Becoming an Indiana Navigator and Certified Application Counselor

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1 Becoming an Indiana Navigator and Certified Application Counselor

2 Learning Objectives I. Introduce and explain the functions of consumer assistants II. Define Application Organizations, federal Navigators, Indiana Navigators, and Certified Application Counselors III. Discuss certification and certification renewal procedures for Application Organizations, federal Navigators, Indiana Navigators, and Certified Application Counselors IV. Review conflicts of interests, privacy, security and confidentiality standards, and state enforcement actions for consumer assistants V. Examine tips for assisting population subtypes

3 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

4 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.

5 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

6 Application Organizations (AOs)

7 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 must be registered with the Indiana Department of Insurance (IDOI).

8 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: (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) , (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 *All fees are current as of August 11, 2015 but are subject to change. Non-resident businesses will pay $100 for online filing.

9 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) , (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 Navigator@idoi.in.gov *All fees are current as of August 11, 2015 but are subject to change. Non-resident businesses will pay $100 for online filing.

10 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: 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 ed to navigator@idoi.in.gov

11 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

12 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

13 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 eligibility appeals Assisting with enrollment 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

(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

14 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.

15 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 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.

16 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: Fax: ("attn: Navigator Director"), or Mail: Indiana Department of Insurance, c/o Navigator Director, 311 W. Washington St., Ste. 300, Indianapolis, IN *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.

17 Indiana Navigator Exam Procedures and Guidelines 1. Register: 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 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.

be taken no later than 90 days after submitting the online application Upon passing, you and IDOI will receive

18 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.

19 Checking the Status of Your IN Navigator Application Applicants may check the status of their application online at: 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 ing Navigator@idoi.in.gov.

20 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.

21 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?

consumers and include: Financial Conflict of Interest Receiving direct or indirect financial

(e.g. receiving $5 from No Name Insurance Company for enrolling a consumer in one of their plans)

22 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

Paid commission Grants Credit/loans Gifts Free or discounted travel or prizes CAN Accept:

23 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

24 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.

25 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 , consumer personal information must be securely destroyed or disposed of in a way that will make the information unusable. Per Ind. Code , 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.

26 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 (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

quality of applications through complaints and internal

If there is a consistent problem with a given Indiana

27 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

28 Certified Application Counselors (CACs)

29 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.

30 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 . The 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: 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).

31 CAC Responsibilities Assist with Marketplace applications Facilitate enrollment of eligible individuals in QHPs and insurance affordability programs Disclose any conflicts of interests and comply with privacy and security agreements Act in the best interest of the consumer Abide by federal standards

32 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 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.

33 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 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

34 Ethical Standards for Consumer Assistants DO 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 x x x x DO NOT Make up or guess an answer to a question Ask anyone for more information than absolutely necessary Joke about sensitive physical, social or cultural difference Use derogatory or profane language toward or about a consumer 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.

35 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 ( ) offers immediate assistance in English and Spanish with a language line for other options.

36 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: 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 2.2% Visual disability 3.7% Cognitive disability 5.2% Ambulatory disability 7.4% Self-care disability 2.5% Independent living disability 5.7% TOTAL DISABILITY PREVALENCE 13.1%

37 Helpful Resources for Consumer Assistants Indiana Department of Insurance (IDOI) or ; Information for IN Navigators: Centers for Medicare and Medicaid (CMS) Call Center ; 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 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) ; 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

THE INDIANA NAVIGATOR PROGRAM: What Healthcare Providers Need to Know

THE INDIANA NAVIGATOR PROGRAM: What Healthcare Providers Need to Know Presented by: J Hopkins, Vice President Beth Overmyer, Executive Vice President ClaimAid Consulting Version 2.14.14 THE INDIANA NAVIGATOR