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Feds: Agent role in partnership exchanges up to states

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States can choose whether to let agents and brokers work with their new health insurance exchanges, or Web-based health insurance supermarkets, and they also can choose whether to let producers be navigators.

The Center for Consumer Information and Insurance Oversight (CCIIO), an arm of the U.S. Department of Health and Human Services (HHS), talks about the relationship between producers and exchanges, and between producers and navigators, in a new batch of guidance explaining how a state should go about setting up a “state partnership exchange.”

The CCIIO developed the guidance to implement the exchange provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA).

PPACA drafters included the exchange provisions in an effort to increase competition in the health insurance market, help consumers enroll in public and private health plans, and create a mechanism that the government could use to ease the process of providing new health insurance purchase tax credits.

A state can choose whether to run its own state-based exchange, let HHS provide all exchange services for its residents through a federally facilitated exchange (FFE), or shares exchange responsibilities with HHS through a partnership exchange arrangement.

PPACA requires exchanges to arrange for nonprofit “Navigators” — ombudsmen that are not directly compensated by health plans — to help consumers understand the new system. Some agents and brokers have suggested that the Navigators could crowd them out of the market, and possibly give consumers bad advice; Navigator program defenders have argued that the main users of Navigators are low-income consumers and other consumers who are not getting much, if any, advice from producers today.

“All states, regardless of what type of exchange is in operation, can determine whether to permit agents and brokers to enroll consumers in qualified health plans (QHPs) through the exchange,” officials said in a guidance section on “interaction with agents and brokers.” “In addition, all states will continue to set standards for the agent and broker industry and to play their traditional role in licensing and overseeing agents and brokers.”

In partnership exchanges states, and in states that rely entirely on FFEs, producers “will use the FFE agent and broker Web portal, which will allow agents and brokers to sign an agreement with the exchange and complete exchange training and registration,” officials said.

Producers can be Navigators for a state partnership exchange.

Because of the way PPACA is written, “agents and brokers who choose to work as Navigators cannot be compensated for enrolling individuals into either QHPs or other non-QHP health insurance or health plans,” officials said.

“HHS plans to issue further guidance on the role of agents and brokers in the exchange.” officials said.

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