Sec. 4154.051. SUFFICIENCY OF FEDERAL QUALIFICATIONS. (a) The commissioner shall determine whether the standards and qualifications for navigators provided by 42 U.S.C. Section 18031 and any regulations enacted under that section are sufficient to ensure that navigators can perform the required duties, including:
(1) assisting consumers in completing the uniform application for health coverage affordability programs available through a health benefit exchange;
(2) explaining how health coverage affordability programs work and interact, including Medicaid, the children's health insurance program, and advance premium tax credits and cost-sharing assistance;
(3) explaining health insurance concepts related to qualified health plans, including premiums, cost-sharing, networks, and essential health benefits;
(4) providing culturally and linguistically appropriate information;
(5) avoiding conflicts of interest; and
(6) establishing standards and processes relating to privacy and data security.
(b) If the commissioner determines that the standards provided by regulations enacted under 42 U.S.C. Section 18031 are insufficient to ensure that navigators can perform the required duties, the commissioner shall make a good faith effort to work in cooperation with the United States Department of Health and Human Services and to propose improvements to those standards. If after a reasonable interval the commissioner determines that the standards remain insufficient, the commissioner by rule shall establish standards and qualifications to ensure that navigators in this state can perform the required duties.
(c) At a minimum, rules adopted under this section must provide that a navigator in this state has not:
(1) had a professional license suspended or revoked;
(2) been the subject of any other disciplinary action by a financial or insurance regulator of this state, another state, or the United States; or
(3) been convicted of a felony.
(d) The commissioner shall at regular intervals obtain from the health benefit exchange a list of all navigators providing assistance in this state and, with respect to an individual, the name of the individual's employer or organization.
(e) The commissioner may by rule establish a state registration for navigators sufficient to allow the department to ensure that navigators satisfy the standards provided by Subsection (c) and collect the information described by Subsection (d).
Added by Acts 2013, 83rd Leg., R.S., Ch. 1236 (S.B. 1795), Sec. 1, eff. September 1, 2013.
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