Senate Bill 2686

AN ACT TO PROVIDE FOR LICENSING OF HEALTH INSURANCE NAVIGATORS UNDER THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT; TO PROVIDE FOR DEFINITIONS; TO PROVIDE FOR THE POWERS AND DUTIES OF THE COMMISSIONER OF INSURANCE WITH RESPECT TO THE FOREGOING; TO PROVIDE FOR APPLICABILITY; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. The Legislature finds that the provisions of the federal Patient Protection and Affordable Care Act may cause the formation of health insurance exchanges operating in Mississippi under federal law and employing navigators or navigator entities whose role will be to direct individuals and companies to health insurance policies. The Legislature further finds that licensing and regulation of such navigators or navigator entities to ensure that they are trained and knowledgeable in the subject matter of individual and group health insurance plans and insurance coverage is necessary to avoid substantial risk to the health, safety and welfare of the residents of this state.

SECTION 2. As used in this article, the following terms shall have the following meanings unless the context clearly indicates otherwise:

(a) "Exchange" means a state, federal or partnership exchange or marketplace operating in Mississippi under Section 1311 of the federal act.

(b) "Federal act" means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and regulations or guidance issued under those acts.

(c) "Navigator" means an individual, including assistors, application counselors, or other persons, authorized by the federal act to provide insurance advice and guidance to uninsured individuals and groups seeking health insurance coverage. For the purpose of this act, if an organization or business entity serves as a navigator, an individual performing navigator duties for that organization or business entity shall be considered to be acting in the capacity of a navigator.

(d) "Patient navigator" means an individual who offers assistance to patients, families and caregivers to help overcome health care system barriers and to facilitate timely access to

quality medical and psychosocial care as defined by the health care community he or she serves.

SECTION 3. (1) No navigator shall provide advice, guidance or other assistance with regard to health benefit plans as a navigator under the provisions of the federal act unless licensed in accordance with this article.

(2) The Commissioner of Insurance shall not issue a license to any applicant who does not meet or conform to the following qualifications or requirements:

(a) The applicant shall establish to the satisfaction of the commissioner that he or she has the background, experience, knowledge and competency in the subject matter that will enable him or her to deliver accurate information and advice to individuals and groups in this state seeking to obtain health insurance coverage under the provisions of the federal act;

(b) The applicant shall have successfully completed not less than thirty-five (35) hours of instruction in health benefit insurance, the exchange provisions of the federal act and any other programs approved by the commissioner;

(c) The applicant shall pass such examination as shall be required by the commissioner unless such applicant is exempted by the commissioner based on the applicant's experience and qualifications and in accordance with regulations adopted by the commissioner;

(d) An applicant shall be not less than eighteen (18) years of age and must be of good moral character and must submit in a form approved by the commissioner such information, including, without limitation, criminal history and regulatory background information as the commissioner may require; and

(e) An applicant for a renewal license shall have completed continuing education classes approved by the commissioner.

SECTION 4. (1) Violations of any provision of this act or the federal act, including any act or omission that would be a ground for denial, suspension or revocation of the license of an agent, shall be a ground for denial, suspension or revocation

of a license under this act.

(2) No navigators shall solicit any person or business that is currently insured under an existing health benefit plan.

(3) No navigator shall receive any commission, compensation or anything of value from any insurer, health benefit plan, business or consumer for providing advice or services specifically authorized to be provided as a navigator under the provisions of the federal act. Navigators shall be compensated for advice or services rendered in accordance with the provisions of the federal act only as provided for by the federal act.

(4) Navigators shall provide factually accurate information to uninsured persons and businesses regarding the availability of premium tax credits under Section 36B of the Internal Revenue Code of 1986 and cost-sharing reductions under Section 1402 of the

federal act.

(5) Notwithstanding any other provision of law to the contrary, licensing as a navigator under the provisions of this act shall not constitute licensing as an agent or administrator. No person providing advice or services as a navigator under the provisions of the federal act shall be compensated for such advice or services as the holder of a license as an agent or administrator; provided, however, that the provisions of this subsection shall not prohibit the holder of a license as an agent or administrator from being compensated for advice or services rendered as such a licensee and not as a navigator. Navigators licensed under the provisions of this act shall not, except as specifically authorized by the provisions of the federal act:

(a) Engage in any activities that would require licensing as an agent or administrator unless licensed thereunder;

(b) Provide advice concerning the benefits, terms and features of a particular health benefit plan or offer advice about which health benefit plan is better or worse for a particular individual or business, except in the capacity of a licensee as an agent or administrator; or

(c) Recommend a particular health benefit plan or advise individuals or businesses about which health benefit plan to choose, except in the capacity of a licensee as an agent or administrator.

SECTION 5. The Commissioner of Insurance may adopt rules and regulations to effect the implementation of this act.

SECTION 6. The provisions of this act shall not apply to patient navigators as defined in Section 2(d) of this act.

SECTION 7. This act shall take effect and be in force from and after July 1, 2014.