New Funding Opportunity Announcement for Navigators in Federally-facilitated and State Partnership Marketplaces

Background

CMS has published a Funding Opportunity Announcement (FOA) on the availability of up to $54 million in cooperative agreements to fund Navigators in Federally-facilitated or State Partnership Marketplaces. The Affordable Care Act requires Marketplaces to establish a Navigator program to help consumers understand new coverage options and find the most affordable coverage that meets their health care needs.

Each Marketplace will have at least two types of entities serving as Navigators, and at least one type of entity will be a community and consumer-focused nonprofit organization. Applicants should have expertise in eligibility and enrollment rules and procedures; the range of qualified health plan options and insurance affordability programs; the needs of underserved and vulnerable populations (such as rural populations and individuals with limited English proficiency); and privacy and security standards. Applicants that expect to assist a specific community or population may apply, although awardees must serve all consumers who seek their assistance.  Smaller-sized entities and individuals are encouraged to partner with other entities or individuals to apply as a consortium.

Navigator Standards

CMS has also published a proposed rule creating conflict of interest; training, certification, and recertification; and meaningful access standards for Navigators in the Federally-facilitated and State Partnership Marketplaces, as required by 45 C.F.R. § 155.210(b). The conflict of interest standards would require all Navigator entities to submit to the Marketplace a written attestation that the Navigator is not an ineligible entity and will remain free from certain conflicts of interest, create a written plan to remain free of conflicts of interest during the term as a Navigator, provide information to consumers about the full range of available qualified health plan (QHP) and insurance affordability program options, and disclose to the Marketplace and consumers any required disclosures. The proposed standards would also apply to federally-funded non-Navigator assistance personnel (in person assistors) in the State Partnership Marketplaces.

The proposed rule also contains two proposed amendments to the existing rule governing the Navigator program and would apply to all Marketplaces, including State Based Marketplaces. These amendments would clarify that any Navigator licensing, certification, or other standards prescribed by the state or Marketplace must not prevent the application of the provisions of Title I of the Affordable Care Act; and add to the list of entities ineligible to become Navigators, those entities with relationships to issuers of stop loss insurance, including those who are compensated directly or indirectly by  issuers of stop loss insurance in connection with enrollment in Qualified Health Plans or non-Qualified Health Plans.  The proposed regulations would also clarify that the same ineligibility criteria that apply to Navigators would also apply to non-Navigator assistance personnel providing services in any Federally-facilitated Exchanges, including in State Consumer Partnership Exchanges.

The Notice of Proposed Rulemaking is available here: http://www.gpo.gov/fdsys/pkg/FR-2013-04-05/pdf/2013-07951.pdf.

Overview of Navigator Duties

Successful applicants will be capable of conducting the following required Navigator duties:

• Maintain expertise in eligibility, enrollment, and program specifications;
• Conduct public education activities to raise awareness about the Exchange;
• Provide information and services in a fair, accurate, and impartial manner. Such information must acknowledge other health programs (such as Medicaid and the Children’s Health Insurance Program (CHIP));
• Facilitate selection of a Qualified Health Plan;
• Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under Section 2793 of the Public Health Service Act, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and
• Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange, including individuals with limited English proficiency, and ensure accessibility and usability of Navigator tools, such as fact sheets, and functions for individuals with disabilities in accordance with the Americans with Disabilities Act and Section 504 of the Rehabilitation Act.

Application Process

Applications are available now by visiting http://www.grants.gov/ and searching for CFDA number 93.750. The FOA provides detailed information on applicant eligibility requirements, a state listing of Federally-facilitated and State Partnership Marketplaces, award criteria and instructions for application submission.  Additionally, applicants are strongly encouraged to submit a non-binding Letter of Intent to Apply by May 1, 2013. Receipt of such letters enables HHS to better plan for the application review process. To read the FOA, visit http://www.grants.gov/ and search for CFDA number 93.750.

CMS will hold pre-application conference calls for potential applicants. The calls will provide an overview of the FOA, budget guidance, and other available materials, as well as an opportunity for potential applicants to ask questions.

Pre-Application Call Dates:

• April 11, 2013 (3:30-5:00pm Eastern Daylight Time)
  Toll-free teleconference phone number: 877-267-1577; ID: 5119
  
• April 19, 2013 (3:30-5:00pm Eastern Daylight Time)
  Toll-free teleconference phone number: 877-267-1577; ID: 2917
  
• April 24, 2013 (3:30-5:00pm Eastern Daylight Time)  **ADDITIONAL DATE**
  Toll-free teleconference phone number: 877-267-1577; ID: 8100

• April 30, 2013 (3:30-5:00pm Eastern Daylight Time)  **ADDITIONAL DATE**
  Toll-free teleconference phone number: 800-837-1935; ID: 54234452

Other Key Dates:

• Letter of Intent (optional): May 1, 2013
• Application due date:  June 7, 2013
• Anticipated Notice of Award: August 15, 2013