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Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges

$330,362,123

Total Assistance, FY 2008 to Present
Agency: CENTERS FOR MEDICARE AND MEDICAID SERVICES, HEALTH AND HUMAN SERVICES, DEPARTMENT OF
Assistance Type: COOPERATIVE AGREEMENTS
Popular Name: Navigator Grants
CFDA Number
93.332

Objectives: The Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges (Funding Opportunity) will enable recipients to operate as Exchange Navigators in States with a Federally-facilitated Exchange (FFE), as authorized by the Patient Protection and Affordable Care Act (PPACA). Section 1311(i) of the PPACA requires Exchanges to establish a Navigator grant program. The following duties are required of all recipients of funding under this Funding Opportunity, including but are not limited to: • Conducting public education activities to raise awareness about the Exchange; • Facilitating selection of a QHP; • Providing information in a manner that is culturally and linguistically appropriate to the needs of the population served by the Exchange, including individuals with limited English proficiency, and ensuring accessibility and usability of Navigator tools and functions for individuals with disabilities; • Providing referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under section 2793 of the Public Health Service Act, 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; • Complying with applicable training and conflict of interest standards; • Obtaining the authorization of applicants for coverage available through an Exchange application prior to accessing their personally identifiable information; and • Providing targeted assistance to serve underserved or vulnerable populations, as identified by the Exchange, within the Exchange service area. Change: The Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2020 Final Rule amended 45 C.F.R. § 155.210(e)(9), effective June 24, 2019, to make the provision of certain types of assistance, including post-enrollment assistance, permissible for FFE Navigators instead of required. However, due to significant increased funding in this Funding Opportunity and ensuring that consumers understand and have their questions answered about their health plan, coverage, or a determination under such plan or coverage, and IRS tax implications, for example, CMS plans to pursue regulatory changes to reinstate these post-enrollment assistance topics as required Navigator duties within this period of performance.

 
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