Skip to main content
National Disability Navigator Resource Collaborative

AAHD Logo
  • Home
  • About Us
    • Official Partners
    • Friends of the NDNRC
    • Community Outreach Collaboratives
  • Conversations
    • Blog
    • News to Use
    • FAQ
    • Open Enrollment NaviGator
    • Archived Newsletters
  • NDNRC Materials
    • Disability Guide
    • Fact Sheets
    • Medicaid Social Media Toolkit
    • Statement on ACA
    • Webinars & Presentations
  • Resources & Links
    • Disability Specific
    • Mental & Behavioral Health
    • Populations with Special Health Care Needs
    • Marketplace and Medicare
    • Marketplace and Medicaid
    • Enrollment: Overview
    • ACA Resources: Government
    • ACA Enrollment Resources
  • Contact Us
You are here: Home / Blog / Summary of Final Rules for 2015 Marketplace

Summary of Final Rules for 2015 Marketplace

May 29, 2014 by NDNRC

Last week, we referenced the new regulations that were released by the Centers for Medicare & Medicaid Services. Families USA has prepared a succinct explanation of how these roles impact navigators and enrollment specialists. Their explanation of the final regulations is as follows:

  • Specifies several types of state requirements that would conflict with federal requirements for assisters, including: a) requirements for assisters to refer consumers to entities that are not required to provide impartial assistance, b) requirements that would prevent assisters from providing assistance to all consumers, c) requirements that would prevent assisters from providing advice regarding substantive benefits or comparative benefits of different health plans, and d) requirements that would directly or in effect prevent the implementation of marketplace enrollment assistance programs.
  • Allows health care providers to become assisters, regardless of their relationship to health insurance issuers.
  • Clarifies that it is within assisters’ scope of duties to provide comprehensive information to consumers about the substantive benefits and features of health plans, including clarifying the similarities and differences among plans, and assisting consumers with making informed decisions.
  • Clarifies that assisters can make unsolicited contact with consumers to conduct outreach – but not to provide enrollment assistance unless they have a prior relationship with the consumer.
  • Clarifies that assisters cannot provide applicants with gifts unless they are of nominal value, nor can they offer promotional items from third parties to incentivize enrollment. Note that assisters can provide reimbursement for limited consumer expenses, such as travel costs or postage.
  • Permits the Centers for Medicare and Medicaid Services (CMS) to impose civil money penalties on assisters or require corrective action plans for a) violations of federal obligations (for assisters in the federal marketplace) and b) improper use of personally identifiable information, or providing false or fraudulent information to a marketplace (for assisters in both state and federal marketplaces). No penalty will be imposed if CMS concludes that an assister acted in good faith.

Filed Under: Blog

Conversations

  • Ask a Question
  • Blogging About

GET EMAIL UPDATES

News

CBPP Announces 2023 Fall Webinar Series

AAHD is proud to announce that we will be working with the Center on Budget and Policy Priorities … Read More »

  • Proposed Rules Would Limit Short-Term Plans
  • CBPP Announces Summer Webinars

Blog

Medicaid Unwinding Resources

Which States Have a Different OE10 Deadline?

ACA Coverage and Disability – What It Means and Important Stats

Newsletters

September 29, 2023

NIH OFFICIALLY DESIGNATES PEOPLE WITH DISABILITIES AS A HEALTH DISPARITIES POPULATION This week, … [Read More...]

  • September 22, 2023
  • September 15, 2023

In Cooperation

  • The NDNRC is currently a funded project of the American Association on Health and Disability (AAHD) and was initially funded by a grant from the Robert Wood Johnson Foundation (RWJF)
Get quick answers about Obamacare laws and the Health Insurance Marketplace

Contact Information

American Association on Health and Disability (AAHD)
110 N. Washington Street, Suite 407
Rockville, MD 20850
(301) 545-6140
www.aahd.us  |  Email
Privacy Policy
  • Facebook
  • Instagram
  • Twitter

Copyright © 2023 NDNRC · All Rights Reserved · Powered by All Saints Media