On July 17, 2013, CMS published a final rule to establish standards for “Navigators”
in federally-facilitated and state partnership Affordable Insurance
Exchanges under the ACA. Under prior CMS regulations, Exchanges
must award grants to Navigators to provide impartial information to
consumers about health insurance, the Exchange, Qualified Health
Plans (QHPs), various insurance affordability programs, and
grievance procedures, among other functions. The July 17, 2013
final rule establishes conflict-of-interest, training and
certification, and meaningful access standards applicable to
Navigators (and certain other non-Navigator assistance personnel
funded through federal Exchange Establishment grants). State
Exchanges have the option of using this guidance or developing
their own. The rule also clarifies certain licensing and
certification requirements and specifies that entities with
relationships to issuers of stop loss insurance are ineligible to
become Navigators.
