TDI Stakeholder Meeting on Proposed Navigator Rules – January 6, 2014

After this hearing, TDI will consider all comments and suggestions and publish the rule in the Texas Register.

Senator Kirk Watson

Need to avoid the political straw man in this discussion
His bill prevents felons from being navigators, as well as prevents electioneering
Does not want to make it harder for navigators to do their job
SB 1795 was necessary because Texas chose not to create their own exchange
TDI has yet to provide justification as to why they went as far with these rules as they did
TDI has not providers any answers to the questions Texas Senators have posed
Told the Commissioner that this is inappropriate
Process matters here
TDI hasn’t explained the need for the arbitrary additional 40 hours of training
Was it the demand by the Governor?
TDI hasn’t explained how they came to the 13/13/14 hours on Medicaid, security and ethics, respectfully
TDI has not explained why navigators have to pay registration fees and the cost associated with additional training
TDI has not explained the need to show financial responsibility, like surety bonds
TDI has yet to provide a detailed timeline for the navigators to come into compliance with the proposed rules
There has not been a timeline for each step that must be completed
TDI has not explained how registration and limiting the use of the term “navigator” protects consumers
Under the currently timeline that all navigators must be in compliance by March 31, 2014, it would give navigators only about a month to get into compliance
Requests that the compliance deadline be postponed until after the enrollment deadline ends

Senator Sylvia Garcia

Believes these rules are obstacles and burdensome roadblocks that will prevent individuals from getting insurance
Believes that navigators should have the abilities to help get voters involved – voter engagement
The additional 40 hours of training is baffling – more hours required than any other state in the nation
Wisconsin requires the 2^nd highest amount of training, 16/yr.
Limiting the term “Navigator” is unreasonable unless it is clarified to be just in the health insurance arena
There should be no fees
There should be an extension for individuals who speak English as a second language and training and materials should be made available
The implementation date should be extended

Representative Donna Howard

Representative Paul Workman

Sent a letter late last year urging the quick approval of the TDI navigator rules
Believes 40 additional hours of training is appropriate because insurance is a complicated subject
Poorly trained navigators do more harm than good
Fraud has already been documented in Texas
It is imperative that Texas adopt stringent rules for navigator, and encourages TDI to adopt the rules

Jessica Schlifer representing Senator Rodney Ellis

Rules impose excessive fees and training requirements
They will hinder Texans from making health care decisions
If these rules are truly about consumer protection, why are there exemptions in the rule for specific entities like insurance companies and insurance agents

Connor Kinney representing Representative Lon Burnam

Most concerned with the lengthy training requirement and the costs associated
Need to ensure access to navigators
No other state requires this amount of training, and TDI has not explained why navigators need this lengthy training
TDI has provided him documents that he is not allowed to release to the public

Robert McVay representing Representative Ryan Guillen

Many of the Representative’s comments have been covered
His goal is to protect people who need help – proud to have carried this bill in the House
Wants to ensure people get access to insurance who need it without getting ripped off

Dr. Martha Sphinx, Alamo Area Council of Governments

Collaborative partner for a navigator grant with the United Way of Tarrant County
Provides oversight of program in 11 counties
Have trained 16 navigators
Have been very selective
Background checked
Issued a special code to access navigator training ~30hr
Many exams throughout to continue training
2 hours of HIPAA training
Professional liability coverage
The 16 navigators have performed magnificently
Participate in the HICAP program
Concerned that TDI’s rules put up some unnecessary obstacles
Skeptical that there is sufficient content for additional 40 hour training
Why pay for training when the community partner training is available from the state for free?
Recommends that changes take place after March 31^st

Representative for Representative Ruth Jones McClendon

These rules are creating roadblocks
Troubled that the rules go beyond consumer protection
To broad, too vague
Need to clarify mission and scope of authority apply only to a small group
Concern that rules could negatively impact nonprofit organizations or hospitals, pharmacies, etc.
Would lie revisions based on all of these comments

Claude Andrews

Thoroughly know the problems of the older and uninsured populations
Suspend all rules, and allow federal rules to take precedent to expedite this program

Benjamin Hernandez, City of Houston Health Department

Concerned with proposed rules because they have experience with working with vulnerable populations
Certified benefit councils (CBCs) have decades of experience working with vulnerable populations, and they are similar to navigators
CBCs register with TDI and there is no fee
CBCs have 25 hours of training, and doesn’t believe it should be any different
Navigator program should mirror the CBC program

Clayton Travis, Mental Health Policy Fellow – Texas Cares for Children

Defines navigator too broadly, needs refinement
Rules are too burdensome
40 hours of additional training seems excessive
Should uses existing training programs within HHSC and save tax payer dollars
With these rules, there will be a decreased likelihood that Texas families will find insurance
Many families do not know about their eligibility options or what is available

Houston Urban Business League

Believes the program in place is already working, but perhaps with a tweak or two it could be better
We don’t need changes that are over bearing

Maureen Milligan, THOT

Recommends navigator definition be more narrow
Additional cost, timeline and training requirements may not be legislative intent
Consider using Medicaid and CHIP requirements
Consider the impact to local taxpayers

JT Dwyer, Seton

Implement changes after the marketplace closes, not on March 31^st because it is highly likely that the administration may extend the date
Believes that is the intent of many others have expressed today, but would like the language to be more fluid so it can move with any changes in the administration’s timeline