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April 2013 St@teside

Latest Release of Federal Rules and Regulations

In the past several weeks, the Department of Health and Human Services (HHS) has released guidance on two prominent topics: Federal Medical Assistance Percentage (FMAP) and Navigators and Non-Navigator Assistance Personnel
The Centers for Medicare and Medicaid Services (CMS) released the final rule on increased FMAP changes, which details the enhanced federal matching funds that states will receive for their newly eligible Medicaid enrollees beginning in January 2014. The federal match will begin at 100 percent in 2014 and gradually will be decreased to 90 percent in 2020. The final rule defines newly eligible adults and the methodology needed to document claims for enhanced FMAP for the newly eligible adults.
HHS also released its proposed rule on navigators and non-navigator assistance personnel (also referred to as assisters) and a funding opportunity announcement (FOA) for those interested in serving as navigators for the federally facilitated exchange (FFE) and state partnership exchanges. The proposed rule outlines the navigators’ roles and responsibilities, licensure and certification, compensation, conflicts-of-interest, and program financing. These standards will also apply to the federally funded assisters in state-based exchanges (SBEs) and state partnership exchanges. Key provisions of the proposed rule include the following:
The navigators’ role has been defined as providing fair, impartial, and accurate information to assist consumers in applying for health insurance, but they will not determine eligibility, select QHPs, or enroll applicants in QHPs.
  • Agents and brokers can serve as navigators, but they cannot receive compensation for enrolling individuals into health plans and they must comply with disclosure requirements. 
  • FFE navigators and federally funded assisters must attest that they are free of conflict of interest and disclose relationships with any issuers.
  • FFE navigators and federally funded assisters must complete 30 hours of HHS-approved training and comply with continuing education requirements.
  • Navigators and assisters must be able to offer services to individuals with disabilities and in culturally and linguistically appropriate ways to meet the needs of exchange service populations.

Comments on the proposed rule are due on May 6, 2013. Those interested in responding to the FOA should submit a non-binding Letter of Intent to Apply by May 1, 2013, and all applications are due June 7, 2013.