Full Text of SB1194 98th General Assembly
SB1194sam001 98TH GENERAL ASSEMBLY | Sen. William R. Haine Filed: 4/15/2013
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| 1 | | AMENDMENT TO SENATE BILL 1194
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 1194 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Short title. This Act may be cited as the | 5 | | Navigator Certification Act. | 6 | | Section 5. Definitions.
As used in this Act: | 7 | | "Director" means the Director of Insurance. | 8 | | "Exchange" means any health benefit exchange established | 9 | | or operating in this State, including any exchange established | 10 | | or operated by the United States Department of Health and Human | 11 | | Services. | 12 | | "Navigator" means a person or entity selected to perform | 13 | | the activities and duties identified in 42 U.S.C. 18031(i) in | 14 | | this State. "Navigator" includes any person or entity who | 15 | | receives grant funds from the United States Department of | 16 | | Health and Human Services, the State of Illinois, or an |
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| 1 | | exchange or private funds to perform any of the activities and | 2 | | duties identified in 42 U.S.C. 18031(i), including, but not | 3 | | limited to, in-person assisters and application counselors.
| 4 | | Section 10. Certificate required.
| 5 | | (a) No individual or entity shall perform, offer to | 6 | | perform, or advertise any service as a navigator in this State | 7 | | or receive navigator grant funding from the United States | 8 | | Department of Health and Human Services, the State of Illinois, | 9 | | or an exchange or private funds unless certified as a navigator | 10 | | by the Director under this Act. | 11 | | (b) A navigator who complies with the requirements of this | 12 | | Act
may do any of the following: | 13 | | (1) conduct public education activities to raise | 14 | | awareness of the availability of qualified health plans; | 15 | | (2) distribute fair and impartial information | 16 | | concerning enrollment in all qualified health plans | 17 | | offered within the exchange and the availability of the | 18 | | premium tax credits under Section 36B of the Internal | 19 | | Revenue Code of 1986, 26 U.S.C. 36B, and cost-sharing | 20 | | reductions under Section 1402 of the federal Patient | 21 | | Protection and Affordable Care Act; | 22 | | (3) facilitate enrollment in qualified health plans, | 23 | | without suggesting that an individual select a particular | 24 | | plan; | 25 | | (4) provide referrals to appropriate federal and State |
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| 1 | | agencies for any enrollee with a grievance, complaint, or | 2 | | question regarding their health plan or coverage or a | 3 | | determination under such plan or coverage; | 4 | | (5) provide information in a manner that is culturally | 5 | | and linguistically appropriate to the needs of the | 6 | | population being served by the exchange. | 7 | | (c) A navigator may not: | 8 | | (1) engage in any activities that would require an | 9 | | insurance producer license; | 10 | | (2) provide advice concerning the substantive | 11 | | benefits, terms, and conditions of a particular health plan | 12 | | or offer advice about which health plan is better or worse | 13 | | for a particular individual or employer; | 14 | | (3) recommend or endorse a particular health plan or | 15 | | advise consumers about which health plan to choose; | 16 | | (4) provide any information or services related to | 17 | | health benefit plans or other products not offered in the | 18 | | exchange; or | 19 | | (5) accept any compensation or consideration that is | 20 | | dependent, in whole or in part, on whether a person enrolls | 21 | | in or purchases a private health benefit plan. | 22 | | (d) Items (2), (3), and (4) of subsection (c) of this | 23 | | Section do not apply to navigators who enroll individuals in | 24 | | the State Medicaid program or other public programs. | 25 | | (e) Only a person licensed as an insurance producer in this | 26 | | State may: |
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| 1 | | (1) sell, solicit, or negotiate health insurance; | 2 | | (2) provide advice concerning the substantive | 3 | | benefits, terms, and conditions of a particular health plan | 4 | | or offer advice about which health plan is better or worse | 5 | | for a particular individual or employer; or | 6 | | (3) recommend a particular health plan or advise | 7 | | consumers about which health plan to choose.
| 8 | | Section 15. Application for certificate.
| 9 | | (a) An entity or individual applying for a navigator | 10 | | certificate shall make application to the Director on a form | 11 | | developed by the Director and declare under penalty of refusal, | 12 | | suspension, or revocation of the certificate that the | 13 | | statements made in the application are true, correct, and | 14 | | complete to the best of the individual's knowledge and belief. | 15 | | Before approving the application, the Director shall find that | 16 | | the individual: | 17 | | (1) is at least 18 years of age; | 18 | | (2) resides in this State or maintains his or her | 19 | | principal place of business in this State; | 20 | | (3) is not disqualified due to having committed any act | 21 | | that would be grounds for denial, suspension, or revocation | 22 | | of a navigator certification in accordance with Section 30 | 23 | | of this Act; | 24 | | (4) has successfully completed the federal and State | 25 | | training provided by the Exchange or equivalent State |
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| 1 | | requirements as determined by the Department; and | 2 | | (5) when applicable, has the written consent of the | 3 | | Director pursuant to 18 U.S.C. 1033, or any successor | 4 | | statute regulating crimes by or affecting persons engaged | 5 | | in the business of insurance whose activities affect | 6 | | interstate commerce. | 7 | | (b) An entity that acts as a navigator, supervises the | 8 | | activities of individual navigators, or receives funding to | 9 | | perform such activities shall obtain a navigator entity | 10 | | certificate. An entity applying for a navigator entity | 11 | | certificate shall make application on a form containing the | 12 | | information prescribed by the Director and shall list the | 13 | | individuals acting as navigators under the entity certificate. | 14 | | (1) The entity shall designate a certified navigator | 15 | | responsible for the business entity's compliance with the | 16 | | laws of this State and the Exchange. | 17 | | (2) The entity, under penalty of revocation, | 18 | | suspension, or other discipline prescribed by the | 19 | | Director, shall certify that each individual completes the | 20 | | mandatory training required by item (4) of subsection (a) | 21 | | of Section 15 of this Act. | 22 | | (c) The Director may require any documents deemed necessary | 23 | | to verify the information contained in an application submitted | 24 | | in accordance with subsections (a) and (b) of this Section. | 25 | | (d) Entities certified as navigators shall provide the | 26 | | Director with a list of all individual navigators that it |
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| 1 | | employs, supervises, or is affiliated with at renewal. | 2 | | (e) The Director may require, in a manner determined by the | 3 | | Director, that each entity that acts as a navigator demonstrate | 4 | | a level of financial responsibility capable of protecting all | 5 | | persons against the wrongful acts, misrepresentations, or | 6 | | negligence of the navigator. | 7 | | (f) Prior to any exchange becoming operational in this | 8 | | State, the Director, in coordination with the exchange, shall | 9 | | prescribe the initial training and continuing education | 10 | | requirements for navigators.
| 11 | | (g) Certificate holders must inform the Director, in | 12 | | writing, of a change of address within 340 days after the | 13 | | change. | 14 | | (h) In order to assist in the performance of the Director's | 15 | | duties, the Director may contract with the National Association | 16 | | of Insurance Commissioners (NAIC), or any affiliates or | 17 | | subsidiaries that the NAIC oversees, to perform any ministerial | 18 | | functions, including the collection of fees, related to | 19 | | certification that the Director and the nongovernmental entity | 20 | | may deem appropriate. | 21 | | Section 20. Certificate renewal.
| 22 | | (a) An individual navigator and entity certificate shall be | 23 | | valid for one year. | 24 | | (b) A navigator may file an application for renewal of a | 25 | | certificate in a method prescribed by the Director. Any |
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| 1 | | navigator who fails to timely file for certificate renewal | 2 | | shall be charged a late fee in an amount prescribed by the | 3 | | Director. | 4 | | (c) Prior to the filing date for application for renewal of | 5 | | a certificate, an individual navigator shall comply with | 6 | | ongoing training and continuing education requirements | 7 | | established by the Director. The navigator shall file with the | 8 | | Director, by a method prescribed by the Director, satisfactory | 9 | | certification of completion of the continuing education | 10 | | requirements. Any failure to fulfill the ongoing training and | 11 | | continuing education requirements shall result in the | 12 | | expiration of the certificate.
| 13 | | Section 25. Navigator referrals.
On contact with a person | 14 | | who acknowledges having existing health insurance coverage | 15 | | obtained through an insurance producer, a navigator shall refer | 16 | | the person back to that insurance producer for information, | 17 | | assistance, and any other services unless: | 18 | | (1) the individual is eligible for but has not obtained | 19 | | a federal premium subsidy and cost-sharing assistance | 20 | | available only through an exchange; | 21 | | (2) the insurance producer is not authorized to sell | 22 | | health plans in an individual exchange; or | 23 | | (3) the individual would prefer not to seek further | 24 | | assistance from the individual's insurance producer. | 25 | |
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| 1 | | Section 30. License denial, nonrenewal, or revocation.
| 2 | | (a) The Director may place on probation, suspend, revoke, | 3 | | or refuse to issue or renew a marketplace navigator's | 4 | | certificate or may levy civil penalty as established by | 5 | | emergency rule. | 6 | | (b) If an action by the Director is to nonrenew, suspend, | 7 | | or revoke a certificate or to deny an application for a | 8 | | certificate, then the Director shall notify the applicant or | 9 | | certificate holder and advise, in writing, the applicant or | 10 | | certificate holder of the reason for the suspension, | 11 | | revocation, or denial or nonrenewal of the applicant's or | 12 | | certificate holder's certificate. The applicant or certificate | 13 | | holder may make written demand upon the Director within 30 days | 14 | | after the date of mailing for a hearing before the Director to | 15 | | determine the reasonableness of the Director's action. The | 16 | | hearing must be held within not fewer than 20 days nor more | 17 | | than 30 days after the mailing of the notice of hearing and | 18 | | shall be held pursuant to Part 2402 of Title 50 of the Illinois | 19 | | Administrative Code. | 20 | | (c) A marketplace entity license may be suspended, revoked, | 21 | | or refused or information turned over to the U.S. Department of | 22 | | Health and Human Services and applicable state agencies if the | 23 | | Director finds, after hearing, that an individual licensee's | 24 | | violation was known or should have been known by one or more of | 25 | | the partners, officers, or managers acting on behalf of the |
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| 1 | | marketplace navigator entity. | 2 | | (d) In addition to or instead of any applicable denial, | 3 | | suspension, or revocation of a certificate, a person may, after | 4 | | hearing, be subject to a civil penalty in accordance with | 5 | | emergency rules issued by the Director. | 6 | | (e) The Director has the authority to enforce the | 7 | | provisions of and impose any penalty or remedy authorized by | 8 | | this Act against any person who is under investigation of or | 9 | | charged with a violation of this Act or rules even if the | 10 | | person's certificate has been surrendered or has lapsed by | 11 | | operation of law. | 12 | | (f) Upon the suspension, denial, or revocation of a | 13 | | certificate, the certificate holder or other person having | 14 | | possession or custody of the certificate shall promptly deliver | 15 | | it to the Director in person or by mail. The Director shall | 16 | | publish all suspensions, denials, or revocations after the | 17 | | suspensions, denials, or revocations become final in a manner | 18 | | designed to notify the public. | 19 | | (g) A person whose certificate is revoked or whose | 20 | | application is denied pursuant to this Section is ineligible to | 21 | | apply for any license for 3 years after the revocation or | 22 | | denial. A person whose certificate as a marketplace navigator | 23 | | has been revoked, suspended, or denied may not be employed, | 24 | | contracted, or engaged in an Exchange-related capacity during | 25 | | the time the revocation, suspension, or denial is in effect. |
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| 1 | | Section 35. Reporting to the Director.
| 2 | | (a) Each navigator shall report to the Director within 30 | 3 | | calendar days after the final disposition of a matter that | 4 | | violates the provisions set forth in this Act that results in | 5 | | any administrative action taken against him in another | 6 | | jurisdiction or by another governmental agency in this State. | 7 | | The report shall include a copy of the order, consent to order, | 8 | | or other relevant legal documents. | 9 | | (b) Within 30 days after the initial pretrial hearing date, | 10 | | a navigator shall report to the Director any criminal | 11 | | prosecution of the navigator of a matter that violates the | 12 | | provisions set forth in this Act taken in any jurisdiction. The | 13 | | report shall include a copy of the initial complaint filed, the | 14 | | order resulting from the hearing, and any other relevant legal | 15 | | documents. | 16 | | (c) An entity that acts as a navigator that terminates the | 17 | | employment, engagement, affiliation, or other relationship | 18 | | with an individual navigator shall notify the Director within | 19 | | 30 days following the effective date of the termination, using | 20 | | a format prescribed by the Director, if the reason for | 21 | | termination is one of the reasons set forth in this Act or the | 22 | | entity has knowledge the navigator was found by a court or | 23 | | government body to have engaged in any of the activities | 24 | | prohibited by this Act. Upon the written request of the | 25 | | Director, the entity shall provide additional information, | 26 | | documents, records, or other data pertaining to the termination |
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| 1 | | or activity of the individual.
| 2 | | Section 40. Hospitals; hospital affiliates; All Kids | 3 | | Application Agents. | 4 | | (a) The requirements of this Act shall not apply to | 5 | | hospitals or hospital affiliates or any entity or medical | 6 | | provider enrolled with the Department of Healthcare and Family | 7 | | Services as an All Kids Application Agent (AKAA), that do not | 8 | | actively recruit enrollees in the Illinois Health Benefits | 9 | | Exchange, with regard to assisting uninsured individuals | 10 | | seeking medical care in understanding the process for enrolling | 11 | | in the Illinois Healthcare Marketplace. | 12 | | (b) The Director may by rule establish registration and | 13 | | training requirements applicable to hospitals or hospital | 14 | | affiliates or any AKAA that desire to assist uninsured | 15 | | individuals that seek medical care to understand the process | 16 | | for enrolling in the Illinois Health Benefits Exchange. | 17 | | (c) No hospitals or hospital affiliates or any AKAA that | 18 | | assists uninsured individuals that seek medical care may: | 19 | | (1) sell, solicit, or negotiate health insurance; | 20 | | (2) provide advice concerning the substantive | 21 | | benefits, terms, and conditions of a particular health plan | 22 | | or offer advice about which health plan is better or worse | 23 | | for a particular individual or employer; | 24 | | (3) recommend or endorse a particular health plan or | 25 | | advise consumers about which health plan to choose; or |
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| 1 | | (4) provide any information or services to uninsured | 2 | | individuals related to the purchase of health benefit plans | 3 | | or other products not offered in the exchange. | 4 | | (d) Nothing in this Section shall prohibit hospitals or | 5 | | hospital affiliates or any AKAA from informing patients in | 6 | | non-emergency situations about the provider's participation in | 7 | | particular networks or plans in order to ensure that patients | 8 | | can understand their payment responsibilities relating to | 9 | | copayments, coinsurance, or deductibles. | 10 | | (e) Nothing in this Section shall prohibit hospitals or | 11 | | hospital affiliates or any AKAA, otherwise authorized by the | 12 | | Department of Healthcare and Family Services to enroll | 13 | | individuals into Medicaid, from continuing that practice in the | 14 | | absence of rules required by this Section. | 15 | | (f) Nothing in this Section authorizes the Director to make | 16 | | determinations or adopt rules relating to the ability for | 17 | | hospitals or hospital affiliates or any AKAA to enroll | 18 | | individuals in Medicaid if those entities have otherwise been | 19 | | authorized by the Department of Healthcare and Family Services | 20 | | to enroll individuals into Medicaid. | 21 | | Section 45. Other laws; rulemaking authority.
| 22 | | (a) The requirements of this Act shall not apply to any | 23 | | individual or entity licensed as an insurance producer in this | 24 | | State. | 25 | | (b) Pursuant to the authority granted by this Act, the |
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| 1 | | Director may adopt rules as may be necessary or appropriate for | 2 | | the administration and enforcement of this Act.
| 3 | | Section 97. Severability. The provisions of this Act are | 4 | | severable under Section 1.31 of the Statute on Statutes.
| 5 | | Section 99. Effective date. This Act takes effect upon | 6 | | becoming law.".
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