Texas Department of Insurance considers rules for navigators

The commissioner of the Texas Department of Insurance (TDI) recently held hearings to consider new rules for regulating navigators, who are charged with connecting consumers with health insurance under the federal Patient Protection and Affordable Care Act (ACA). At hearings on December 20 and January 6, TDI heard testimony from those supporting and opposing the proposed rules, which were presented in response to SB 1795 by Watson, enacted by the 83rd Legislature in 2013.

The proposed rules would establish a different definition for navigators than was established in SB 1795 and would require a navigator who fell under the proposed definition to complete an additional 40 hours of training on Texas-specific Medicaid, privacy requirements, and ethics. The state training would be in addition to a 20- to 30-hour training requirement set by federal rule in July 2013.

The proposed rules also would require navigators to register with TDI, be at least 18 years old and a U.S. citizen, submit to fingerprinting and a background check, show identification when performing navigator services, and pay a $50 registration or renewal fee to TDI. The department estimates the cost of training would range from $200 to $800 for initial registration and from $60 to $120 for annual continuing education.

Navigator entities — the nonprofits or government agencies that oversee or perform navigator services — would have to register with TDI and pay a $50 fee. They would have to secure and maintain evidence of financial responsibility either through a $50,000 surety bond or a $100,000 professional liability policy or by depositing $25,000 in U.S. government securities with the comptroller. Both navigator entities and individual navigators would be prohibited from electioneering, charging consumers a fee, selling, soliciting or negotiating health insurance, and recommending or providing advice about different health benefit plans.

SB 1795 prohibited navigators from advertising their professional superiority, participating in electioneering, or accepting compensation dependent on a person choosing a specific plan.

Supporters of the proposed rules expressed concerns about the sufficiency of federal standards for navigators and said that the proposed training requirements, background checks, and deadlines were necessary to safeguard consumers against fraud and abuse during the current ACA marketplace enrollment period.  Those testifying against the rules expressed concerns that TDI’s definition of a “navigator” was overly broad and that the proposed training requirements, financial requirements and deadlines would make it difficult for navigators to register with TDI before the end of the enrollment period.

TDI has said that SB 1795 charged the commissioner with reviewing and determining the sufficiency of standards for navigators under federal law and required her to establish standards and qualifications to ensure navigators could perform their required duties. The bill directed the commissioner to authorize additional training for navigators and authorized TDI to establish a state navigator registration system.

TDI has said it conducted multiple conference calls with the U.S. Department of Health and Human Services (HHS) and found insufficiencies in the applicability of federal regulations, navigators’ qualifications, education requirements, privacy requirements, and accountability. SB 1795 required TDI to make a good faith effort to work in cooperation with HHS  to propose improvements to federal standards if the commissioner found those standards insufficient.

The proposed rules would take effect on March 1, pending a final decision by Commissioner Julia Rathgeber.

by Lauren Ames

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