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Life Health > Health Insurance > Your Practice

Exchanges get counselor guidance

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A federal health insurance exchange agency has come up with advice about how its exchanges will manage relationships with one type of consumer helper — the “certified application counselor.”

In the new guidance, Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight, talks about how the “federally facilitated exchanges” run by CCIIO will designate CACs, and how the FFEs will fire CACs violating privacy standards or breaking other program rules.

Federal regulators now require both federally run exchanges and state-run exchanges to have another type of consumer helper, the CAC.

A CAC will be like a navigator, but without necessarily having the ability to provide “culturally and linguistically appropriate” help, according to the Nevada Silver State Health Insurance Exchange.

A CAC employee or volunteer will help consumers understand and fill out exchange applications but might not necessarily be able to provide that help in Spanish or Chinese.

The new guidance will have a direct effect only on CCIIO’s federally facilitated exchanges.

CCIIO said it wants to post a CAC organization application form on the CMS website this month.

Organizations that want to become CAC organizations must agree in writing to meet federal exchange requirements, including privacy and security standards, officials said.

Once an organization agrees in writing to serve as a CAC and follow exchange rules, a CCIIO-run FFE will include the organization on its list of CACs for the people living in that FFE’s state, officials said.

“Generally, designation will not be withdrawn unless there is a pattern of noncompliance,” officials said. “However, a stricter standard will be applied to violation of privacy and security standards.”

An FFE will consider the number and severity of the violations when deciding whether to kick out a CAC, officials said.

An organization must still protect any private consumer information it has, even if an FFE expels the organization from the CAC program, officials said.

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