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The Texas Department of Insurance (TDI) held an informal meeting on December 20 relating to the development of rules to implement SB 1795 (83rd Texas Legislature, Regular Session) concerning navigators for health benefit exchanges. The next stakeholder meeting will be on January 6, 2014.
 
Representative Geanie Morrison

  • Supports the proposed rules
  • SB 1795 gave TDI  the ability to determine if the Federal navigator rules were sufficient to protect personal health information
  • Concern with the federal rules:
    • The standards for navigators were only in private contracts
    • No ethics training
    • No background checks
    • Have created real world problems
      • Navigators have encourages individuals to commit fraud so they can receive more subsidies
      • Some navigators were preforming their duties before finishing training
  • HHS refuses to share contracts and privacy standards with TDI
  • This current rule will fix the federal insufficiencies
  • Prohibits navigators from electioneering
  • Immediate implementation of this rule is imperative

 
Senator Kirk Watson

  • Authored SB 1795
  • The vast majority of navigators are credible and upstanding
  • The bill just instructed that the navigators must be able to find and help those trying to apply
  • The bill already instructs for background checks and prohibits electioneering
  • TDI needs to demonstrate that they are following the intent of the law
  • This rule suggests the law didn’t meet specific requirements
  • Need to ensure that this rule doesn’t create unnecessary obstacles
  • This has become highly politicized
  • TDI needs to justify the additional training requirements
    • Tripled hours from the federal rule
    • Increases cost for compliance
  • The navigators are being assessed fees without the capability to collect fees
  • The bill had no fiscal note, this rule implements one
  • Navigators would be given only one month to get into compliance according to the proposed timeline

 
Representative Kenneth Sheets

  • Believes that the legislation allows TDI to create these proposed rules
  • There have been documented examples of navigators encouraging tax fraud
  • The legislation was broad because at the time the federal rules had not come out
    • Texas had to create rules specific to Texas
  • Healthcare.gov, the inability to keep your current plan; navigators are just the next problem to address
  • Additional training is needed for accuracy
  • Private information is crucial to keep confidential
  • The federal rules do not require certification

 
Representative Chris Turner

  • Opposed to the proposed rules because they do not aim to protect consumers, they are just politically driven
  • The legislation was not intended to create barriers and make it harder than it already is to get coverage
  • The Project Veritas coverage  of navigators committing fraud was handled immediately by the employer and people were terminated
  • Appreciates the January 6th meeting
  • Concerned with the timeline for compliance
  • Concerned with added cost – approximately 1,000 a navigator and most navigator entities are non-profits
  • Believes the additional hours are an arbitrary number based on Governor Perry’s recommendation
  • Navigators are the next political target in the ACA
  • Wants the rule process postponed until after March 1st

 
Sister JT Dwyer, Seton

  • Seton is the largest provider of health care in Texas
  • They target caring for uninsured and underinsured
  • The protection of personal information is crucial
  • Concerned with the prohibition of using the word “navigator” in any other circumstances
    • Commonly used word in many health care settings
    • Wants TDI to explain their reasoning for this prohibition
  • Concerned with the large scope of the definition “navigator services”
    • Would this apply to neighbors helping neighbors?
    • Need clarification in the rule that this applies to ACA navigators only, and not those in the community doing education and outreach

 
Tim McKinney, CEO of the United Way of Tarrant County

  • They received a $5.9M grant to provide navigators in their community
  • He has 158 navigators
  • Not involved in electioneering
  • Have many years in providing information and education while protecting personal information
  • Believes the navigator registration should be free
  • They already do level 1 background checks
  • The navigator program should be modeled like HICAPP and Community Partners Program
  • Nothing is retained by the navigators in his program except for the consent form
  • Under this proposed rule, costs could exceed $148K for his program’s navigators

 
Jaqueline West, Community Council of Greater Dallas

  • The navigator entities already have safeguards in place
  • Additional training and costs will just result in less navigators in the community

 
Martha Blaine, Executive Director of the Community Council of Greater Dallas

  • Subcontractor under the Consumer Health Insurance Marketplace and Education Services (CHIMES) Coalition
  • Concerned with the rule’s definition of a navigator
    • The ACA’s definition is more clear
    • The rule should be limited to the individual navigators attached to navigator entities  with grants
    • Navigator entities are the only people that can do enrollment
  • This rule creates a large financial burden that they cannot afford, roughly $25,000

 
Cecilia Fontineau, Texas Organizing Project (TOP)

  • Asks TDI to look at the whole picture
  • Believes the majority of navigators are well trained
  • She hadn’t had insurance in 8 years and has chronic illnesses
    • Will receive insurance January 1st
  • Navigators are very necessary

 
Lilliana Ruiz, TOP

  • Her community is low income and Hispanic
  • She has 2 family members with no health insurance recently die of cancer
  • She needs insurance and needs help from a navigator

 
Allison Brim, TOP Organizational Director

  • Opposed to the rules
  • TOP has 30,000 members eligible for coverage in the marketplace
  • They are trying to reach out to educate and connect them with a navigator
  • The rules are a contradiction to a State who believes in less regulation
  • The additional rules and regulations are burdensome
  • In TOP’s experience, the navigators are doing great and need our support

 
Senator Donna Campbell

  • Supports the proposed rules
  • The federal rules are insufficient
  • Privacy standards will be more robust
  • There already has been navigator fraud, thus the necessity of the rules
  • Federal HHS has admitted that they do not have the ability to oversee the navigators

 
Bee Morehead, Texas Impact

  • Oppose some provisions, support some provisions
  • Some of the provisions add undue burdens on the non-profit community
  • Falls short of articulating TDI’s enforcement strategy against bad actors
  • Understand that the rule exempts individuals working in HHSC’s Community Partnership Program because the rule exempts individuals regulated by another state agency already
    • Support this provision
  • Scope of “navigator” is so broad that it could be read to include conversations between friends, family and members of the clergy
    • Could also be read to include private sector human resource specialists working for firms
  • Wants clarification that the rule only includes certified ACA navigators
  • There are existing state laws and rules that already uses the word “navigator,” so they would like clarification that the prohibition of the word only applies in the context of health insurance application assistance
  • Supports the registration process
  • The burdensome cost will probably be paid by federal grants to the non-profits  to pay a private company for training that would be duplicative of free HHSC training that already exists
  • Needs better due process language

 
Charles Bailey, THA

  • Oppose some provisions, support some provisions
  • Hospitals are the safety net for the uninsured, over $6B a year
  • Many hospital staff will be providing navigator-type services which will fall under the scope of the rule
  • Supports the exemptions in the proposed rules
  • The scope of the proposed rules is overly broad and they will regulate many additional groups and organizations than SB 1795 intended
  • If you provide any of the navigator “designated services,” you fall under the navigator requirements in the proposed rules
    • Hospital staff explain health insurance eligibility, how to gain coverage, etc. and under this rule that would require them to be a registered navigator
    • Does not believe that is the intention of the law
  • Federal regulations says that a navigator has to provide certain duties, so if the individual or entity is not performing ALL the duties, they cannot be a navigator
  • They will provide written comments clarifying some of these issues with recommendations

 
Stacey Pogue, CPPP

  • Medicaid and CHIP outreach and enrollment is now through the marketplace
  • This rule limits who can do this outreach now to people with specific state authority
  • The language in SB 1795 lists 6 duties a navigator could perform, but the rule flips it by requiring the navigator to perform those 6 duties
    • This would affect CPPP’s ongoing education about health insurance
  • The training required in the rule is 3x more than the federal rule requirement
    • This is also out of step with all other state programs
    • This amount of training is more than any other state identified

 
Maureen Milligan, THOT

  • There will always be individuals who won’t perform consistent with requirements, but that does not mean that the requirements are problematic
  • The definition and scope of the word navigators needs to be more refined to more narrowly target the certain population or group
  • Does not want the rule to restrict any outreach or education on how health systems work
    • Has a direct financial impact on communities when there is a lack of information on how to access the health care system
  • Hours and cost of training are excessive, and possible contrary to SB 1795
    • Could be proficiency based training instead of set hours could be an option
  • Appreciate the exemptions for the CACs

 
Bruce Bower

  • Suggested that the rules should be vetted through the Medical Care Advisory Committee (MCAC)