Michigan Laws 500.1262 – Navigator; certification; application; funding from exchange prohibited; duties; determination by director that program to certify and train navigators protects personally identifiable information
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Terms Used In Michigan Laws 500.1262
- Affordable care act: means the patient protection and affordable care act, Public Law 111-148, as amended by the health care and education reconciliation act of 2010, Public Law 111-152. See Michigan Laws 500.1261
- Certificate: means a document issued by the director authorizing a person to act as a navigator or certified application counselor for the qualifications specified in the document. See Michigan Laws 500.1261
- Certified navigator: means a person that is certified as a navigator under this chapter. See Michigan Laws 500.1261
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Department: means the department of insurance and financial services. See Michigan Laws 500.102
- Director: means , unless the context clearly implies a different meaning, the director of the department. See Michigan Laws 500.102
- Enrollee: means an individual who is entitled to receive health services under a health insurance contract, unless the context requires otherwise. See Michigan Laws 500.116
- Exchange: means an American health benefits exchange established or operating under the affordable care act. See Michigan Laws 500.1261
- Insurance: means any of the kinds of insurance described in chapter 6. See Michigan Laws 500.1261
- Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
- Navigator: means a person that receives any funding from an exchange or the federal government and is designated or selected by an exchange or the federal government to perform any of the duties described in 42 USC 18031(i)(3). See Michigan Laws 500.1261
- Negotiate: means the act of conferring directly with or offering advice directly to a purchaser or prospective purchaser of a particular contract of insurance concerning any of the substantive benefits, terms, or conditions of the contract, provided that the person engaged in that act either sells insurance or obtains insurance from insurers for purchasers. See Michigan Laws 500.1261
- Qualified health plan: means that term as defined in section 1301 of the affordable care act. See Michigan Laws 500.1261
- Sell: means to exchange a contract of insurance by any means, for money or its equivalent, on behalf of an insurance company. See Michigan Laws 500.1261
- Solicit: means attempting to sell insurance or asking or urging a person to apply for a particular kind of insurance from a particular company. See Michigan Laws 500.1261
- state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories belonging to the United States; and the words "United States" shall be construed to include the district and territories. See Michigan Laws 8.3o
(1) Beginning June 30, 2015, an individual shall not act as a navigator unless he or she has filed an application under section 1263(1) and is certified with this state as a navigator.
(2) Unless certified as a navigator, an individual shall not receive funding from an exchange.
(3) Subject to the affordable care act, a certified navigator shall do all of the following:
(a) Conduct public education activities to raise awareness of the availability of qualified health plans.
(b) Distribute fair and impartial information concerning enrollment in all qualified health plans offered within the exchange and the availability of the premium tax credits under section 36B of the internal revenue code of 1986, 26 USC 36B, and cost-sharing reduction under section 1402 of the affordable care act.
(c) Facilitate selection of a qualified health plan.
(d) Provide referrals to appropriate state agencies for an enrollee with a grievance, complaint, or question regarding the enrollee’s health plan, coverage, or a determination under such plan coverage.
(e) Provide information in a manner that is culturally and linguistically appropriate to the needs of the population served by the exchange.
(4) A certified navigator shall not do any of the following:
(a) Sell, solicit, or negotiate health insurance.
(b) Recommend a particular health benefit plan.
(c) Provide any information or services related to insurance regulated under this act other than health benefit plans or other products offered in the exchange.
(5) If an exchange is operational in this state, the director shall determine whether a program to certify and train navigators protects the privacy and security of personally identifiable information of the residents of this state under the laws of this state. If the director determines that the program does not protect the residents of this state under this subsection, the director shall do all of the following:
(a) Establish a certification and training program that must include, but is not limited to, all of the following:
(i) A criminal history check using the department of state police’s internet criminal history access tool (ICHAT).
(ii) Training on privacy and security of personal identifying information, training on ethics, training on provisions of the affordable care act relating to navigators and certified application counselors and any necessary state-specific training as determined by the director.
(b) Develop an application and disclosure form by which an applicant for a certificate shall disclose any potential conflicts of interest, as well as any other information required by the director.
(c) Submit an annual report to the standing committees of the senate and house of representatives with jurisdiction over health policy. The report must include all of the following:
(i) The director’s assessment of any federal program to certify and train navigators and certified application counselors.
(ii) Any changes implemented by the department as a result of a federal program to train navigators and certified application counselors.