Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 950 - NAVIGATOR CERTIFICATION AND TRAINING FOR HEALTH BENEFIT MARKETPLACES › Section 031-950-3 - Certification of navigators

Current through 2024-29, July 17, 2024
1.
Certification required.
An individual may not serve as a
				navigator or perform navigator duties on behalf of a navigator organization or
				business entity as described in
				24-A
				M.R.S. §2188 unless certified in
				accordance with this section. An organization or business entity that serves as
				a navigator may not employ, contract with, or allow an individual to perform
				navigator duties on its behalf unless the individual is certified in accordance
				with this section.
2.
Examination
. An individual applying for navigator
				certification must pass a navigator examination administered or approved by the
				Superintendent and satisfy any applicable qualification standards established
				by the Marketplace or otherwise required by the
Affordable Care
				Act
and the regulations thereunder. If the Marketplace requires
				navigators to pass an examination administered by the Marketplace, the
				Superintendent may determine that this examination satisfies the requirement of
				this subsection or may require an additional examination limited to matters
				that are not fully addressed in the examination administered by the
				Marketplace.
3.
Application
				process.
An individual applying for certification as a navigator shall
				submit to the Superintendent an application and disclosure on the forms
				prescribed by the Superintendent. Certification will be issued upon the
				Superintendent's determination that the applicant has met the requirements
				specified in
				24-A
				M.R.S. §2188 and this rule.
4.
Reporting of Actions and Material
				Changes
. Any change of address, telephone number, e-mail address, name
				or other material change in the conditions or qualifications set forth in the
				original application of a certified navigator must be reported to the
				superintendent no later than 30 days after the change. An individual navigator
				shall report to the superintendent if the navigator is no longer affiliated
				with their navigator grantee organization. This requirement includes any
				conviction of a crime other than a traffic violation or any disciplinary action
				brought by an insurance regulatory official of any other jurisdiction against
				the navigator. A navigator shall report to the superintendent any
				administrative action taken against the navigator in another jurisdiction, by
				another governmental agency in this State, or by any federal agency, including
				actions by the Centers for Medicare and Medicaid Services and the Marketplace,
				within 30 days of the final disposition of the matter. This report must include
				a copy of the order, consent to order or other relevant legal documents. Within
				30 days of the initial pretrial hearing date, a navigator shall report to the
				superintendent any criminal prosecution of the individual taken in any
				jurisdiction. The report must include a copy of the initial complaint filed,
				the order resulting from the hearing and any other relevant legal documents.
				The failure to report an action or material change in the conditions or
				qualifications set forth in the original application may result in a late fee
				or discipline pursuant to
				24-A
				M.R.S. §§2188(6)
				and
				1420-K.
5.
Fee
. The Superintendent
				may require each applicant for certification to pay a fee. If the
				Superintendent requires a fee, it shall be payable to Treasurer, State of Maine
				upon submission of the application. The Superintendent may also modify such fee
				from time to time in any reasonable amount.
6.
Duration.
An individual
				navigator's certification will expire upon the earlier of the completion of the
				navigator grantee organization's grant performance period or one year unless a
				renewal application is submitted and the Superintendent can verify that the
				applicable training and examination requirements are satisfied.
7.
Termination
. In addition
				to the grounds specified in
				24-A
				M.R.S. §2188(6), an
				individual navigator's certification may be suspended, revoked, or terminated
				if the Marketplace denies, suspends, or terminates the certification of the
				individual navigator or the navigator grantee organization.
8
Training requirement.
As a
				condition of obtaining and maintaining certification, an individual must
				satisfactorily fulfill all initial and ongoing training standards established
				by the Marketplace or otherwise required by the
Affordable Care
				Act
and the regulations thereunder.
9.
Verification of
				compliance.
If the Superintendent determines that the Marketplace does
				not have effective procedures for transmitting information to identify
				individuals who have successfully completed the Marketplace's examination and
				training requirements, the Superintendent shall require certified navigators
				and applicants for certification to provide satisfactory proof of
				compliance.