Teams around the United States are working harder to implement the Patient Protection and Affordable Care Act of 2010 (PPACA) now that the fall elections seem to have increased the odds that the law will stay in effect.
In Minnesota, for example, the Minnesota Health Insurance Exchange Advisory Task Force has been working on matters such as exchange finances, risk adjustment mechanisms, and consumer support.
The consumer support arm of the task force, the Navigator and Agent/Broker Work Group, recently developed a report on recommendations and service levels for the exchange Consumer Assistance/Navigator Program.
Other states seem to be assuming that the people who help consumers use exchange programs will need at least 16 to 24 hours of initial training, the work group said in the report.
The PPACA exchanges
Drafters of PPACA included the exchange provisions in an effort to help consumers and small employers do a better job of shopping for health coverage.
Starting late in 2013, the exchanges, or Web-based health insurance supermarkets, are supposed offer individual consumers, families and small groups menus of standardized, high-quality health plan options. Low-income and moderate-income consumers and some small groups are supposed to be able to use new federal tax credits to pay for the coverage.
Some states are letting the U.S. Department of Health and Human Services (HHS) provide all exchange services for their residents. Other states are building their own exchange programs.
A new type of advisor, the Navigator, is supposed to serve as an ombudsman, or help desk service, for consumers who are trying to figure out how to use the new system to buy coverage. The Navigators can get funding from the exchanges, but they are not supposed to get commissions or other compensation from health insurers.
Health insurance agents and brokers have clashed with regulators, consumer groups and others in some states over whether commercial health insurance producers should be able to serve as Navigators; whether the Navigator staff members who work directly with consumers should be licensed insurance agents or have other types of licenses or certifications; and whether Navigator entities should have to have some version of the errors and omissions liability insurance coverage that commercial health insurance producers have.
Exchange builders also have to confront matter such as the standards Navigator staff members must meet.
People who advise consumers
In Minnesota, the Navigator and Agent/Broker Work Group is talking about creating a category of “in-person assisters.”
The list of advisors that could provide consumer assistance for an exchange user could include a Navigator staff member, and agent, a broker or an in-person assister, the work group said.
The kinds of consumer assistance the assisters will provide will include general public education, guidance on how individuals and families can use the exchange system, helping individuals to figure out what kinds of benefits they seem to be eligible for, helping individuals fill out applications for programs such as Medicaid and the new PPACA premium tax credit program, and understanding plan choices, the work group said.
The work group came up with the estimate that people who help consumers use the exchanges might need 16 to 24 hours of training.
But, “at this time, the work group has not come to consensus on recommended durations of training,” the work group said. “Duration of each content area is dependent upon the finalized curriculum and content. Ultimately, the goal is to ensure a quality and highly efficient and effective consumer assistance training program.”
HHS is planning to provide model training standards but has not yet issued the standards, the work group said.
The work group noted in the recent report that, in that report, it was not addressing questions about certification or licensure of providers of exchange consumer assistance, but only about the kinds of training that the assistance providers should have.
The work group came up with a list of 15 content areas that exchange assister training programs might cover.
The content areas could include an explanation of the provisions of PPACA, such as the new guaranteed-issue rules and the new tax credit subsidies; information about the Minnesota exchange works; the needs of underserved and vulnerable populations; appeal and dispute resolution mechanisms; and conflict of interest rules.
The training program should cover who has what kind of role, and what kinds of licenses or certifications an individual might need to perform various roles, the work group said.