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Feds to exchange helpers: Control your robots

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The Centers for Medicare & Medicaid Services (CMS) has translated new exchange helper regulations into plain English.

CMS put the explanation of what officials there think the regulations mean for Patient Protection and Affordable Care Act (PPACA) exchange helpers in a slidedeck aimed at navigators, non-navigator assistance personnel and certified application counselors.

Some of the slides apply only to helpers working with the public exchanges that CMS runs for its parent department, the U.S. Department of Health and Human Services (HHS).

In a page on “robo-calls,” for example, officials warn helpers who work with exchanges wholly or partly run by HHS about use of automated communication systems. The helpers can use robo-calls to communicate with consumers if they already have relationships with those consumers, officials say. But a helper may not start any telephone “cold call” to a consumer “using an automatic dialing system or artificial or prerecorded voice,” officials say.

In another slide, officials note that HHS has prohibited exchange helper organizations at the HHS-run exchanges from paying workers on a per-application, per-individual-assisted, per-enrollment basis. The rule does not apply to the exchange helper organizations working with state-based exchanges, officials say.

“However, CMS will continue to evaluate and monitor the use of these compensation models” in state-based exchanges, CMS officials say. California, Connecticut and some other states are running their own exchanges.

An arm of CMS — the Center for Consumer Information and Insurance Oversight (CCIIO) — has been running exchange programs for HHS in a majority of the states.

PPACA itself includes provisions requiring all exchanges to offer consumers access to “navigators,” or independent exchange ombudsman programs. Exchange managers later created many other categories of assisters, counselors and other helpers who could provider other types of help; aid consumers without meeting all of the many requirements, such as “linguistic competency,” that navigators must meet; or accept funding from funding sources that navigators cannot use.