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pdfSupporting Statement – Part A
Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and NonNavigator Assistance Personnel
A. Background
On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act. On
March 30, 2010, the Health Care and Education Reconciliation Act of 2010 was also signed into law.
The two laws collectively are referred to as the Affordable Care Act.
The Affordable Care Act creates Health Insurance Exchanges (Exchanges), new competitive
marketplaces where consumers and small businesses can purchase private health insurance. Consumers
who access health insurance coverage through Exchanges will be able to receive direct assistance from
Navigators authorized to help consumers through the registration, eligibility determination, and plan
selection process as they enroll in the Exchanges. Some Exchanges will also provide additional consumer
assistance as well as education and outreach.
Section 1311(i)(4) of the Affordable Care Act requires the Secretary to establish standards for Navigators,
including provisions to ensure that any entity selected as a Navigator is qualified, and licensed if
appropriate, to engage in the Navigator activities required by the law and to avoid conflicts of interest.
Final Exchange regulations at 45 CFR 155.205(d) and (e) also require that each Exchange must have a
consumer assistance function, and must conduct outreach and education activities to educate consumers
about the Exchange and insurance affordability programs to encourage participation. Individuals and
entities fulfilling the duties under 45 CFR 155.205(d) and (e) are referred to as non-Navigator assistance
personnel.
In order to ensure that any entity selected as a Navigator is qualified to engage in the Navigator activities
required by the law and to avoid conflicts of interest, certain disclosures will be necessary. These
disclosures were specified in a notice of proposed rulemaking published on April 5, 2013 at 78 FR 20581,
codified at 45 CFR 155.210 and 155.215. These disclosures are now being finalized as part of a final
rulemaking being published concurrently with this supporting statement. The disclosures relate to
eligibility requirements for Navigators, the mitigation of conflicts of interest, the methods of disclosure of
any non-prohibited conflicts of interest, registration prior to training, the maintenance of proof of
certification or recertification, and the dissemination to consumers of the full range of QHP options and
insurance affordability programs for which they may be eligible. These requirements also apply to nonNavigator assistance personnel. These standards are only applicable in Federally-facilitated Exchanges
and for federally-funded non-Navigator assistance personnel in State-based Exchanges.
B. Justification
1.
Need and Legal Basis
The establishment of Navigator Programs to provide education and outreach to consumers about health
insurance exchanges and to provide culturally and linguistically appropriate information in a fair,
accurate, and impartial manner among consumers is authorized by Sections 1311(d)(4)(K) and 1311(i) of
the Affordable Care Act.
Section 1321(c)(1) of the Affordable Care Act authorizes the Secretary of HHS to “establish and operate”
a federal Exchange within any State that does not elect or is not prepared to establish a State-based
Exchange, as well as to “take such actions as are necessary to implement” the requirements for
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establishing an Exchange, including the awarding of Navigator grants.
Section 1311(i)(4) of the Affordable Care Act requires the Secretary to establish standards for Navigators,
including provisions to ensure that any entity selected as a Navigator is qualified, and licensed if
appropriate, to engage in the Navigator activities required by the law and to avoid conflicts of interest. In
addition, Exchanges must provide various forms of consumer assistance in order to fulfill the
requirements of 45 CFR 155.205(d) and (e).
2.
Information Users
Navigators as well as non-Navigator assistance personnel fulfilling the requirements of 45 CFR
155.205(d) and (e) in Federally-facilitated Exchanges have to provide an attestation to the Exchange that
they are not ineligible to serve as a Navigator or non-Navigator assistance personnel. In addition,
Navigators and non-Navigator assistance project leads have to prepare and submit a plan for mitigating
conflicts of interest during their term as a Navigator grantee or non-Navigator assistance personnel. This
mitigation plan is only required on a per entity basis, not a per individual basis. Navigators will include
attestation information within their grant application through previously approved OMB covered forms,
and as such, the burden for Navigators providing this information is not calculated in this PRA.
Navigators and non-Navigator assistance personnel are required to provide information to eligible
consumers about the full range of QHP options and insurance affordability programs for which they may
be eligible. A disclosure to the Exchange and each consumer receiving assistance, about certain nonprohibited conflicts of interest, are required by Navigators and non-Navigator assistance personnel.
Prior to performing any Navigator or non-Navigator assistance personnel duties, individuals are required
to register for training as a prerequisite to becoming certified. After their first year performing their
required duties, they will be required to be recertified. Navigators and non-Navigator assistance
personnel are required to maintain proof of their certification or recertification.
3.
Use of Information Technology
All Navigators and non-Navigator assistance personnel will provide conflict of interest disclosures to the
Exchange electronically. Disclosures to consumers will be able to be provided orally. Registration and
maintenance of proof of certification or recertification will also be through electronic means. Details on
the specific electronic format for submission will be made available to Navigators and non-Navigator
assistance personnel as soon as systems are developed.
Government Paperwork Elimination Act (GPEA)
Is this collection currently available for completion electronically?
No, this will be a new electronic data collection.
Does this collection require a signature from the respondent(s)?
Navigators and non-Navigator assistance personnel will submit disclosures using the format
prescribed by HHS. While they have to identify themselves, there is no requirement for an
electronic signature.
If CMS had the capability of accepting electronic signature(s), could this collection be made available
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electronically?
Not applicable. The collection will be made electronically. An e-signature will not be required.
If this collection isn’t currently electronic but will be made electronic in the future, please give a date
(month & year) as to when this will be available electronically and explain why it can’t be done sooner.
Not applicable. The collection will be made electronically.
If this collection cannot be made electronic, or if it isn’t cost beneficial to make it electronic, please
explain.
4.
Not applicable. The collection will be made electronically.
Duplication of Efforts
This information collection does not duplicate any other effort and the information cannot be
obtained from any other source.
5.
Small Businesses
There are no unique impacts to small businesses involved.
6.
Less Frequent Collection
Non-Navigator assistance personnel are only required to provide the required attestation, mitigation
plan, and disclosure of certain non-prohibited conflicts of interest to the Exchange one time, unless
there is a change which would require the submission of an updated disclosure. Navigators are only
required to provide the mitigation plan, disclosure of certain non-prohibited conflicts of interest to
the Exchange one time, unless there is a change which would require the submission of an updated
disclosure.
Navigators and non-Navigator assistance personnel are required to disclose to consumers receiving
assistance information about the full range of QHP options and insurance affordability programs for
which they are eligible, as well as certain non-prohibited conflicts of interest. These disclosures are
required on a per consumer basis to ensure that each consumer is provided all information as
required by statute and regulation.
Navigators and non-Navigator assistance personnel are required to register one time for initial
training and certification. Navigators and non-Navigator assistance personnel are required to
maintain proof of their initial certification, and, in subsequent years, proof of their recertification.
This recordkeeping requirement is annual in frequency.
7.
Special Circumstances
A disclosure of non-prohibited conflicts of interest may need to be reported to the agency more often
than quarterly if a Navigator or non-Navigator assistance personnel has a change in the nature of the
conflict of interest initially reported, necessitating an updated disclosure.
Navigators and non-Navigator assistance personnel would maintain the proposed disclosures as
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described for the duration of their term as a Navigator or non-Navigator assistance personnel which
may exceed three years.
8.
Federal Register/Outside Consultation
We are adding collection requirements associated with 45 CFR 155.210 and 155.215. These
requirements were proposed in CMS-9949 (Patient Protection and Affordable Care Act; Exchange
and Insurance Market Standards for 2015 and Beyond). No changes are being made to currently
approved collection requirements.
Describe efforts to consult with persons outside the agency to obtain their views on the availability
of data, frequency of collection, the clarity of instructions and recordkeeping, disclosure, or
reporting format (if any), and on the data elements to be recorded, disclosed, or reported.
CMS specified these collections in a proposed rule published on April 5, 2013 at 78 FR 20581.
CMS solicited public comments on these collections. We received a few comments regarding the
estimated wages; these comments generally stated an appreciation for an estimate of a livable wage;
however the comments noted a concern that the wage estimates are unrealistic. No comments
recommended specific wage estimates.
The wage estimates are not being modified. The estimates are not mandatory wages and are not
broken down based on the role geographic differences may play in setting actual wages. There is
nothing in the final rule that would require any Navigators or non-Navigator assistance personnel to
be paid any specific amount. In addition Navigators and non-Navigator assistance personnel wages
could be funded in many different ways. For example, a Navigator grantee may have outside
funding sources for wages, with their Navigator grant completely funding all outreach and education
and application assistance activities not included in wages. These are estimates commonly used for
estimating paperwork burden and do not represent a recommendation or a requirement of how much
Navigator and non-Navigator personnel are to be paid.
In the March 21, 2014 Exchange and Insurance Market Standards for 2015 and Beyond
proposed rule (79 FR 15854), we requested public comment on each of the proposed rule’s
information collection requirements. Because the comment period for the information
collection requirements was 60 days (ending May 20, 2014), whereas the proposed rule’s
comment period was 30 days, we did not discuss the comments and responses to the
information collection requirements in the final rule published on May 27, 2014.
Accordingly, we will post a 30-day notice in the Federal Register in advance of these
information collection requirements being finalized. The comment and response can be
viewed in Appendix C.
Consultation with representatives of those from whom information is to be obtained or those who
must compile records should occur at least once every 3 years - even if the collection of
information activity is the same as in prior periods. There may be circumstances that may
preclude consultation in a specific situation. These circumstances should be explained.
We do not foresee circumstances that would preclude CMS from consulting with Navigators or nonNavigator assistance personnel.
9.
Payments/Gifts to Respondents
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Payments and gifts will not be provided.
10. Confidentiality
CCIIO may collect some personally identifiable information related to disclosures of non-prohibited
conflicts of interest as well as registration prior to training. To the extent provided by law, we will
maintain respondent privacy with respect to the information being collected.
11. Sensitive Questions
In order to perform their required duties, Navigators and non-Navigator assistance personnel may need to
communicate with clients about sensitive topics, such as their health status and needs, in order to assist
with eligibility determinations and enrollment. As such, requests for some information such as individual
or family income, employment status, citizenship, and other characteristics that people might commonly
consider private may be communicated.
12.
Burden Estimates (Hours & Wages)
Wage per hour data1 for Navigator grantee personnel, project leads, and senior level executives; and nonNavigator assistance project leads, personnel, and senior level executives are as follows:
Navigator Personnel – GS-9 equivalent
Mid-Level Project Lead – GS-12 equivalent
Senior Level Executive – GS-15 equivalent
$20
$29
$48
Non-Navigator Assistance Personnel – GS-9 equivalent
Non-Navigator Assistance Mid-Level Project Lead- GS 12 equivalent
Non-Navigator Senior Level Executive – GS-15 equivalent
$20
$29
$48
At this time there are 105 Navigator grantees. We estimate that there are 3,000 individuals working as
Navigators. In addition, each grantee organization has one Project Lead and one Senior Level executive.
We estimate the number of non-Navigator assistance project leads to be 300 and 1800 for personnel.
Previous estimates have indicated that we expect 4,336,646 applications to be submitted for coverage
through the Exchange during the 2013-2014 open enrollment period.2 We estimate about 25 percent of
consumers submitting applications for Marketplace coverage will seek assistance from Navigator
personnel. In total we estimate that Navigators will assist 1,084,161 individuals during 2014.
Preparing an attestation that an individual or entity is not ineligible to serve as non-Navigator assistance
personnel is estimated to have a burden of 0.25 hours (15 minutes) per respondent.
Preparing a conflict of interest mitigation plan is estimated to have a burden of 5 hours per Navigator
grantee. The Senior Level Executive is expected to prepare the mitigation plan at a cost of $240 (5 X 48).
1 Wage data from OPM GS Wage Tables at http://www.opm.gov/policy-data-oversight/pay-leave/salarieswages/2013/general-schedule/gs_h.pdf.
2 See Supporting Statement for Data Collection to Support Eligibility Determinations for Insurance Affordability
Programs and Enrollment through Affordable Insurance Exchanges, Medicaid and Children’s Health Insurance
Program Agencies, available at http://www.cms.gov/Regulations-andGuidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10440.html.
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For 105 grantees the total time burden associated with preparing the mitigation plan is estimated to be 525
hours (5 X 105) at a total cost of $126,000 (240 X 525).
For non-Navigator assistance personnel, preparing a conflict of interest mitigation plan is estimated to
have a burden of 5 hours per respondent.
Preparing disclosure to consumers receiving assistance information about the full range of QHP options
and insurance affordability programs for which they are eligible, including completion of any
necessary forms, is estimated to have a burden of 1 hour per consumer at a cost of $20 (1 X 20). For
1,084,161 consumers the total time burden for this disclosure is estimated to be 1,084,161 hours at a total
cost of $21,683,220 (20 X 1,084,161).
Preparing disclosure of non-prohibited conflicts of interest is estimated to have a burden of 0.16 hours (10
minutes) per Navigator personnel at a cost of $3.20 (.16 X 20) For 3,000 Navigator personnel the total
time burden associated with preparing this disclosure is estimated to be 480 hours (0.16 X 3,000) at a
total cost of $9,600 (20 X 480).
For non-Navigator assistance personnel disclosure of non-prohibited conflicts of interest is estimated to
have a burden of 0.16 hours (10 minutes) per respondent.
Registering prior to training is estimated to have a burden of 0.25 hours (15 minutes) per respondent. For
a Navigator Senior Level Executive the estimated cost for registration is $12 (0.25 X 48), for Navigator
Project Leads the estimated cost is $7.25 (0.25 X 29) and for Navigator personnel the estimated cost is $5
(0.25 X 20). For 105 Senior Level Executives the total time burden associated with registration prior to
training is estimated to be 26.25 hours (0.25 X 105) at a total cost of $1,260 (48 X 26.25). For 105
Project Leads the total time burden associated with registration is estimated to be 26.25 hours (0.25 X
105) at a total cost of $761.25 (29 X 26.25). For 3,000 Navigator personnel the total time burden
associated with registration is estimated to be 750 hours (0.25 X 3,000) at a total cost of $150,000 (20 X
750).
For non-Navigator assistance personnel, registration prior to training is estimated to have a burden of 0.25
hours (15 minutes) per respondent.
Maintenance of proof of certification or recertification is estimated to have a burden of 0.016 hours (1
minute) per respondent.3 For a Navigator Senior Level Executive the estimated cost for maintenance of
proof od certification or recertification is estimated to be $0.77 (0.016 X 48), for Navigator Project Leads
the estimated cost is $0.46 (0.016 X 29) and for Navigator personnel the estimated cost is $0.32 (0.016 X
20). For 105 Senior Level Executives total time burden associated with maintenance of proof of
certification or recertification is estimated to be 1.68 hours (0.016 X 105) at a total cost of $80.64 (48 X
1.68). For 105 Project Leads the total time burden associated with maintenance of proof is estimated to
be 1.68 hours (0.016 X 105) at a total cost of $48.72 (29 X 1.68). For 3,000 Navigator personnel the total
time burden associated with maintenance of proof is estimated to be 48 hours (0.016 X 3,000) at a total
cost of $960 (20 X 48).
For non-Navigator assistance personnel, maintenance of proof of certification or recertification is
estimated to have a burden of 0.016 hours (1 minute) per respondent.4
3 See Appendix A for screen shots of a sample registration portal and a sample certification certificate; see
Appendix B for specific data elements required for Navigator and non-Navigator assistance personnel registration.
4 See Appendix A for screen shots of a sample registration portal and a sample certification certificate; see
Appendix B for specific data elements required for Navigator and non-Navigator assistance personnel registration.
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In accordance with 45 CFR 155.210(e)(6) and 45 CFR 155.215(g), Navigators, as well as those
non-Navigator personnel to whom 45 CFR 155.215 applies, are required to maintain procedures
to inform consumers of the functions and responsibilities of Navigators and non-Navigator
assistance personnel (as applicable), and to obtain authorization for the disclosure of consumer
information to the Navigator or non-Navigator assistance personnel (as applicable). This is a
one-time requirement for the organization.
We estimate that it would take a Navigator or non-Navigator assistance personnel project lead up
to 2 hours to create the form for providing authorization to applicants, and a Navigator or nonNavigator senior executive up to 1 hour to review the procedure, for a total time burden of up to
3 hours. We estimate the cost burden associated with creating this procedure would be $106 per
organization. The total cost for all 105 Navigator grantee organizations is estimated to be
$11,130. The total cost for all 300 non-Navigator assistance personnel organizations is estimated
to be $31,800.
There are also recordkeeping requirements associated with developing and maintaining a model
agreement and authorization form. Each organization is expected to maintain a copy of the
executed forms. We estimate that the time burden associated with maintaining a copy of
executed agreement and authorization forms for each consumer would be 0.016 hours (1
minute); we assume these would be maintained through electronic copies with minimal cost.
In addition, there are burdens on individual Navigators, as well as those non-Navigator
assistance personnel to whom 45 CFR 155.215 applies. Under 45 CFR 155.210(e)(6) and
155.215(g), respectively, Navigators and non-Navigator assistance personnel are required to
inform consumers of the functions and responsibilities of Navigators and non-Navigator
assistance personnel and obtain authorization for the disclosure of consumer information to a
Navigator or non-Navigator assistance personnel prior to obtaining the consumer’s personally
identifiable information.
In the final rule on certified application counselors (78 FR 42824, 42854-42855), we estimated
that it would take a certified application counselor 0.25 hours (15 minutes) to provide consumers
with information about the functions and responsibilities of a certified application counselor,
obtain their authorizations, and provide any applicable conflict of interest disclosures. Because
here we are only estimating the time required to provide consumers with information about the
functions and responsibilities of a Navigator or non-Navigator assistance personnel and obtain
their authorization, we estimate that it would take a Navigator or non-Navigator assistance
personnel 0.1667 hours (10 minutes) to perform this task.
The total cost estimate for the consumer authorization process for Navigators and non-Navigator
assistance personnel therefore would be $3.33. The total time burden on all 3,000 Navigators is
estimated to be approximately 500 hours, and the total cost burden on all 3,000 Navigators is
estimated to be $9,990. The total time burden on all 1,800 non-Navigator assistance personnel is
estimated to be 300 hours, and the total cost burden on all 1,800 non-Navigator assistance
personnel is estimated to be $5,994.
Table 1 - Annual Recordkeeping and Reporting Requirements, By Respondent
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Labor
Cost of
Reporting
per
Response
($)
7.30
Capital/
Maintenance
Costs ($)
0
Total Cost
($)
Number of
Respondents
-
Number
of
Responses
-
Burden
per
Response
(hours)
0.25
Total
Annual
Burden
(hours)
-
Hourly
Labor
Cost of
Reporting
($)
29.20
105
1
5
525
48
240
0
126,000
-
-
5
-
29
145
0
-
3000
361
1
1,084,161
20
20
0
21,683,220
3,000
1
.16
480
20
3.20
0
9,600
-
-
.16
-
20
3.20
0
-
105
1
0.25
26.25
48
12
0
1260
105
1
0.25
26.25
29
7.25
0
761.25
3,000
1
0.25
750
20
5
0
150,000
Non-Navigator
Assistance Project
Lead
300
1
0.25
75
29
7.25
0
2175
Non-Navigator
Assistance Personnel
Certification and
Recertification
§155.215(b)(1)
Navigator Senior
Level Executives
1800
1
0.25
450
20
5
0
9000
105
1
0.016
1.68
48
0.77
0
80.64
Navigator Project
Leads
105
1
0.016
1.68
29
0.46
0
48.72
3,000
1
0.016
48
20
0.32
0
960
-
-
0.016
-
29
0.46
0
-
Proposed Regulation
Section(s)
Conflict of Interest
Attestation
§155.215(a)(2)(ii)
Non-Navigator
Assistance Program
Conflict of Interest
Mitigation
Plan§155.215(a)(1)(ii)
& (a)(2)(iii)
Navigator Senior
Executive
Non-Navigator
Assistance Project
Lead
Conflict of Interest
Disclosure of
Coverage Options §
155.215(a)(1)(iii) &
(a)(2)(iv)
Conflict of Interest
Disclosure to
Exchange and
Consumers §
155.215(a)(1)(iv) &
(a)(2)(v)
Navigator Personnel
Non-Navigator
Assistance Personnel
Training Registration
§155.215(b)(1)(ii)
Navigator Senior
Level Executives
Navigator Project
Leads
Navigator Personnel
Navigator Personnel
Non-Navigator
Assistance Project
Lead
8
-
Labor
Cost of
Reporting
per
Response
($)
0.32
Capital/
Maintenance
Costs ($)
0
Total Cost
($)
Number of
Respondents
-
Number
of
Responses
-
Burden
per
Response
(hours)
0.016
Total
Annual
Burden
(hours)
-
Hourly
Labor
Cost of
Reporting
($)
20
Navigator Senior
Level Executives
105
1
1
1
48
48
0
5,040
Navigator Project
Leads
105
1
2
2
29
58
0
6,090
3,000
1
0.1827
0.1827
20
3.654
0
10,962
Non-Navigator
Assistance Senior
Level Executives
300
1
1
1
48
48
0
14,400
Non-Navigator
Assistance Project
Lead
300
1
2
2
29
58
0
17,400
Non-Navigator
Assistance Personnel
Total
Navigator Program
Non-Navigator
Assistance Program
1800
1
0.1827
0.1827
20
3.654
0
6,577.20
681
938.308
0
3,210
372
1,862.04
21,994,022.61
2400
-
-
-
Proposed Regulation
Section(s)
Non-Navigator
Assistance Personnel
Consumer
authorization forms
(§155.210(e)(6) and
§155.215(g)
Navigator Personnel
18.04
-
13. Capital Costs
There are no capital costs needed for this collection requirement.
14. Cost to Federal Government
I. REVIEW OF DOCUMENTATION SUBMITTED BY NAVIGATOR AWARDEES
It is expected that Navigators will submit a conflict of interest attestation through the grant application
process, which is covered under another PRA burden estimate. In addition, Navigators will have to
submit a risk mitigation plan and a conflict of interest disclosure to the Federally-facilitated Exchange.
In contrast, non-Navigator assistance personnel that are covered by this burden estimate will be operating
in Consumer Partnership Marketplaces and as such, will submit any required attestations, risk mitigation
plans, and conflict of interest disclosures directly to a state operating in a consumer partnership with
CMS.
A. Risk Mitigation Plan and Conflict of Interest Disclosure to Exchange
The risk mitigation plans and non-prohibited conflicts of interest disclosures that a Navigator may
have to provide during the course of a grant period will be reviewed and approved by CMS grant
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project officers, with an estimated wage of $29 per hour.5 The time to review each risk mitigation
plan and conflict of interest disclosure submission is estimated to be 0.5hours (30 minutes) total.
Hours: 0.5 hours (30 minutes) per submission
Cost: $29 mid-level range x .5 hours (30 minutes) per submission = $14.50 per submission
15. Changes to Burden
We estimate that this collection would increase the total annual cost to Navigator programs by
$22,092.00. We did not previously estimate the total annual cost to non-Navigator assistance programs,
but we estimate that this collection would increase that cost by $38,377.20.
16. Publication/Tabulation Dates
At this time, HHS does not expect that the data collected in the quarterly and annual reports will be
published or shared with other agencies.
17. Expiration Date
This collection does not lend itself to the displaying of an expiration date.
5 Wage data from OPM GS Wage Tables at http://www.opm.gov/policy-data-oversight/pay-leave/salarieswages/2012/general-schedule/gs_h.pdf.
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| File Type | application/pdf |
| Author | MEREDITH GITANGU |
| File Modified | 2014-06-25 |
| File Created | 2014-06-25 |