93.750: PPHF Cooperative Agreement to Support Navigators in Federally-facilitated and State Partnership Exchanges

93.750

Inactive

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

July 11, 2018

June 3, 2017

Section 1311(i) of the Affordable Care Act authorizes Exchange Navigators in States with a Federally-facilitated Exchange (FFE). Exchanges are required to develop and implement Navigator grant programs. Navigators will serve consumers in States with an FFE, including State Partnership Exchanges. As health reform implementation continues, consumers will benefit from understanding new programs, taking advantage of new protections, and navigating the system to find the most affordable coverage that meets their needs. Exchange Navigators are intended to assist consumers in those areas in the following ways: • Maintain expertise in eligibility, enrollment, and program specifications and 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 (e.g., Medicaid, Children’s Health Insurance Program (CHIP)); • Facilitate selection of a QHP; • Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under Section 2793 of the Public Health Service (PHS) 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.

B - Cooperative Agreements

Funding through the cooperative agreement is open to self-employed individuals and private and public entities including community and consumer-focused nonprofit groups; 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.

Beneficiaries must propose to serve in a State with a FFE to be eligible to be served by applicants receiving funding through this cooperative agreement.