California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 8 - Enrollment Assistance › Section 6656 - Navigator Program Request for Application and Selection Criteria

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Navigator Program applicants shall submit
				an application in response to a request for application in accordance with the
				following process:
(1) The individual or
				entity shall submit an application that includes all information,
				documentation, and declarations required in subdivision (b) of this
				Section.
(2) Grants will be awarded
				under the Navigator Program to successful applicants using the following
				evaluation criteria:
(A) Cost
				effectiveness;
(B) Ability to carry
				out the duties described in Section
				6664; and
(C) Existing relationship, or ability to
				establish relationships with the consumers likely to be eligible for enrollment
				in a Qualified Health Plan (QHP).
(3) Individuals and Entities selected to
				participate in the Navigator Program shall:
(A) Submit the following:
1. An executed agreement conforming to the
				Roles and Responsibilities defined in Section
				6664;
2. Proof of general liability insurance with
				coverage of not less than $1,000,000 per occurrence with the Exchange named as
				an additional insured, and workers compensation insurance; and
3. A completed STD. 204, payee data
				record.
(B) Complete the
				training requirements pursuant to Section
				6660.
(4) The Exchange shall review the application
				and, if applicable, request missing information necessary to select a Navigator
				applicant.
(5) Entities not
				selected to participate in the Navigator Program may submit a protest in
				writing to the Exchange at 1601 Exposition Blvd., Sacramento, 95815, which
				shall:
(A) Be in writing, signed by an
				individual who is authorized to contractually bind the applicant;
(B) Be received by the Exchange within five
				(5) business days of the date the rejected applicant is notified they have not
				been selected to participate in the Navigator Program; and
(C) Provide a statement of reason(s) for the
				protest, including facts and evidence to explain why the applicant believes the
				Exchange has incorrectly rejected the applicant.
(6) Final decisions regarding the selection
				of entities to participate in the Navigator Program and responses to protests
				will be reviewed by the Exchange's Executive Director, or his or her designee,
				in accordance with the following criteria:
(A)
				Submission of an application that includes all required information and
				documentation, as set forth in subdivisions (a)(1) and (a)(4);
(B) Ability of the applicant to meet the
				Navigator Program criteria, as set forth in subdivision (a)(2);
(C) Compliance with the requirements of
				submitting a protest, as set forth in subdivision (a)(5); and
(D) Evaluation and investigation of the facts
				and evidence as detailed in the protest letter.
(7) Within 30 days of the Exchange receiving
				the written protest from a rejected applicant, the Exchange's Executive
				Director, or his or her designee, shall mail the final determination of the
				protest to the rejected applicant.