Full Text of SB1194 98th General Assembly
SB1194sam002 98TH GENERAL ASSEMBLY | Sen. William R. Haine Filed: 4/22/2013
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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 | | "Certified application counselor" has the same meaning as | 8 | | in federal regulations and guidelines. | 9 | | "Director" means the Director of Insurance. | 10 | | "Exchange" means any health benefit exchange established | 11 | | or operating in this State, including any exchange established | 12 | | or operated by the United States Department of Health and Human | 13 | | Services. | 14 | | "Navigator" means a person or entity selected to perform | 15 | | the activities and duties identified in 42 U.S.C. 18031(i) in | 16 | | this State. "Navigator" includes any person or entity who |
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| 1 | | receives grant funds from the United States Department of | 2 | | Health and Human Services, the State of Illinois, or an | 3 | | exchange or private funds to perform any of the activities and | 4 | | duties identified in 42 U.S.C. 18031(i), including, but not | 5 | | limited to, in-person assisters as defined by federal | 6 | | regulations or guidelines.
| 7 | | Section 10. Certificate required.
| 8 | | (a) No individual or entity shall perform, offer to | 9 | | perform, or advertise any service as a navigator in this State | 10 | | or receive navigator grant funding from the United States | 11 | | Department of Health and Human Services, the State of Illinois, | 12 | | or an exchange or private funds unless certified as a navigator | 13 | | by the Director under this Act. | 14 | | (b) A navigator who complies with the requirements of this | 15 | | Act
shall do the following: | 16 | | (1) conduct public education activities to raise | 17 | | awareness of the availability of qualified health plans; | 18 | | (2) distribute fair and impartial information | 19 | | concerning enrollment in qualified health plans offered | 20 | | within the exchange and the availability of the premium tax | 21 | | credits under Section 36B of the Internal Revenue Code of | 22 | | 1986, 26 U.S.C. 36B, and cost-sharing reductions under | 23 | | Section 1402 of the federal Patient Protection and | 24 | | Affordable Care Act; | 25 | | (3) facilitate enrollment in qualified health plans; |
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| 1 | | (4) provide referrals to appropriate federal and State | 2 | | agencies for any enrollee with a grievance, complaint, or | 3 | | question regarding their health plan or coverage or a | 4 | | determination under such plan or coverage; | 5 | | (5) provide information in a manner that is culturally | 6 | | and linguistically appropriate to the needs of the | 7 | | population being served by the exchange. | 8 | | (c) A navigator may not: | 9 | | (1) sell, solicit, or negotiate any of the classes of | 10 | | insurance enumerated in Section 4 of the Illinois Insurance | 11 | | Code; | 12 | | (2) offer advice about which health plan is better or | 13 | | worse 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 insurance products not | 18 | | offered in the exchange; or | 19 | | (5) accept any compensation or consideration directly | 20 | | or indirectly from any issuer of accident and health | 21 | | insurance or stop-loss insurance that is dependent, in | 22 | | whole or in part, on whether a person enrolls in or | 23 | | purchases a particular private health benefit plan. | 24 | | (d) Items (1), (2), (3), (4), and (5) of subsection (c) of | 25 | | this Section do not apply to navigators when assisting | 26 | | individuals with the enrollment process in the State Medicaid |
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| 1 | | program or other public programs. | 2 | | Section 15. Application for certificate.
| 3 | | (a) An entity or individual applying for a navigator | 4 | | certificate shall make application to the Director on a form | 5 | | developed by the Director and declare under penalty of refusal, | 6 | | suspension, or revocation of the certificate that the | 7 | | statements made in the application are true, correct, and | 8 | | complete to the best of the individual's or entity's knowledge | 9 | | and belief. Before approving the application, the Director | 10 | | shall find that the individual: | 11 | | (1) is at least 18 years of age; | 12 | | (2) resides in this State or maintains his or her | 13 | | principal place of business in this State; | 14 | | (3) is not disqualified due to having committed any act | 15 | | that would be grounds for denial, suspension, or revocation | 16 | | of a navigator certification in accordance with Section 30 | 17 | | of this Act; | 18 | | (4) has successfully completed the federal and State | 19 | | training provided by the Exchange or equivalent State | 20 | | requirements as determined by the Department; and | 21 | | (5) when applicable, has the written consent of the | 22 | | Director pursuant to 18 U.S.C. 1033, or any successor | 23 | | statute regulating crimes by or affecting persons engaged | 24 | | in the business of insurance whose activities affect | 25 | | interstate commerce. |
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| 1 | | (b) An entity that acts as a navigator, supervises the | 2 | | activities of individual navigators, or receives funding to | 3 | | perform such activities shall obtain a navigator entity | 4 | | certificate. An entity applying for a navigator entity | 5 | | certificate shall make application on a form containing the | 6 | | information prescribed by the Director and shall list the | 7 | | individuals acting as navigators under the entity certificate. | 8 | | (1) The entity shall designate a certified navigator | 9 | | responsible for the navigator entity's compliance with the | 10 | | laws of this State and the Exchange. | 11 | | (2) The entity, under penalty of revocation, | 12 | | suspension, or other discipline prescribed by the | 13 | | Director, shall certify that each individual completes the | 14 | | mandatory training required by item (4) of subsection (a) | 15 | | of Section 15 of this Act. | 16 | | (c) The Director may require any documents deemed necessary | 17 | | to verify the information contained in an application submitted | 18 | | in accordance with subsections (a) and (b) of this Section. | 19 | | (d) Entities certified as navigators shall provide the | 20 | | Director with a list of all individual navigators that it | 21 | | employs, supervises, or is affiliated with at renewal. | 22 | | (e) The Director may require, in a manner determined by the | 23 | | Director, that each entity that acts as a navigator demonstrate | 24 | | a level of financial responsibility capable of protecting all | 25 | | persons against the wrongful acts, misrepresentations, or | 26 | | negligence of the navigator. |
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| 1 | | (f) Prior to any exchange becoming operational in this | 2 | | State, the Director, in coordination with the exchange, shall | 3 | | prescribe the initial training and continuing education | 4 | | requirements for navigators.
| 5 | | (g) Certificate holders must inform the Director, in | 6 | | writing, of a change of address within 30 days after the | 7 | | change. | 8 | | (h) In order to assist in the performance of the Director's | 9 | | duties, the Director may contract with the National Association | 10 | | of Insurance Commissioners (NAIC), or any affiliates or | 11 | | subsidiaries that the NAIC oversees, to perform any ministerial | 12 | | functions, including the collection of fees, related to | 13 | | certification that the Director and the nongovernmental entity | 14 | | may deem appropriate. | 15 | | Section 20. Certificate renewal.
| 16 | | (a) An individual navigator and entity certificate shall be | 17 | | valid for one year. | 18 | | (b) A navigator may file an application for renewal of a | 19 | | certificate in a method prescribed by the Director. Any | 20 | | navigator who fails to timely file for certificate renewal | 21 | | shall be charged a late fee in an amount prescribed by the | 22 | | Director. | 23 | | (c) Prior to the filing date for application for renewal of | 24 | | a certificate, an individual navigator shall comply with | 25 | | ongoing training and continuing education requirements |
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| 1 | | established by the Director. The navigator shall file with the | 2 | | Director, by a method prescribed by the Director, satisfactory | 3 | | certification of completion of the continuing education | 4 | | requirements. Any failure to fulfill the ongoing training and | 5 | | continuing education requirements shall result in the | 6 | | expiration of the certificate.
| 7 | | Section 25. Navigator referrals.
On contact with a person | 8 | | who acknowledges having existing health insurance coverage | 9 | | obtained through an insurance producer, a navigator shall refer | 10 | | the person back to that insurance producer for information, | 11 | | assistance, and any other services unless: | 12 | | (1) the individual is eligible for but has not obtained | 13 | | a federal premium subsidy and cost-sharing assistance | 14 | | available only through an exchange; | 15 | | (2) the insurance producer is not authorized to sell | 16 | | health plans in an individual exchange; or | 17 | | (3) the individual would prefer not to seek further | 18 | | assistance from the individual's insurance producer. | 19 | | Section 30. Certificate denial, nonrenewal, or revocation.
| 20 | | (a) The Director may place on probation, suspend, revoke, | 21 | | or refuse to issue or renew a navigator's certificate or may | 22 | | levy civil penalty as established by rule. | 23 | | (b) If an action by the Director is to nonrenew, suspend, | 24 | | or revoke a certificate or to deny an application for a |
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| 1 | | certificate, then the Director shall notify the applicant or | 2 | | certificate holder and advise, in writing, the applicant or | 3 | | certificate holder of the reason for the suspension, | 4 | | revocation, or denial or nonrenewal of the applicant's or | 5 | | certificate holder's certificate. The applicant or certificate | 6 | | holder may make written demand upon the Director within 30 days | 7 | | after the date of mailing for a hearing before the Director to | 8 | | determine the reasonableness of the Director's action. The | 9 | | hearing must be held within not fewer than 20 days nor more | 10 | | than 30 days after the mailing of the notice of hearing and | 11 | | shall be held pursuant to Part 2402 of Title 50 of the Illinois | 12 | | Administrative Code. | 13 | | (c) A navigator entity certificate may be suspended, | 14 | | revoked, or refused or information turned over to the U.S. | 15 | | Department of Health and Human Services and applicable state | 16 | | agencies if the Director finds, after hearing, that a certified | 17 | | individual's violation was known or should have been known by | 18 | | one or more of the partners, officers, or managers acting on | 19 | | behalf of the navigator entity. | 20 | | (d) In addition to or instead of any applicable denial, | 21 | | suspension, or revocation of a certificate, a person may, after | 22 | | hearing, be subject to a civil penalty in accordance with | 23 | | emergency rules issued by the Director. | 24 | | (e) The Director has the authority to enforce the | 25 | | provisions of and impose any penalty or remedy authorized by | 26 | | this Act against any person who is under investigation of or |
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| 1 | | charged with a violation of this Act or rules even if the | 2 | | person's certificate has been surrendered or has lapsed by | 3 | | operation of law. | 4 | | (f) Upon the suspension, denial, or revocation of a | 5 | | certificate, the certificate holder or other person having | 6 | | possession or custody of the certificate shall promptly deliver | 7 | | it to the Director in person or by mail. The Director shall | 8 | | publish all suspensions, denials, or revocations after the | 9 | | suspensions, denials, or revocations become final in a manner | 10 | | designed to notify the public. | 11 | | (g) A person whose certificate is revoked or whose | 12 | | application is denied pursuant to this Section is ineligible to | 13 | | apply for any certificate for 3 years after the revocation or | 14 | | denial. A person whose certificate as a navigator has been | 15 | | revoked, suspended, or denied may not be employed, contracted, | 16 | | or engaged in an Exchange-related capacity during the time the | 17 | | revocation, suspension, or denial is in effect. | 18 | | Section 35. Reporting to the Director.
| 19 | | (a) Each navigator shall report to the Director within 30 | 20 | | calendar days after the final disposition of a matter that | 21 | | violates the provisions set forth in this Act that results in | 22 | | any administrative action taken against him in another | 23 | | jurisdiction or by another governmental agency in this State. | 24 | | The report shall include a copy of the order, consent to order, | 25 | | or other relevant legal documents. |
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| 1 | | (b) Within 30 days after the initial pretrial hearing date, | 2 | | a navigator shall report to the Director any criminal | 3 | | prosecution of the navigator of a matter that violates the | 4 | | provisions set forth in this Act taken in any jurisdiction. The | 5 | | report shall include a copy of the initial complaint filed, the | 6 | | order resulting from the hearing, and any other relevant legal | 7 | | documents. | 8 | | (c) An entity that acts as a navigator that terminates the | 9 | | employment, engagement, affiliation, or other relationship | 10 | | with an individual navigator shall notify the Director within | 11 | | 30 days following the effective date of the termination, using | 12 | | a format prescribed by the Director, if the reason for | 13 | | termination is one of the reasons set forth in this Act or the | 14 | | entity has knowledge the navigator was found by a court or | 15 | | government body to have engaged in any of the activities | 16 | | prohibited by this Act. Upon the written request of the | 17 | | Director, the entity shall provide additional information, | 18 | | documents, records, or other data pertaining to the termination | 19 | | or activity of the individual.
| 20 | | Section 40. Certified application counselor. | 21 | | (a) A certified application counselor may not: | 22 | | (1) sell, solicit, or negotiate any of the classes of | 23 | | insurance enumerated in Section 4 of the Illinois Insurance | 24 | | Code; | 25 | | (2) offer advice about which health plan is better or |
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| 1 | | worse for a particular individual or employer; | 2 | | (3) recommend or endorse a particular health plan or | 3 | | advise consumers about which plan to choose; | 4 | | (4) provide any information or services related to | 5 | | health benefit plans or other insurance products not | 6 | | offered in the exchange; or | 7 | | (5) accept any compensation or consideration directly | 8 | | or indirectly from any issuer of accident and health | 9 | | insurance or stop-loss insurance that is dependent, in | 10 | | whole or in part, on whether a person enrolls in or | 11 | | purchases a particular health benefit plan. | 12 | | (b) Items (1), (2), (3), (4) and (5) of subsection (a) of | 13 | | this Section do not apply to certified application counselors | 14 | | when assisting individuals with the enrollment process in the | 15 | | State Medicaid program or other public programs. | 16 | | (c) The Director shall develop education and certification | 17 | | requirements for certified application counselors by rule. | 18 | | Section 45. Other laws; rulemaking authority.
| 19 | | (a) The requirements of this Act shall not apply to any | 20 | | individual or entity licensed as an insurance producer in this | 21 | | State. | 22 | | (b) Pursuant to the authority granted by this Act, the | 23 | | Director may adopt rules as may be necessary or appropriate for | 24 | | the administration and enforcement of this Act.
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| 1 | | Section 97. Severability. The provisions of this Act are | 2 | | severable under Section 1.31 of the Statute on Statutes.
| 3 | | Section 99. Effective date. This Act takes effect upon | 4 | | becoming law.".
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