict of Interest
Disclosure Form and Privacy and Security Agreement
4. Submit all documents at end of online application or to [email protected]
*All fees are current as of August 11, 2015 but are subject to change.
Non-resident businesses will pay $100 for online filing.
AO Reporting Requirements
• All AOs report certain things to the Indiana Department of
Insurance(IDOI) via a Service Request Form including:
Within thirty (30) days:
 Change in legal name or address
 Changes in “conflict of interest” status
 Additions and deletions of Indiana Navigators
associated with the AO
 Administrative, state, and federal actions following
the final disposition of the matter, including:
•
•
•
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Administrative action against the AO’s professional
license, certification, or registration within any jurisdiction
A federal or state criminal action within any jurisdiction
An administrative action or court order requiring payment
of state income tax
An administrative or legal action related to unfair trade
practice or fraud in the business of insurance within any
jurisdiction
As soon as reasonably
possible but no later
than five (5) days
following discovery:
 Security breach or
improper disclosure of
a consumer's personal
information
The consumer must be
notified within 10 days of
discovery.
All forms may be emailed to [email protected]
Indiana Navigators
Indiana Navigators
• Certified to help consumers complete applications for insurance
affordability programs such as Medicaid, and QHPs, 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
Angela Reavis, Indiana Navigator at Tulip
Tree Family Health Care in Fort Branch, IN
Indiana Navigators
• All individuals completing Indiana Health Coverage Programs
(IHCP; also known as Medicaid) and/or Marketplace enrollments
are required to become an Indiana Navigator.
Main Responsibilities:
Consumer
outreach and
education
Assessing the
level and type
of consumer
need
Assisting with
enrollment
Assisting with
eligibility
appeals
Checking
consumer
enrollment
status
Indiana Navigator Prohibited History and Conduct
Individuals cannot be an Indiana Navigator if he or she:
• Has had the following denied, suspended, or revoked:
– Insurance agent or broker licenseIndiana Navigator certification or equivalent
license or certification
• Has been convicted of a disqualifying felony or other crime
– Decision made by Indiana Department of Insurance (IDOI)
• Has admitted to/been convicted of unfair trade practice/fraud in insurance
business
• Failed to pay state income tax or child support obligation
Indiana Navigators DO NOT advise on plan selection. Only health
insurance producers licensed in Indiana are authorized to do so. They
MAY provide general information to help consumers make the best
choice according to his or her needs.
Indiana Navigator Certification Steps 1-3 (of 6)
There is no particular order for completing the certification steps, but keep in mind
that all documents/forms can be attached electronically to the online application.
1. Complete online New Application for Indiana Navigator Certification. ($50
and $14.40 processing fee for Indiana residents)* (Licensed insurance
producers and consultants are excluded from this requirement and must submit
the Designation Form for Licensed Producers and Consultants.)
2. Review the Pre-Certification Training Materials and Complete
Precertification Training and Continuing Education from an IDOIapproved Navigator Pre-Certification education (PE) provider. (IPHCA
recommends www.IndianaNavigators.org for just $4.95.) The provider will report
completion to IDOI.
3. Complete and submit a Background Check ($7-17 for Indiana residents) *
(Licensed insurance producers and consultants are excluded from this
requirement.)
*All fees are current as of August 11, 2015 but are subject to change.
Non-residents will pay $100 for online filing.
Indiana Navigator Certification Steps 4-6 (of 6)
4. Review the Conflict of Interest Policy, then complete and submit
the Conflict of Interest Disclosure Form.
5. Review, sign, and submit the Privacy and Security Agreement.
6. Register for (cost is $84.75*) and pass certification exam. View the next
slide for exam information , and follow the Certification Examination
Procedure and Guidelines. (Licensed insurance producers and consultants
are excluded from this requirement.)
Submitting Required Documents:
All forms/documents may be attached electronically to the end of the online
application. They may also be submitted to IDOI by:
•
•
•
Email: [email protected]
Fax: 317-232-5251 ("attn: Navigator Director"), or
Mail: Indiana Department of Insurance, c/o Navigator Director, 311 W. Washington St.,
Ste. 300, Indianapolis, IN 46204.
*All fees are current as of August 11, 2015 but are subject to change.
Indiana Navigator Exam Procedures and Guidelines
1. Register: https://secure.vitapowered.com/idoi/login.screen.
2. Create an account and complete the registration form.
3. Select the exam that matches your course certificate of
completion.
4. Pay for exam ($84.75*).
5. Schedule your exam at nearest Ivy Tech location. If there are no
available seats at the center of your choice, you
may submit a Seat Request email.
6. Take the certification exam. You will need the
following information:
– Login ID and Password
– Course Certificate of Completion or IDOI Waiver
– Federal or State ID
*Fee is current as of August 11, 2015 but is subject to change.
Indiana Navigator Exam Quick Facts
•
•
•
•
•
Exam content will follow the Score Report
Allotted time for completion: 90 minutes
Multiple choice consisting of 60 questions
Must score at least 70 percent accuracy level (42 correct)
Must be taken no later than 90 days after submitting the online
application
• Upon passing, you and IDOI will receive notification of approval.
View more information and quick FAQs on the
Indiana Navigator Examination Procedure and
Guidelines page
Checking the Status of Your IN Navigator Application
• Applicants may check the status of their application online
at: www.sircon.com/login.html.
– Application submissions will remain "Pending"/"Under State
Review" until all six steps are complete.
– Application submissions still pending/incomplete after 90 days from
the submission date will be withdrawn.
• All Navigators receive a unique ID number
upon successful completion of all steps.
A certificate may be requested by emailing
[email protected].
Maintaining & Renewing Indiana Navigator
Certification
Sixty (60) days prior to the annual 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 two (2) hours of continuing education through an IDOIapproved Navigator CE provider.
2. Complete shorter application and pay filing ($50) and processing fee
($8.63)*
3. Review the Conflict of Interest Policy and sign and submit new Conflict of
Interest Disclosure Form if you have an actual or potential Conflict of
Interest.
*Fees are current as of August 11, 2015 but are subject to change.
Non-residents will pay $100 for filing.
Reporting Requirements for Indiana Navigators
• Inform Indiana Department of Insurance (IDOI) using the
Service Request Form within 30 days of information
changes such as:
Legal Name
Address
Criminal
History
Delinquent state
tax and/or child
support payments
Security breaches or
improper disclosure
of consumer's PII no
later than 5 days
following discovery
Conflicts of
Interest
Conflicts of Interest Policy for Navigators
What are they?
• Personal or business interests that may influence assistance Indiana
Navigators/AOs provide to consumers and include:
Financial Conflict of Interest
 Receiving direct or indirect financial compensation or incentive for
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.
Loyalty Conflict of Interest
 Having a direct or indirect relationship or an interest in a third
party that prohibits or inhibits the Navigator/AO from exercising
independent judgment in the best interest of consumer
Compensation from Insurance Companies
Indiana Navigators and AOs must follow these rules regarding
accepting such as cash and gifts from insurance companies :
CANNOT Accept:
•
•
•
•
•
•
Cash
Paid commission
Grants
Credit/loans
Gifts
Free or discounted travel
or prizes
CAN Accept:
• Goods or other
advertisement with
a value of less
than $100 per year,
per insurance issuer
Privacy, Security and Confidentiality Standards
• Indiana Navigators and AOs have access to
some very personal information such as income,
Social Security number (SSN), birthdate, and
address—this information is known as
Personally Identifiable Information (PII)
• Due to the sensitivity of PII, Navigators and AO
must agree to maintain confidentiality of and
protect information provided by a consumer in
the application and enrollment processes for a
qualified health plan (QHP) or state health
insurance program like HIP.
Privacy, Security and Confidentiality Standards
• When sharing consumer PII with authorized individual(s), only provide
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 Actions of Indiana Navigators
• Provide inaccurate, misleading, incomplete or materially untrue information on
application
• Obtain or attempt to obtain a license, certification or registration through
misrepresentation or fraud
• Violate: an insurance law/regulation, subpoena or order of the commissioner, rule of
the Marketplace, 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 compensation for a health insurance issuer in connection with enrollment of
an individual into a health insurance plan
State Enforcement Actions for Navigators
• 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
Certified Application Counselors
(CACs)
CACs: A Background
• Like Indiana Navigators, CACs provide free, unbiased assistance
to consumers applying for and enrolling in health coverage.
– In Indiana, CACs must also be certified Indiana Navigators.
• The federal government (Centers for Medicare and Medicaid)
provides the training and certification materials but does not
provide any funding for it.
– However, there is no cost associated with becoming a CAC.
• Individuals who want to become CACs must be affiliated with a
CAC Designated Organization (CDO), an organization
designated by the Marketplace to oversee individual CACs.
– Organizations (FQHCs) receiving HRSA funding must become a CDO and
appoint enrollment staff as CACs.
• CACs may not impose fees for assistance.
CAC Designated Organization (CDO) Registration
Steps
1. Complete the application to be a Certified Application Counselor Organization
•
The individual identified as the authorized representative on the application should hear
back from CMS within a few weeks by email. The email will contain a contract.
2. Sign contract and return to CMS.
3. Once approved, help staff or volunteers become certified as individual CACs.
•
The authorized representative must assign each CAC a unique number which will
consist of the organization’s number (e.g. INCACA9401).
4. CAC organizations must have these two agreements in place before assisting
consumers:
•
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An agreement between the CAC organization and the Centers for Medicare and
Medicaid Services (CMS).
Agreement(s) between the CAC organization and individual CAC(s) (staff and/or
volunteers).
CAC Responsibilities
Assist with
Marketplace
applications
Facilitate enrollment of
eligible individuals in
QHPs and insurance
affordability programs
Act in the best
interest of the
consumer
Disclose any conflicts
of interests and comply
with privacy and
security agreements
Abide by federal
standards
CAC Certification
• CMS recommends that CACs complete CAC training prior to the
beginning of each annual Open Enrollment Period, even if this is
prior to the expiration date of their certification, to receive the
most up-to-date information.
1. Complete Marketplace-approved training (Available on
https://marketplace.medicarelearningnetworklms.com/Default.aspx) and
pass all examinations.
2. Enter into an agreement with the designated CAC organization regarding
compliance with federal standards.
3. Disclose to the CAC organization any potential conflicts of interest.
4. Upon completion of the training, the CAC organization will issue
certificates once they have completed these requirements.
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)
– Organizations wishing to have federal Navigator funding must submit a written
proposal and application to CMS to be considered.
– In April 2015, CMS announced the new funding period will be 36 months;
recipients will be announced in early September 2015.
– View a listing of recipients by state here.
• Must complete comprehensive training via the Medicare Learning
Network (20 hours)
• If working in Indiana: required to also become Indiana Navigators
Ethical Standards for Consumer Assistants
DO
DO NOT
 Be honest regarding personal bias or
conflict of interest
 Give complete and accurate
information
 Admit when you do not know the
answer
 Protect personal information
 Be sensitive to different cultures
 Use professional language
 Empower consumer to make educated
choices
x Make up or guess an answer to a
question
x Ask anyone for more information
than absolutely necessary
x Joke about sensitive physical, social
or cultural difference
x Use derogatory or profane language
toward or about a consumer
x Disclose personal information to
anyone not assisting with the
enrollment of the individual
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
• In Indiana, it is most likely that consumer assistants will work with
individuals that have a type of disability
• You should:
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–
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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
Type of disability
Prevalence in Indiana in 2011
Hearing disability
Visual disability
Cognitive disability
Ambulatory disability
Self-care disability
Independent living disability
2.2%
3.7%
5.2%
7.4%
2.5%
5.7%
TOTAL DISABILITY PREVALENCE
13.1%
Helpful Resources for Consumer Assistants
• Indiana Department of Insurance (IDOI)
– 1-800-622-4461 or 317-232-2385; Information for IN Navigators:
www.in.gov/idoi/2823.htm
• 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) Helpline
– 1-800-706-7893
– Available Monday-Friday 9 a.m. to 7 p.m. EST (busiest from the 13th to the 15th of the
month
• Family and Social Services Administration–Division of Family
Resources (DFR)
– 1-800-403-0864; www.in.gov/fssa/2407.htm
– Open Monday-Friday 8 a.m. to 4:30 p.m. EST
– Provides Medicaid, Hoosier Healthwise (HHW), and Healthy Indiana Plan (HIP)
information and assistance