California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 8 - Enrollment Assistance › Section 6664 - Roles and Responsibilities

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Certified Enrollment Entities and
				Certified Enrollment Counselors shall perform the following functions:
(1) Maintain expertise in eligibility,
				enrollment, and program specifications. Individuals and entities registered
				under the Navigator Program must also conduct outreach and education to raise
				awareness about the Exchange;
(2)
				Provide information and services in a fair, accurate and impartial manner,
				which includes providing information that assists consumers with submitting the
				eligibility application, clarifying the distinctions among health coverage
				options, including QHPs, and helping consumers make informed decisions during
				the health coverage selection process. Such information and services shall
				include assistance with all other insurance affordability programs (e.g.,
				Medicaid and Children's Health Insurance Programs);
(3) Facilitate selection of a QHP;
(4) Provide referrals to any applicable
				office of health insurance Consumer Assistance or health insurance ombudsman
				established under Section
				2793 of the Public Health Service
				Act, 42 U.S.C. §
											300gg-93, or any other appropriate State
				agency or agencies, for any enrollee with a grievance, complaint, or question
				regarding their health plan, coverage, or a determination under such plan or
				coverage;
(5) Comply with the
				privacy and security requirements in
				45 C.F.R. §
											155.260;
(6) Prior to receiving access to any
				consumer's personally identifiable information as defined in Section
				6650 of Article 8, the Certified
				Enrollment Counselor shall:
(A) Inform the
				consumer that the Certified Enrollment Counselor must obtain his or her
				authorization prior to accessing any personally identifiable
				information;
(B) Inform each
				consumer of the roles and responsibilities of the Certified Enrollment
				Counselor as set forth in Section
				6664, subdivisions (a)(1)-(5),
				(7);
(C) Obtain oral or written
				authorization from the consumer to access the consumer's personally
				identifiable information;
1. Written
				authorization shall contain a consumer's signature and a written attestation
				completed by the Certified Enrollment Counselor affirming under penalty of
				perjury that the Certified Enrollment Counselor:
i. Is a Certified Enrollment Counselor
				affiliated with a Certified Enrollment Entity in the Navigator program as
				defined in Section
				6650;
ii. Conveyed all the information required
				under this subdivision to the consumer in a language and manner which he or she
				understands; and
iii. Obtained
				written authorization from the consumer consenting to the release of his or her
				personally identifiable information in order to fulfill the duties as described
				in Section
				6664.
2. Oral authorization shall be accompanied by
				a written attestation completed by the Certified Enrollment Counselor affirming
				under penalty of perjury that the Certified Enrollment Counselor:
i. Is a Certified Enrollment Counselor
				affiliated with a Certified Enrollment Entity in the Navigator program as
				defined in Section
				6650;
ii. Conveyed all the information required
				under this subdivision to the consumer in a language and manner which he or she
				understands; and
iii. Obtained oral
				authorization from the consumer consenting to the release of his or her
				personally identifiable information in order to fulfill the duties as described
				in Section
				6664.
(D) Inform the consumer that the Certified
				Enrollment Counselor cannot choose a health insurance plan on the consumer's
				behalf;
(E) Inform the consumer
				that the Certified Enrollment Counselor will provide the consumer with
				information regarding the health insurance options and insurance affordability
				programs for which he or she may be eligible;
(F) Inform the consumer that his or her
				personally identifiable information will be kept private and secure in
				accordance with 45 C.F.R.
				§
												155.260;
(G) Inform the consumer that if the Certified
				Enrollment Counselor cannot assist the consumer, he or she will refer the
				consumer to another Certified Enrollment Counselor or the Covered California
				call center;
(H) Inform the
				consumer that the Certified Enrollment Counselor will not charge a fee in
				exchange for performing the duties described in Section
				6664;
(I) Inform the consumer that the assistance
				is based only on the information provided by the consumer, and if the
				information given is inaccurate or incomplete, the Certified Enrollment
				Counselor may not be able to offer assistance;
(J) Inform the consumer that the
				authorization set forth in Section
				6664, subdivision (a)(6)(C), may
				be revoked at any time; and
(K)
				Maintain a record of such authorization for a minimum of ten (10)
				years.
(7) Ensure that
				voter registration assistance is available in compliance with Chapter 6 of the
				California Elections Code;
(8) For
				Certified Enrollment Entities only, maintain a physical presence in the state
				of California so that face-to-face assistance can be provided to applicants and
				enrollees;
(9) Provide information
				regarding the process of filing Exchange eligibility appeals;
(10) Provide referrals to licensed tax
				advisers, tax preparers, or other resources for assistance with tax preparation
				and tax advice related to consumer questions about the Exchange application and
				enrollment process, exemptions from the requirement to maintain minimum
				essential coverage and from the individual shared responsibility payment, and
				premium tax credit reconciliations;
(11) Inform each consumer that Certified
				Enrollment Entities and Certified Enrollment Counselors are not acting as tax
				advisors or attorneys when providing enrollment assistance and cannot provide
				tax or legal advice within their capacity as a Certified Enrollment Entity or
				Certified Enrollment Counselor;
(12) Provide targeted assistance to serve
				underserved or vulnerable populations, as identified by the Exchange, within
				the Exchange service area; and
(13)
				Comply with any applicable federal or state laws and
				regulations.