By John Reichard, CQ HealthBeat Editor
July 12, 2013 -- The Centers for Medicare and Medicaid Services (CMS) released a final regulation late last week that calls for 30 hours of training for "navigators," the people who will be charged with providing expert advice on a wide range of issues to people signing up for insurance coverage under the health law.
The rule also outlines standards for certified application counselors, who will also help people with their questions about how to get coverage. Navigators and certified application counselors will be providing help in the 33 states that will be served by the federal insurance exchange or that will be partnering with that exchange. The remaining 17 states are setting up their own such marketplaces and will provide help, at least initially, through what are known as "in-person assisters."
Tricia Brooks of the Georgetown University Center for Children and Families, a supporter of the health law, said she was pleased with at least two of the provisions in the final rule.
In an interview, Brooks said the rule allows states to add their own licensing and certification standards for those who provide assistance, but only as long as they don't interfere with the ability of navigators to fulfill their responsibilities under the health law (PL 111-148, PL 111-152). Brooks said that a number of states are considering legislation that would interfere with navigators performing those duties, and the final rule's language should head off such restrictions.
Brooks also praised a requirement that there be a training program in each state for "certified application counselors," people who can help counsel applicants on signing up for coverage, but aren't paid by the federal government or the state. An example would be a hospital staffer who provides help. The counselors will be extremely important in providing assistance in states served in whole or in part by the federal exchange, Brooks said, noting that those are states that will receive relatively little in federal grant money to train navigators.
Navigators, certified application counselors, and in-person assisters must be knowledgeable about qualified health plans, insurance affordability programs, the tax implications of enrollment decisions, eligibility for premium tax credits and cost-sharing reductions and other topics.
The rule requires that navigator and non-navigator assistance personnel in the federal exchange states have 30 hours of training and pass a test ensuring their competence. States with their own exchanges can establish more rigorous requirements. In the case of Maryland, 120 hours is required. But Brooks said Maryland is the "outlier." She said 30 hours is a "good start." If the right people are selected as navigators; those people would already have some baseline knowledge of the law, she said. The 30 hours also can be enough if those assisters are provided good technical support, she added.
