HHS Finalizes Exchange Navigator Regulations

On July 12, 2013, the Department of Health and Human Services published a final rule on exchange navigator and non-navigator personnel, exchange consumer assistance tools and programs, and certified application counselors. The new rule deals with the various programs that will assist consumers in learning about and enrolling in the ACA’s qualified health plans through the health insurance exchanges. There are three of these: the navigator program, the only program officially recognized in the statue; “non-navigator assistance personnel,” which have at times in the past been referred to as in-person assisters; and certified application counselors. HHS also released a helpful fact sheet setting out the distinctions among the various categories, including information on the role of brokers and agents in exchanges.

The final rule requires all navigators in a federal exchange, including partnerships, to fulfill training requirements, pass a certification exam, and receive continuing education, and be certified or recertified on at least an annual basis; states running their own exchanges are expected to have certification and training requirements. Navigators must be prepared to meet the needs of enrollees in both the individual and SHOP exchange.