Texas Department of Insurance adopts final rules on navigators

steth_basic6The individuals and entities known as navigators, who are charged with helping consumers find health care coverage under the federal Patient Protection and Affordable Care Act, will be subject to new rules in Texas starting this month. The Texas Department of Insurance (TDI) issued the final rules following a stakeholder input meeting and two public hearings.

The final rules require navigators to register with TDI, submit fingerprints, complete a background check, provide proof of identity, and complete 20 hours of Texas-specific training as follows:

  • five hours on Texas-specific Medicaid and Children’s Health Insurance Program provisions;
  • five hours on applicable privacy requirements;
  • five hours on ethics;
  • two hours on basic insurance terminology and how insurance works;
  • two hours on exam preparation; and
  • one hour to complete the final examination.

The final rules prohibit navigators from:

  • charging a fee to consumers;
  • selling, soliciting, or negotiating health insurance coverage;
  • recommending a specific health benefit plan; and
  • engaging in electioneering, financing, or otherwise supporting the candidacy of an individual for government positions while operating as a navigator.

The final rules do not require navigators to pay a registration fee, but entities that employ or oversee individual navigators must provide evidence of financial responsibility as in the proposed rules. TDI estimates that a navigator entity’s cost to provide initial training for individual navigators employed by or associated with it would be a minimum of $50 plus the cost of materials and supplies. Both navigator entities and individual navigators must register with TDI.

Navigators have until March 1, 2014, to register with TDI and until May 1, 2014, to complete the required 20 hours of Texas-specific training.

For more on this issue, see previous post:  Texas Department of Insurance considers rules for navigators.

by Lauren Ames

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