The Centers for Medicare and Medicaid Services confirmed yesterday, following the release of proposed rules on Navigators and what they’re calling non-Navigator assistance personnel, that the information is not necessarily intended for brokers. The agency told Employee Benefit Adviser that more details for agent and broker certification is coming soon.

The CMS rule does say that agents and brokers can become Navigators if they so choose but, “holding an agent or broker license is neither necessary, nor by itself sufficient, to perform the duties of a Navigator, as these licenses generally do not address areas in which Navigators need expertise, including the public coverage options that would be available to some consumers.”

The report goes on to say that any agent or broker interested in becoming a Navigator must meet all the requirements of that job. This includes the fact that all Navigators are prohibited from receiving compensation “directly or indirectly from any health insurance issuer in connection with enrollment of consumers into QHPs or non-QHPs … and we interpret that provision to apply to the receipt of trailer commissions.” It confirms, though, that agents and brokers who sell other lines of insurance are not prohibited from compensation by issuers on those other lines of sale.

While the job of the Navigator seems to overlap with the existing role the broker, many states that are opening exchanges have said that brokers will continue to play an essential role in their current capacity. “I do think that when ACA was first passed there was a lot of talk about how it will reduce the broker’s role. But just about everybody that I’ve talked to have come full circle and see them controlling the small group market,” says Vince Ashton, president and CEO of Health Pass New York, a private exchange for small businesses. “They’re not trying to go around them.”

The CMS ruling, as with all similar proposals, is posted on the Federal Register here. It will be open for comments before a final rule is published. CMS has outlined in a timeline that a Navigator portal, presumably for screening and training those interested in the role, will be open in July. 

 

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