Felons as new PPACA navigators?

By BenefitsPro


By Kathryn Mayer

Republican senators slammed the Patient Protection and Affordable Care Act’s navigator program Thursday arguing that the rule is so lenient that a convicted felon could qualify as a navigator and get access to consumers’ confidential health information.

In a letter to Health and Human Services Secretary Kathleen Sebelius, nine senators — led by Finance Committee Ranking Member Orrin Hatch (R-Utah) — wrote that the program lacked appropriate safeguards to protect the privacy of consumers and demanded more details on its requirements.

“The standards proposed by your Department could result in a convicted felon receiving federal dollars and gaining access to confidential taxpayer information," the letter stated. "The same standards allow any individual who has registered with the exchange and completed two days of training to facilitate enrollment, as if the decision to purchase health insurance is similar to the decision of registering to vote."

The “unreasonably low standard” for becoming a navigator both undermines the state’s ability to ensure consumers are protected and raises questions about the appropriate use of federal resources and the protection of highly sensitive information, they said.

It’s not the first time Republicans have pushed back on the navigator rules. They’ve previously pressed the administration for information on protecting consumers’ sensitive data from navigators in hearings this spring.

Established under PPACA, the navigator program provides grants to organizations to help individuals enroll in the new health insurance plans through exchanges. In April, HHS announced the availability of $54 million in funding to support navigators.

The navigators are expected to provide “fair, impartial and accurate information that assists consumers with submitting the eligibility application, clarifying distinctions among [qualified health plans] and helping qualified individuals make informed decisions during the health plan selection process.” They also will provide additional assistance to consumers with disabilities, limited proficiency in English or who are unfamiliar with health insurance.

The administration has said that navigators do not have to be licensed agents or brokers and may not be paid by insurance companies, a move that angered many in the industry. The senators said that brokers and agents are trained professionals who have the experience and requirements to guide consumers in their health plan options.

“As you are well aware, health insurance agents and brokers are subject to strict state-level exam-based licensing laws and annual continuing education requirements, as well as significant federal and state privacy, security and market conduct requirements,” they wrote. “Furthermore, agents and brokers have a personal legal and financial liability to comply with all of these laws and requirements, as well as a requirement to maintain professional liability insurance to protect consumers.”

The senators posed a list of 15 questions to the administration — including about privacy requirements, the minimum requirements for navigators and how the administration plans to prevent potential fraud — and asked for a response by August 1.

In addition to Hatch, the June 20 letter was signed by Sens. Johnny Isakson (R-Ga.), Tom Coburn (R-Okla.), John Barrasso (R-Wyo.), Pat Roberts (R-Kan.), Mike Enzi (R-Wyo.), Richard Burr (R-N.C.), John Thune (R-S.D.) and John Cornyn (R-Texas).

Originally published on BenefitsPro.com