93.332: Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges

93.332

Active

Centers for Medicare and Medicaid Services (CMS) [HHS]

July 27, 2022

July 27, 2022

The Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges (Funding Opportunity) will enable recipients to operate as Exchange Navigators in States with a Federally-facilitated Exchange (FFE), as authorized by the Patient Protection and Affordable Care Act (PPACA). Section 1311(i) of the PPACA requires Exchanges to establish a Navigator grant program. The following duties are required of all recipients of funding under this Funding Opportunity, including but are not limited to: • Conducting public education activities to raise awareness about the Exchange; • Facilitating selection of a QHP; • Providing information in a manner that is culturally and linguistically appropriate to the needs of the population served by the Exchange, including individuals with limited English proficiency, and ensuring accessibility and usability of Navigator tools and functions for individuals with disabilities; • Providing 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; • Complying with applicable training and conflict of interest standards; • Obtaining the authorization of applicants for coverage available through an Exchange application prior to accessing their personally identifiable information; and • Providing targeted assistance to serve underserved or vulnerable populations, as identified by the Exchange, within the Exchange service area. Change: The Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2020 Final Rule amended 45 C.F.R. § 155.210(e)(9), effective June 24, 2019, to make the provision of certain types of assistance, including post-enrollment assistance, permissible for FFE Navigators instead of required. However, due to significant increased funding in this Funding Opportunity and ensuring that consumers understand and have their questions answered about their health plan, coverage, or a determination under such plan or coverage, and IRS tax implications, for example, CMS plans to pursue regulatory changes to reinstate these post-enrollment assistance topics as required Navigator duties within this period of performance.

B - Cooperative Agreements

Under section 1311(i)(2)(B) of the PPACA, eligible entities may include, but are not limited to, trade, industry and professional associations; commercial fishing industry organizations; ranching and farming organizations; community and consumer-focused nonprofit groups; and other entities capable of meeting program requirements. Eligible applicants may choose to partner with other entities and/or individuals to form a consortium of subrecipients in order to target a larger total portion of the underserved and vulnerable populations. Funding through the cooperative agreement is open to individuals and private and public entities capable of carrying out the Navigator duties and other program requirements in a FFE, as outlined in statute, regulations, and this announcement, including community and consumer-focused nonprofit groups; faith-based organizations; trade, industry and professional associations; commercial fishing industry organizations; ranching and farming organizations; chambers of commerce; unions; resource partners of the Small Business Administration; licensed insurance agents and brokers; and other public or private entities. Other entities may include, but are not limited to, Indian Tribes, tribal organizations, urban Indian organizations, and State or local human services..

The following list, includes but is not limited to, the varying types of beneficiaries served under this cooperative agreement: Individual/Family, Minority group, Specialized group (e.g., LGBT, health professionals, students, veterans), Small business, Anyone/general public, Small Business Person, Black, American Indian, Spanish Origin, Other Non-White, Migrant, Immigrants, U.S. Citizen, Women, Disabled (e.g. Deaf, Blind, Physically Disabled), Physically Afflicted (e.g. TB, Arthritis, Heart Disease), Mentally Disabled, Unemployed, Low Income, Major Metropolis (over 250,000), Other Urban, Suburban, Rural.

https://sam.gov/fal/151a93292f7840609ed49006e3cbfee4/view